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Psychosis: Facts and Myths

Psychosis: Facts and Myths. Current and past theories of psychosis and how to use them to build a treatment alliance. Learning Objectives. By the end of this 2 hour session: Describe current neuroscientific theories of psychosis

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Psychosis: Facts and Myths

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  1. Psychosis: Facts and Myths Current and past theories of psychosis and how to use them to build a treatment alliance

  2. Learning Objectives By the end of this 2 hour session: • Describe current neuroscientific theories of psychosis • Contrast these with previous and unsupported theories of psychosis • Use them to help develop a treatment alliance with mental health consumers

  3. Social and Clinical Questions • What do we know about the neuroscience of psychosis? • How can we use this information to build a treatment alliance?

  4. “Musical hallucinations [are] the commonest form of non-psychotic hallucinations” -Oliver Sacks, 10/22/07 KQED interview

  5. Psychosis – Old and New • Explanatory paradigm • Basic and Base, “id”, “psychological” • Phenomenological paradigm • Descriptive, symptom-based, “biological” • Normality paradigm • Alternative view of reality, “social”

  6. 19th and early 20th century • Freud • Neurosis = ego’s reality-based suppression of the id • Psychosis = ego’s indulgence of the id

  7. Psychosis Myth #1 • Chronic psychosis is a return to a core, primitive level of brain processing • “psychotic process”

  8. 19th and early 20th century Emil Kraepelin • Dementia Praecox • Destruction of personality • Manic Depressive Insanity • Paraphrenia • without loss of personality

  9. Psychosis Myth #2 • Chronic psychosis is a cliff: once you fall over it, you can never get back to where you were • “unremitting deterioration”

  10. 1960s and 1970s • “Normal response to an abnormal world” • Psychosis as a label meant to define standards of behavior and “citizenship”

  11. Psychosis Myth #3 • Chronic psychosis is an understandable reaction to a rapidly changing society or a particular parenting style • “schizophrenogenic”

  12. So what the heck is psychosis then?

  13. Psychosis is not: • One thing • One type of reaction • One type of process • Something “other than” neurosis

  14. Psychosis as currently defined: • One of four symptoms: • Hallucinations • Paranoia or delusion • Disorganized thinking • Disorganized behavior or catatonia

  15. Psychosis • Hallucinations • Delusions or Paranoia • Disorganization • Catatonia

  16. Social and Clinical Questions • What do we know about the neuroscience of psychosis? • How can we use this information to build an treatment alliance?

  17. The Real Issue • If you were to explain to a family member why someone had a diagnosis of a primary psychotic disorder, how would you do so?

  18. “Cognition” broadly defined • “...the term ‘cognition’ refers to all processes by which sensory input is transformed, reduced, elaborated, stored [and] recovered…” • Ulric Neisser, 1967

  19. What does the brain do? • In terms of sensory processing, what are some key tasks of brain function?

  20. What brains share • We are constantly and unconsciously processing information • What if this process went awry? • What would the subjective experience be like?

  21. Experiment 1 • Listen • Listen • Listen • Listen • Listen • Listen • Listen

  22. Experiment 1 • Listen • Watch • Learn • Distill • Interpret • Integrate • Repackage

  23. Distinguishing Novelty • We are novelty seeking organisms • We preferentially attend to novel stimuli • This process is very fast and initially unconscious

  24. Ignoring Redundancy • We are faced with multiple stimuli at any given time • Most of these stimuli are irrelevant to our current state • We filter out redundant information unconsciously

  25. What if novelty and redundancy discrimination failed? What if redundant stimuli were interpreted as novel stimuli?

  26. In Psychosis • Many people with chronic psychosis have difficulty distinguishing redundant stimuli from novel stimuli • Crowds “uncomfortable”

  27. Experiment 2 • Tickle yourself

  28. Distinguishing Self from Other • We have a clear boundary • We are constantly processing information both internal and external to that boundary • We therefore “tag” self-generated stimuli

  29. An error in information processing(the character of which depends upon the system in question) Psychosis Redefined

  30. Social and Clinical Questions • What do we know about the neuroscience of psychosis? • How can we use this information to build a treatment alliance?

  31. Anyone? case discussion

  32. Case Discussion • L is a 23 year female who complains that her mind plays “tricks” on her. She states that this is the reason why she can no longer tolerate being outside and why her arms feel “like maybe they’re an alien’s arms or something”.

  33. Break Time! Next Up: Experiential

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