What exactly is Psychosis and Schizophrenia?

Why do people sometimes hear voices, believe things that others find strange, or appear out of touch with reality…and what can help?

The present article describes a psychological approach to experiences that are commonly thought to be known as psychosis, or sometimes schizophrenia. It complements parallel reports on the experiences commonly thought of as bipolar disorder and depression.
Hearing voices or feeling paranoid are common experiences which can often be a reaction to trauma, abuse, or deprivation. Calling them symptoms of mental illness, psychosis or schizophrenia is only one way of thinking about them, with advantages and disadvantages.

There is no clear dividing line between ‘psychosis’ and other thoughts, feelings, and beliefs. Psychosis can be understood and treated in the same way as other psychological problems such as anxiety or shyness. Significant progress has been made over the last twenty years both in understanding the psychology of these experiences and in finding ways to help.



Some people find it useful to think of themselves as having an illness. Others prefer to think of their problems as, for example, an aspect of their personality which sometimes gets them into trouble but which they would not want to be without.

In some cultures, experiences such as hearing voices are highly valued.

Each individual’s experiences are unique; no one person’s problems, or ways of coping with them, are exactly the same as anyone else’s.

For many individuals, the experiences are short-lived. Even people who continue to have them nevertheless often lead happy and successful lives.

It is a myth that people who have these experiences are likely to be violent.

Psychological therapies – talking treatments such as Cognitive Behavior Therapy (CBT) – can be very helpful for many people. In the UK, the National Institute for Health and Care Excellence recommends that everyone with a diagnosis of psychosis or schizophrenia should be offered talking therapy. However, most people are currently unable to access it, and we regard this situation as scandalous.



More generally, it is vital that services offer people the chance to talk in detail about their experiences and to make sense of what has happened to them. Surprisingly few currently do. Professionals should not insist that people accept any one particular framework of understanding, for example that their experiences are symptoms of an illness.

Many people find that ‘antipsychotic’ medication helps to make the experiences less frequent, intense, or distressing. However, there is no evidence that it corrects an underlying biological abnormality. Recent evidence also suggests that it carries significant risks, particularly if taken long term.



The British Psychological Society believes that services need to change radically, and that we need to invest in prevention by taking measures to reduce abuse, deprivation, and inequality.

Source:
The British Psychological Society
Division pf Clinical Psychology
NMJ Library
Division of Clinical Psychology

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Fish oil: A miracle for the brain

Eating more fish or taking regular fish oil supplements may help prevent psychosis in those most at risk, researchers claim.

A three month course of daily fish oil capsules appeared to significantly reduce the rate of psychotic disorders in young people, an improvement that seemed to persist when doctors assessed their mental health seven years later.

But while the findings are intriguing, they come from a very small study of teenagers and young adults. The benefits must now be shown in a much larger group before doctors can make any recommendations about the use of fish oils to prevent mental health problems.

Paul Amminger at the University of Melbourne reported in 2010 that a three month course of daily fish oil capsules appeared to stave off psychotic illnesses in teenagers and young adults aged 13 to 24 deemed at high risk of developing the disorders. Seven years on, his group has now revisited 71 of the original 81 participants and shown that the protective effects seem to persist.

Writing in the journal Nature Communications, the scientists report that 4 out of 41 of those who took fish oil for three months had developed psychosis in the seven years since, compared with 16 out of 40 who received a placebo capsule during the trial.

Those on the placebo wing of the trial appeared to develop psychosis more quickly than those taking fish oils, and had an overall greater likelihood of having other psychiatric disorders, the study found.

Schizophrenia is one of the most common serious mental health conditions. One in 100 people in Britain experience symptoms, such as delusions, visual or auditory hallucinations, in their lifetimes, and many continue to lead normal lives. It is most often diagnosed between the ages of 15 and 35. It is called a psychotic illness, and those affected sometimes cannot distinguish between their thoughts and reality.

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“Schizophrenia is a major cause of disability, but early treatment has been linked to better outcomes. Our study gives hope that there may be alternatives to antipsychotic medication,” Amminger told the Guardian.

He believes that omega-3 polyunsaturated fatty acids (PUFAs) could be a stigma-free and long-term way to prevent psychosis in young people who are most at risk, with minimal side effects.

Omega-3 fatty acids are essential for healthy brain development and function, and a lack of them in the diet has been linked to various mental health conditions. “Eating more fish is not only likely to be good for your physical health but also for your mental health,” Amminger said.

In 2006, scientists working for the Cochrane collaboration reviewed the published research on the potential for fish oils to prevent schizophrenia and declared the results inconclusive. They went on to call for larger studies with more patients. Amminger agreed that his latest findings need to be replicated in larger groups opf people before any firm guidance can be given.

Clive Adams, co-ordinating editor of the Cochrane Schizophrenia Group at Nottingham University said the study needed to be considered alongside other published trials on the effects of omega-3 oils, but added that it was a springboard for new trials on the treatments. “The road of treatment of people with schizophrenia is paved with many good intentions and false dawns. This study is important, undertaken by leaders in the field, but it does not provide strong enough proof to really change practice,” he said.

http://www.theguardian.com/science/2015/aug/11/fish-oil-could-help-prevent-mental-health-problems-psychosis?CMP=share_btn_link
Photograph: Graham Turner

New roots discovered in the psychiatric field

Newborns whose mothers were exposed during pregnancy to any one of a variety of environmental stressors — such as trauma, illness, and alcohol or drug abuse — become susceptible to various psychiatric disorders that frequently arise later in life. However, it has been unclear how these stressors affect the cells of the developing brain prenatally and give rise to conditions such as schizophrenia, post-traumatic stress disorder, and some forms of autism and bipolar disorders.

*Important Note: The research is in press, corrected proof. Please see below for more information.*

Now, Yale University researchers have identified a single molecular mechanism in the developing brain that sheds light on how cells may go awry when exposed to a variety of different environmental insults. The findings, to be published in the May 7 issue of the journal Neuron, suggest that different types of stressors prenatally activate a single molecular trigger in brain cells that may make exposed individuals susceptible to late-onset neuropsychiatric disorders.

The researchers found that mouse embryos exposed to alcohol, methyl-mercury, or maternal seizures all activate in the developing brain cells a single gene — HSF1 or heat shock factor — which protects and enables some of the brain cells to survive prenatal insult. Mice lacking the HSF1 gene showed structural brain abnormalities and were prone to seizures after birth, even after exposure to very low levels of the toxins.

In addition, researchers created stem cells — which are capable of becoming many different tissue types, including neurons — from biopsies of individuals diagnosed with schizophrenia. Genes from these “schizophrenic” stem cells responded more dramatically when exposed to environmental insults than stem cells obtained from non-schizophrenic individuals. The findings provide support to the thesis that stress induces vulnerable cells to malfunction.

“It appears that different types of environmental stressors can trigger the same condition if they occur at the same period of prenatal development,” said Yale’s Pasko Rakic, senior author of the study. “Conversely, the same environmental stressor may cause different pathologies, if it occurs at different times during pregnancy.”

Since HSF1 activation can potentially serve as a permanent marker of the stressed/damaged cell, it opens the possibility of identifying these cells in adults in order to explore the pathogenesis of postnatal disorders and how to protect vulnerable cells.

Notes about this neuropsychology research

Rakic is the Dorys McConnell Duberg Professor of Neuroscience and Professor of Neurology and Director of the Yale Kavli Institute for Neuroscience and corresponding author. Kazue Hashimoto-Torii formerly of Yale and now at the Center for Neuroscience, Children’s National Medical Center, Washington, DC is lead author of the paper.

The research was funded primarily though grants R01 NS014841, R01 DA023999 and K99/R00-AA018387 from the National Institutes of Health.

Contact: Bill Hathaway – Yale
Source: Yale press release
Image Source: The image is credited Michael Helfenbein and is adapted from the Yale press release
Original Research: Abstract for “Roles of Heat Shock Factor 1 in Neuronal Response to Fetal Environmental Risks and Its Relevance to Brain Disorders” by Kazue Hashimoto-Tori, Masaaki Torii, Mitsuaki Fujimoto, Akira Nakai, Rachid El Fatimy, Valerie Mezger, Min J. Ju, Seiji Ishii, Shih-hui Chao, Kristen J. Brennand11, Fred H. Gage, Pasko Rakic in Neuron. Published online April 10 2014 doi:10.1016/j.neuron.2014.03.002

Important disclaimer: The abstract page offers this notice: “Note to users: Uncorrected proofs are Articles in Press that have been copy edited and formatted, but have not been finalized yet. They still need to be proof-read and corrected by the author(s) and the text could still change before final publication.”