Pub Date : 2020-10-01DOI: 10.1093/med/9780190653279.003.0015
M. Nordentoft, N. Albert
Psychosis in the schizophrenia spectrum constitutes a major public health problem. There is convincing evidence for positive effects of 2-year specialized early intervention programs with intensive care, assertive outreach, and family involvement. Follow-up studies indicate a risk of loss of positive clinical effects after termination of specialized programs, but clinical effects can be sustained or even improved with prolonged specialized treatment or transfer to standard treatment, including assertive community treatment (ACT) for the most disabled patients. Long-term studies show substantial heterogeneity in clinical and functional outcomes, resulting in a very diverse picture. Ten-year follow-up studies of the OPUS and the AESOP cohort indicate that more than half of the patients will achieve stable remission of psychotic symptoms and that half of those patients can maintain remission in the long run without antipsychotic medication.
{"title":"First-episode psychosis","authors":"M. Nordentoft, N. Albert","doi":"10.1093/med/9780190653279.003.0015","DOIUrl":"https://doi.org/10.1093/med/9780190653279.003.0015","url":null,"abstract":"Psychosis in the schizophrenia spectrum constitutes a major public health problem. There is convincing evidence for positive effects of 2-year specialized early intervention programs with intensive care, assertive outreach, and family involvement. Follow-up studies indicate a risk of loss of positive clinical effects after termination of specialized programs, but clinical effects can be sustained or even improved with prolonged specialized treatment or transfer to standard treatment, including assertive community treatment (ACT) for the most disabled patients. Long-term studies show substantial heterogeneity in clinical and functional outcomes, resulting in a very diverse picture. Ten-year follow-up studies of the OPUS and the AESOP cohort indicate that more than half of the patients will achieve stable remission of psychotic symptoms and that half of those patients can maintain remission in the long run without antipsychotic medication.","PeriodicalId":193490,"journal":{"name":"Psychotic Disorders","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128019979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.1093/med/9780190653279.003.0011
M. Trimble, K. Kanemoto, D. Hesdorffer
This chapter reviews the important place that epilepsy has had in developing concepts of psychosis in general and for understanding some of the basic biological issues of schizophrenia and bipolar disorder. It starts out by offering a historical introduction noting important observations stemming from the nineteenth century. It reviews the complexity of classification in this area, highlighting in particular problems with Diagnostic and Statistical Manual, 5th edition (DSM-5). Epidemiology is followed by brief discussions of the relationship between seizures and psychosis, commenting on some paradoxes revealing why postictal psychoses are underdiagnosed, and the pitfalls of missing forced normalization, a concept that relates to the worsening of behavior with the cessation of seizures in people with intractable epilepsy. Finally, the chapter provides some guides to management of patients with epilepsy who have comorbid psychiatric disorders.
{"title":"Epilepsy and psychosis","authors":"M. Trimble, K. Kanemoto, D. Hesdorffer","doi":"10.1093/med/9780190653279.003.0011","DOIUrl":"https://doi.org/10.1093/med/9780190653279.003.0011","url":null,"abstract":"This chapter reviews the important place that epilepsy has had in developing concepts of psychosis in general and for understanding some of the basic biological issues of schizophrenia and bipolar disorder. It starts out by offering a historical introduction noting important observations stemming from the nineteenth century. It reviews the complexity of classification in this area, highlighting in particular problems with Diagnostic and Statistical Manual, 5th edition (DSM-5). Epidemiology is followed by brief discussions of the relationship between seizures and psychosis, commenting on some paradoxes revealing why postictal psychoses are underdiagnosed, and the pitfalls of missing forced normalization, a concept that relates to the worsening of behavior with the cessation of seizures in people with intractable epilepsy. Finally, the chapter provides some guides to management of patients with epilepsy who have comorbid psychiatric disorders.","PeriodicalId":193490,"journal":{"name":"Psychotic Disorders","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128230522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.1093/med/9780190653279.003.0055
D. Scott
The creation of a valid animal model is of crucial importance to the study of the biological mechanisms underlying disease pathophysiology. This becomes difficult when studying psychiatric illness, most especially psychosis, as humans’ mental state is a strictly internally experienced phenomenon, and thus the biological readout of these conditions is often a behavioral assessment. Therefore, when designing appropriate animal model systems and behavioral assessments for the study of psychiatric illness, it is necessary that appropriate measures be taken to ensure the systems and tasks used fulfill rigorous demands of validity. This chapter discusses different forms of validity, expanding on the classical validity measures of face, predictive, and construct validity. Specific examples of behavioral assessments and animal preparations that adhere to these specific definitions of validity are presented. These include specific experimental paradigms that can be similarly assessed in humans with psychosis and animal models, methods to create an animal preparation based on known psychosis triggers and risk factors, and pharmacological means to demonstrate relevance to the human condition. The chapter argues for a systematic approach to design, verify, and validate an animal model system for research into psychosis specifically, and other psychiatric disorders more generally, based on these different classes of validity.
{"title":"Animal models of psychosis","authors":"D. Scott","doi":"10.1093/med/9780190653279.003.0055","DOIUrl":"https://doi.org/10.1093/med/9780190653279.003.0055","url":null,"abstract":"The creation of a valid animal model is of crucial importance to the study of the biological mechanisms underlying disease pathophysiology. This becomes difficult when studying psychiatric illness, most especially psychosis, as humans’ mental state is a strictly internally experienced phenomenon, and thus the biological readout of these conditions is often a behavioral assessment. Therefore, when designing appropriate animal model systems and behavioral assessments for the study of psychiatric illness, it is necessary that appropriate measures be taken to ensure the systems and tasks used fulfill rigorous demands of validity. This chapter discusses different forms of validity, expanding on the classical validity measures of face, predictive, and construct validity. Specific examples of behavioral assessments and animal preparations that adhere to these specific definitions of validity are presented. These include specific experimental paradigms that can be similarly assessed in humans with psychosis and animal models, methods to create an animal preparation based on known psychosis triggers and risk factors, and pharmacological means to demonstrate relevance to the human condition. The chapter argues for a systematic approach to design, verify, and validate an animal model system for research into psychosis specifically, and other psychiatric disorders more generally, based on these different classes of validity.","PeriodicalId":193490,"journal":{"name":"Psychotic Disorders","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130185040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.1093/med/9780190653279.003.0057
T. Lincoln, A. Brabban
The view that psychotic symptoms lie on a continuum with normal experiences and can be explained by normal psychological processes has provided the basis for adapting cognitive-behavioral interventions for psychosis. Cognitive-behavioral therapy for psychosis (CBTp) focuses on reframing appraisals and modifying behavior related to psychotic symptoms to reduce distress and improve functioning and well-being. To date, the efficacy and effectiveness of CBTp has been demonstrated in over 30 intervention trials and it is widely recommended in various national treatment guidelines. This introduction to CBTp provides an overview of the main strategies employed including interventions for building rapport, developing and working with a shared case formulation, enhancing patients’ use of coping strategies for disabling and distressing symptoms, working with beliefs seen as maintaining hallucinations, delusions and negative symptoms as well as strategies for preventing relapse. It also briefly summarizes the current evidence base for CBTp and point out further developments.
{"title":"Cognitive-behavioral therapy","authors":"T. Lincoln, A. Brabban","doi":"10.1093/med/9780190653279.003.0057","DOIUrl":"https://doi.org/10.1093/med/9780190653279.003.0057","url":null,"abstract":"The view that psychotic symptoms lie on a continuum with normal experiences and can be explained by normal psychological processes has provided the basis for adapting cognitive-behavioral interventions for psychosis. Cognitive-behavioral therapy for psychosis (CBTp) focuses on reframing appraisals and modifying behavior related to psychotic symptoms to reduce distress and improve functioning and well-being. To date, the efficacy and effectiveness of CBTp has been demonstrated in over 30 intervention trials and it is widely recommended in various national treatment guidelines.\u0000 This introduction to CBTp provides an overview of the main strategies employed including interventions for building rapport, developing and working with a shared case formulation, enhancing patients’ use of coping strategies for disabling and distressing symptoms, working with beliefs seen as maintaining hallucinations, delusions and negative symptoms as well as strategies for preventing relapse. It also briefly summarizes the current evidence base for CBTp and point out further developments.","PeriodicalId":193490,"journal":{"name":"Psychotic Disorders","volume":"161 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132394299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.1093/med/9780190653279.003.0047
C. Morgan
The incidence of psychotic disorders is increased, to varying extents, in many migrant and minority ethnic populations in several countries. This chapter briefly reviews the evidence on disparities in incidence between minority and majority populations and then discusses possible explanations. It is unlikely that methodological artifact, including misdiagnosis, can fully account for the high incidence rates observed in some populations. Further, there is no evidence that established neurodevelopmental risk factors for psychosis explain disparities among ethnic groups. It is, then, most likely—and there is growing evidence to support this—that the high rates are a consequence of greater exposure to adverse social conditions and experiences, particularly those involving threat and violence, over the life course among minority ethnic groups. In other words, psychosis occurs more often in some minority populations via a socio-developmental pathway.
{"title":"Migration, ethnicity, and psychoses","authors":"C. Morgan","doi":"10.1093/med/9780190653279.003.0047","DOIUrl":"https://doi.org/10.1093/med/9780190653279.003.0047","url":null,"abstract":"The incidence of psychotic disorders is increased, to varying extents, in many migrant and minority ethnic populations in several countries. This chapter briefly reviews the evidence on disparities in incidence between minority and majority populations and then discusses possible explanations. It is unlikely that methodological artifact, including misdiagnosis, can fully account for the high incidence rates observed in some populations. Further, there is no evidence that established neurodevelopmental risk factors for psychosis explain disparities among ethnic groups. It is, then, most likely—and there is growing evidence to support this—that the high rates are a consequence of greater exposure to adverse social conditions and experiences, particularly those involving threat and violence, over the life course among minority ethnic groups. In other words, psychosis occurs more often in some minority populations via a socio-developmental pathway.","PeriodicalId":193490,"journal":{"name":"Psychotic Disorders","volume":"888 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130126882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.1007/978-3-642-45257-4_13
J. Onwumere, E. Hunter, E. Kuipers
{"title":"Family interventions in psychosis","authors":"J. Onwumere, E. Hunter, E. Kuipers","doi":"10.1007/978-3-642-45257-4_13","DOIUrl":"https://doi.org/10.1007/978-3-642-45257-4_13","url":null,"abstract":"","PeriodicalId":193490,"journal":{"name":"Psychotic Disorders","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124095002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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