A recent study published in The International Journal of Social Psychiatry analyzes how psychiatrists in the UK understand psychosis. Through interviews, the authors found several prominent “positions” on psychosis. They discovered three dominant positions—a biomedical understanding, a critical perspective focused on social context, and an ambivalent stance. The authors, Therese O’Donoghue and Jon Crossley from the Department of Neuroscience at the University of Leicester, also note several key themes discussed by psychiatrists, such as orthodox medical training, power hierarchies in the field, and the need for psychiatrists to appear invulnerable.
“Recently, there has been support from several influential figures in the field for a broader perspective on psychosis. Jim van Os argued that what are currently regarded as mental illnesses are better framed as vulnerabilities, as they are seldom ‘cured.’ They critiqued the evidence-based symptom reduction model which dominates service organizations because of its disconnection from the needs of patients,” O’Donoghue and Crossley write.
Separately, the prominent psychiatrist Sir Robin Murray publicly stated that he regretted ignoring social factors throughout his research career, and called for more research on environmental factors and epigenetics. He cautioned that those still clinging to a Kraepelinian model were refusing to accept the evidence base to the detriment of their patients.”
A new study compared intensive cognitive behavioral case management (CBCM) with and without antipsychotic use in young people diagnosed with first-episode psychosis. The researchers found that there was no difference in outcomes at the six-month endpoint. Both groups improved, and there was no added benefit to having taken antipsychotic medications. The study authors, writing in Schizophrenia Bulletin, explain:
“There was no discernible advantage to receiving antipsychotic medication from the start of the trial,” the researchers write.
The study was led by Shona M. Francey at Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia.Read More
A study in Psychology and Psychotherapy: Theory, Research, and Practice, investigates non-psychiatric doctors’ causal beliefs about the origins of a diagnosis of schizophrenia. The authors, a research team led by Lorenza Magliano from the Department of Psychology at Campania University in Italy, unpack the ways these beliefs influence treatment and prognosis among physicians who endorse biogenetic causes versus psychosocial causes.
Of the 264 participants who expressed their opinion about the most important causes of ‘schizophrenia,’ 54% indicated a belief in a biogenetic cause. The researchers provide practitioners with key points of consideration for understanding how their belief systems impact patients that are given the diagnosis of schizophrenia. Magliano and co-authors explain:
“Presenting schizophrenia as a ‘disease like any other,’ that is, equating the experience of psychosis with that of having a physical disease, was intended to improve social acceptance of ‘schizophrenics’ by reducing blame for this condition. In fact, explaining schizophrenia as caused by genetic factors, chemical imbalances, and brain anomalies causes prognostic pessimism, perceptions of dangerousness and unpredictability, and desire for social distance from these people.”
Schizophrenia is a contested diagnosis that captures a diverse range of experiences, often characterized by psychotic symptoms, such as paranoia, delusions, or hallucinations.
Despite a lack of conclusive evidence, psychiatry has promoted the idea that schizophrenia is a brain disease. This biological approach to understanding ‘schizophrenia’ has been the dominant viewpoint among medical professionals for decades, despite the public (including those with lived experience and their families), who are more likely to endorse psychosocial causes than biogenetic ones.Read More
Despite decades of research and the development of many psychiatric medications, widespread suffering remains among people who hear voices. Hearing voices groups (HVGs) encourage an in-depth exploration of the meaning of voices and use peer support to develop coping strategies. Although HVGs continue to spread around the world, their effectiveness remains unknown and only a few studies have examined members’ experiences. To understand the mechanisms by which these groups operate, we recruited a diverse sample of 113 participants from across the US, who completed detailed qualitative questionnaires describing their voice-hearing histories, experiences in HVGs and changes in their lives outside the group. A subset also participated in follow-up interviews. A collaborative team of researchers and voice hearers used phenomenological, grounded theory and thematic analyses to identify a distinctive set of elements that make HVGs unique: in their style of interaction (non-judgmental, curious, reciprocal and unstructured dialogue among people regarded as equals, in a shared community); and in the content of meetings (welcoming multiple perspectives and exploring coping strategies in non-prescriptive ways, with a focus on expertise by experience). We propose a three-phase model to explain how these elements interact within HVGs to enable significant transformation to occur.
Ninety young people were randomised by computer, 46 to placebo and 44 antipsychotic medication and 33% of those who commenced trial medication completed the entire 6 month trial period. On the SOFAS, both groups improved, and group differences were small and clinically trivial, indicating that treatment with placebo medication was no less effective than conventional antipsychotic treatment (Mean Difference=-0.2, 2-sided 95% confidence interval -7.5 to 7.0, t=0.060, p=0.95).
Within the context of a specialised early intervention service, and with a short duration of untreated psychosis, the immediate introduction of antipsychotic medication may not be required for all cases of first episode psychosis in order to see functional improvement. However, this finding can only be generalised to a very small proportion of FEP cases at this stage, and a larger trial is required to clarify whether antipsychotic-free treatment can be recommended for specific subgroups of those with FEP.
In a time where social distancing is being strongly encouraged in the U.S. and other countries, Hearing Voices Network-USA trainers Caroline Mazel-Carlton and Cindy Marty Hadge from the Western Massachusetts Recovery Learning Community (WMRLC) are helping to coordinate national efforts to ensure that voice hearers and their loved ones have uninterrupted access to life-giving mutual support and connection.
“Having the Foundation’s support has allowed us to expand our online offerings,” Mazel-Carlton told EXCELLENCE. Mazel-Carlton and Hadge helped to support the formation of some of the first online Hearing Voices groups in America, including a new Family and Friends online support group that began last year. Now, the Hearing Voices Network in the USA is quickly ramping up online offerings in response to COVID-19, thanks to the efforts of Hadge, Mazel-Carlton, and others.Read More
Conventional wisdom in the treatment of psychosis suggests that the longer psychosis goes untreated, the worse outcomes people will have long term. This position is often used to support the use of antipsychotics early in the course of treatment. A new study, published in The American Journal of Psychiatry, challenges the evidence for this position.
The researchers, led by Katherine Jonas at Stony Brook University, find that past research documenting a relationship between the duration of untreated psychosis (DUP) and worse long-term outcomes is likely an illusion created by lead-time bias. Their study found that rather than untreated psychosis causing adverse outcomes, those with a shorter duration of untreated psychosis “are in an earlier stage and therefore appear to have better outcomes than those with a long DUP, who are in a later stage.”Read More
Stressful life events have been implicated in the onset of psychotic disorders, but there are few robust studies. We sought to examine the nature and magnitude of associations between adult life events and difficulties and first-episode psychoses, particularly focusing on contextual characteristics, including threat, intrusiveness, and independence.
This study forms part of the Childhood Adversity and Psychosis Study (CAPsy), an epidemiological case-control study in London, United Kingdom. Data on life events and difficulties (problems lasting 4 wk or more) during 1 year prior to onset (cases) or interview (controls) were assessed using the semi-structured Life Events and Difficulties Schedule (LEDS). Data were available on 253 individuals with a first episode of psychosis and 301 population-based controls.
We found strong evidence that odds of exposure to threatening and intrusive events in the 1 year prior to onset were substantially higher among cases compared with controls, independent of age, gender, ethnicity, and social class (ORs > 3). This was consistent across diagnostic categories. We found further evidence that the effect of threatening events and difficulties was cumulative (1 event odds ratio [OR] 2.69 [95% confidence interval (CI) 1.51–4.79]; 2 events OR 4.87 [95% CI 2.34–10.16]; ≥3 events OR 5.27 [95% CI 1.83–15.19]; 1 difficulty OR 3.02 [95% CI 1.79–5.09]; 2 difficulties OR 9.71 [95% CI 4.20–22.40]; ≥3 difficulties OR 12.84 [95% CI 3.18–51.85]).
Threatening and intrusive life events and difficulties are common in the year pre-onset among individuals with a first episode of psychosis. Such experiences may contribute to the development of psychotic disorders.
Several studies have found that patients with schizophrenia experience cognitive benefits from exercise.
A study in Psychiatric Research suggests schizophrenia patients who participate in a 12-week aerobic exercise program may continue to experience cognitive benefits months after the program ends.
“These findings encourage the incorporation of [aerobic exercise] in psychosocial treatment regimens [for schizophrenia],” wrote Takeshi Shimada, Ph.D., of the Medical Corporation Seitaikai Mental Support Soyokaze Hospital in Japan and colleagues.Read More
People with a history of severe infection such as hepatitis or sepsis may be more likely to develop substance-induced psychosis than people without such history, suggests a report in AJP in Advance.