Transcript Psychosis

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:
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Describe current neuroscientific
theories of psychosis
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Contrast these with previous and
unsupported theories of psychosis
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Use them to help develop a treatment
alliance with mental health consumers
Social and Clinical Questions
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What do we know about the
neuroscience of psychosis?
How can we use this information to
build a treatment alliance?
“Musical hallucinations [are] the
commonest form of nonpsychotic hallucinations”
-Oliver Sacks, 10/22/07 KQED interview
Psychosis – Old and New
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Explanatory paradigm
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Phenomenological paradigm
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Basic and Base, “id”, “psychological”
Descriptive, symptom-based, “biological”
Normality paradigm
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Alternative view of reality, “social”
19th and early 20th century
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Freud
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Neurosis = ego’s
reality-based
suppression of the id
Psychosis = ego’s
indulgence of the id
Psychosis Myth #1
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Chronic psychosis is a return to a core,
primitive level of brain processing
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“psychotic process”
19th and early 20th century
Emil Kraepelin
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Dementia Praecox
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Destruction of personality
Manic Depressive
Insanity
Paraphrenia
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without loss of
personality
Psychosis Myth #2
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Chronic psychosis is a cliff: once you fall
over it, you can never get back to
where you were
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“unremitting deterioration”
1960s and 1970s
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“Normal response to
an abnormal world”
Psychosis as a label
meant to define
standards of
behavior and
“citizenship”
Psychosis Myth #3
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Chronic psychosis is an understandable
reaction to a rapidly changing society or
a particular parenting style
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“schizophrenogenic”
So what the heck is
psychosis then?
Psychosis is not:
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One thing
One type of reaction
One type of process
Something “other than” neurosis
Psychosis as currently defined:
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One of four symptoms:
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Hallucinations
Paranoia or delusion
Disorganized thinking
Disorganized behavior or catatonia
Psychosis
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Hallucinations
Delusions or
Paranoia
Disorganization
Catatonia
Social and Clinical Questions
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What do we know about the
neuroscience of psychosis?
How can we use this information to
build an treatment alliance?
The Real Issue
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If you were to explain to a family member
why someone had a diagnosis of a primary
psychotic disorder, how would you do so?
“Cognition” broadly defined
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“...the term ‘cognition’ refers to all
processes by which sensory input is
transformed, reduced, elaborated,
stored [and] recovered…”
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Ulric Neisser, 1967
What does the brain do?
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In terms of sensory processing, what
are some key tasks of brain function?
What brains share
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We are constantly and unconsciously
processing information
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What if this process went awry?
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What would the subjective experience be like?
Experiment 1
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Listen
Listen
Listen
Listen
Listen
Listen
Listen
Experiment 1
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Listen
Watch
Learn
Distill
Interpret
Integrate
Repackage
Distinguishing Novelty
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We are novelty
seeking organisms
We preferentially
attend to novel
stimuli
This process is very
fast and initially
unconscious
Ignoring Redundancy
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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
What if novelty and redundancy
discrimination failed?
What if redundant stimuli were
interpreted as novel stimuli?
In Psychosis
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Many people with chronic psychosis
have difficulty distinguishing redundant
stimuli from novel stimuli
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Crowds “uncomfortable”
Experiment 2
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Tickle yourself
Distinguishing Self from Other
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We have a clear
boundary
We are constantly
processing
information both
internal and external
to that boundary
We therefore “tag”
self-generated
stimuli
Psychosis Redefined
An error in information
processing
(the character of which depends upon the
system in question)
Social and Clinical Questions
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What do we know about the
neuroscience of psychosis?
How can we use this information to
build a treatment alliance?
Anyone?
CASE DISCUSSION
Case Discussion
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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”.
Break Time!
Next Up: Experiential