What is Psychosis?

Manchester Mental Health & Social Care Trust

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Aims & Objectives
 To provide an introduction to psychosis and

associated signs and symptoms.  To develop an awareness of how the signs of psychosis can be identified.  For participants to be aware of vulnerable groups  To provide a baseline of knowledge concerning psychosis from which to develop.

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Terms We Use …
As a large group let us consider what terms are used to describe someone who has a mental illness…..

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Cast your minds back… Think back to being at school or youth club.Consider their behaviour . Try to recall someone who you thought might have been experiencing some difficulties in the way they related to you or others. what was it that made you think they were a bit ‘odd’. In a small group share some of these thoughts. 4 .

The Stigma of Mental Health Health Stigma can be the largest obstacle for those who experience mental health problems 60% of young people admit to verbally abusing people with mental health problems ( Mind 2000) In a survey of young people 38% were unable to name a mental illness (Corrado & Carluccio 2001). 66% of all media coverage associated mental illness with violence (Philo & Secker 1994) 5 .

 Schneider 1959 –Identified first & second rank symptoms to assist in the development of a diagnosis. 6 .  Langfeldt 1961 – Made a distinction between true schizophrenia and schizophrenic states.Developed the term schizophrenia as a ‘splitting of psychic function’. hebephrenic and simple. He also noted that they did not all have a chronic progression.  Bleuler 1911.The Historical Background  Kraepelin 1893 – Developed groups of symptoms into catatonia. paranoia.

It can happen to anyone & can be treated 7 . where there has been some loss of contact with reality When someone becomes ‘ill’ in this way it is called a ‘psychotic episode’ It is most likely to occur in young people around 3 in every 100 young people (more common than diabetes!) Most recover fully .What is Psychosis? The word ‘psychosis’ is used to describe conditions that affect the mind.

Symptoms of Psychosis Psychosis can lead to changes in mood. In order to try to understand the experience of psychosis it can be useful to group together some of the more characteristic symptoms The next few slides describe these symptoms 8 . This can make it hard for even people who know the person best to understand how the person feels. thinking and to abnormal ideas.

Confused Thinking Everyday thoughts become confused or don’t join up properly Sentences are unclear or don’t make sense A person may have difficulty concentrating. following a conversation or remembering things Thoughts appear to be speeded up or slowed down 9 .

False Beliefs It is common for someone experiencing a psychotic episode to hold false beliefs (delusions) The person may be so convinced of these beliefs that even the most logical counterarguments may not dissuade them from the belief For example. a person may be convinced that the way that cars are parked outside his house is irrefutable evidence that the police are watching 10 .

Things may taste or smell as if they are ‘bad’ or even poisoned 11 .Hallucinations In psychosis. they may hear voices when there is no-one else around and there is nothing else to explain them. For example. taste or feel something that is not actually there. see. or they may see things that other people can’t see. smell. a person may hear.

veering from unusually excited to very depressed. Mood swings are common. with everything moving in slow motion. Peoples’ emotions can be dampened. how someone is feeling may change suddenly for no apparent reason. The person may feel ‘strange’ or cut off from the world. they feel less able to express their emotion. 12 .Changed Feelings In a psychotic episode.

someone who believes he is Jesus may want to preach in the street. they may be extremely active or lethargic. or someone may stop eating if they think that their food is poisoned.a person who believes they are in danger may call the police. They may laugh inappropriately or become upset and angry for no apparent reason. sitting around all day. 13 . These changes can be explained by the symptoms previously described .Changed Behaviour People with psychosis often behave differently from the way they usually do.

14 . Attaching a specific name or label to a psychotic illness is not always useful initially. However. a diagnosis is usually attempted eventually. Although diagnosis in first-onset psychosis is particularly tricky.Making a Diagnosis Everybody’s experience is different and unique to them. depending on the type of symptoms displayed and how long the illness lasts. the following slides describe the most common terms in use.

Sometimes these symptoms will rapidly resolve and disappear once the effects of the substance wears off. or withdrawal from. alcohol and drugs can be associated with the appearance of psychotic symptoms.Drug-induced Psychosis Use of. 15 . Sometimes the symptoms last longer although they appear to have clearly begun with substance use.

such as memory loss or confusion. AIDS or a tumor may all produce psychotic-like symptoms) These psychotic symptoms are usually accompanied by other difficulties.Organic Psychosis Sometimes psychotic symptoms may appear as a result of a head injury or a physical illness that disrupts brain functioning (encephalitis. Physical tests can often confirm these diagnoses (MRI. CAT scans etc) 16 .

These stressors may include a death in the family. being sent to prison). Symptoms may initially be severe but the person makes a full recovery in a few days. a sudden change in life circumstances or a particularly traumatic personal event (getting mugged.Brief Reactive Psychosis Psychotic symptoms may arise suddenly in response to a major stress in the person’s life. 17 .

There is no other evidence of psychosis (hallucinations. These ‘delusions’ may be restricted to one area or a limited number of areas.Delusional Disorder The main symptom here is a strong belief in things that are not true. problems with language) but this does not stop this condition from being distressing & disruptive to the person and those around them 18 .

Schizophrenia This term refers to a psychotic illness in which the changes in behaviour or symptoms have been present for at least 6 months. with many making a full and sustained recovery 19 . Symptoms and length of illness vary between patients Contrary to popular belief and previous views amongst professionals. many people with schizophrenia can lead full and happy lives.

However.Schizophreniform Disorder This is just like schizophrenia. 20 . If all symptoms clear up before 6 months. a retrospective alternative diagnosis may be made. the difference is that the symptoms have not lasted for longer than 6 months.

i. someone who is depressed might hear a voice telling them to harm themselves.Bi-polar (manic-depressive) disorder In bi-polar disorder. Extreme highs (mania) or lows (depression) Psychotic symptoms. tend to fit in with the person’s mood . someone who is high may believe they are special and can perform amazing feats.e. psychosis occurs in the context of a more general disturbance in mood. when present. 21 .

Schizoaffective Disorder This diagnosis is made when a person has concurrent or consecutive symptoms of both a mood disorder (such as depression or mania) and psychosis. but displays various elements of both. In other words. the picture is not typical of a mood disorder or a psychosis. 22 .

Psychotic Depression This is a severe depressive illness with psychotic symptoms mixed in. It is this last point that distinguishes a psychotic depression from a bi-polar illness 23 . but without periods of mania or highs occurring at any point during the illness.

Schizophrenia – Positive & Negative Symptoms You will often hear mental health professionals referring to the ‘positive’ and ‘negative’ symptoms of schizophrenia. Positive symptoms refer to those symptoms that are ‘more than’ normal experiences Negative symptoms refer to those symptoms or changes in behaviour that are ‘less than’ a normal range of experiences 24 .

25 . poor motivation and social withdrawal. low mood. agitation.  ‘Secondary’ features of these negative symptoms may include sleep disturbance. social isolation .  They are used to describe such symptoms as: flattened emotions.What are ‘Negative Symptoms’?  This term was developed to describe those symptoms which cause a person to function at a level below those who are mentally healthy.

“ I wrote all the Beatles hits” “ The TV is talking about me” Other way of recognizing positive symptoms is that the person may use unusual words or their conversation is hard to follow. expressing strange or bizarre beliefs about themselves.Talking to oneself or to ‘someone else’ who can’t be seen. appearing perplexed or distracted.Some symptoms you might notice…… ‘Positive’ symptoms .g. 26 . others or the world e.

27 . stop meeting up with friends. they may stay in bed all day. self care might be getting worse or they may smoke more .Often friends or family have more problems coping with these as they are often regarded as ‘bad’ behaviour. The person might just stop going out.Some symptoms you might notice…… ‘Negative’ symptoms .

28 .ICD – Classification of Schizophrenia Any ONE of the following for a month or more on most days. not due to organic brain disease or alcohol / drug intoxication.

Thought echo. Persistent delusions culturally inappropriate and completely impossible OR 29 . influence or passivity. Delusions of control. withdrawal or broadcasting 2. Third person auditory hallucinations.either commentary or voices conversing. 4.ICD – Classification of Schizophrenia 1. 3.

Persistent hallucinations with partial or overvalued ideas. social withdrawal. mutism 4. 30 .Catatonia. neologisms. posturing. irrelevance.ICD – Classification of Schizophrenia Any TWO of the following for one month or more: 1.blunting of affect. Breaks in train of thought. Negative symptoms –apathy. 3. incoherence. 2.paucity of speech.

(2) or (3) for at least ONE WEEK (1) 2 of the following :.DSM – Classification of Schizophrenia Presence of any of (1).delusion.catatonia.flat or inappropriate affect. incoherence. prominent hallucinations. (2) Bizarre delusions (3) Prominent hallucinations commentary or conversing. Also marked social function defect for 6 months and No manic or depressive syndrome. 31 .

 ‘Delusions involve a misinterpretation.’( DSM IV 1994) 32 .How the definition of a ‘delusion’ has changed over time?  A ‘false unshakeable belief which arises out of an internal morbid process out of keeping with a persons educational and cultural background’(Hamilton 1978). the distinction between a delusion and strongly held idea is difficult to make and depends on degree of conviction.. can be modifiable. .

 10.5 per 1000 (Singleton et al 2001) this means 212.000 new cases per annum (DOH 2001)  ‘Point prevalence rate’ ( the number of people with a ‘psychotic’ diagnosis at a single point in time rather than lifetime prevalence) .000 people in UK are likely to have been given a diagnosis of schizophrenia (Kinderman & Cooke 2000) 33 .000 to 50.Incidence & Prevalence .How many people does psychosis affect?  The average incidence of psychosis is 15 per 100.000 in UK (177.000 in England).

Local Incidence & prevalence All areas of Manchester have admission rates for mental health needs above the national average (Griffiths 1998).000 students Manchester. There are over 65.Their sexual and mental health needs have been established as priority areas (Stronach & Walker 2004) The city of Manchester is the second most deprived area in England with an associated higher rate of mental health problems (Griffiths 1998) 34 .

from 6 per 1000 amongst Bangladeshis to 16 per 1000 amongst black African-Caribbean people (Nazroo and King 2002).  The reasons for this difference are highly controversial! (see Jenkins 1998)  People in inner city areas are more likely to be given a diagnosis than suburban areas ( Freeman 1994)  Young people in their late teens and early twenties are more commonly diagnosed ( Cooper 1987) 35 .What groups of people are likely to get a diagnosis of schizophrenia?  This varies among minority ethnic communities .

incremental social function deficit Adapted from Shepard et al 1989 36 . little social function deficit Multiple episode . static social function deficit 8% 35% Multiple episode. little social function deficit Multiple episode.Patterns of course of Schizophrenia 22% 35% Single episode.

27% Complete remission 22% Minor residual symptoms remained 24% Intermediate course – symptoms arose episodically 22% Severe – continued to be symptomatic 9% Unstable / uncertain or were not classified 37 .The course and outcome of schizophrenia In a study by Ciompi in 1976. 228 patients with a diagnosis of schizophrenia were followed up over 37 years.

 The only thing you know about this person before you begin is that he/she MIGHT be exhibiting signs of a psychotic illness  What positive and/or negative symptoms may the person be experiencing?  What might the person be saying or doing with those close to them or strangers?  Be creative and try and make the person as ‘alive’ as possible. write a short description of a person as if you were outlining a ‘character’ in a play.Group Work – Concluding Exercise  As a small group. 38 .

 The symptoms of a psychotic illness involve both ‘positive’ symptoms and ‘secondary’.To Conclude…………  Although the nature of psychosis has been under examination for over a century. less obvious symptoms. psychiatry is still a ‘young science’.  There are specific groups of the population that are more vulnerable to receiving a diagnosis of schizophrenia . 39 .