NZPsS Conference – 2011   www.isps.org   ispsnz@gmail.com  MAKING SENSE OF MADNESS What does psychology have to offer mad ...
 
<ul><li>The psychology of  </li></ul><ul><li>psychosis: </li></ul><ul><li>A research summary </li></ul><ul><li>JOHN READ <...
No single cause. As for other mental health problems - causes, usually in combination, include: <ul><li>Genetic predisposi...
No evidence of genetic predisposition to schizophrenia (Hamilton, 2008, American Journal of Psychiatry) <ul><li>‘ The most...
<ul><li>POVERTY </li></ul><ul><li>England  Kirkbride et al. 2006 </li></ul><ul><li>Rates of psychosis in South East London...
Psychiatric inpatient admission rates - Auckland <ul><li>Wheeler, A.  NZ Medical Journal 2005 </li></ul><ul><li>  Inpatien...
Diagnoses given to Auckland inpatients Wheeler, A.  NZ Medical Journal 2005 <ul><li>Psychotic disorder   (eg ‘schizophreni...
Child Abuse and ‘Schizophrenia’ symptoms <ul><li>200 outpatients </li></ul><ul><li>  Child   No </li></ul><ul><li>Hallucin...
Dutch general population (n = 4045) free from psychotic symptoms, followed for 3 years  (Janssen et al., 2004) <ul><li>Con...
Read, van Os, Morrison, Ross (2005) ‘Childhood trauma, psychosis and schizophrenia: A literature review with theoretical a...
2007 <ul><li>Shevlin et al. 2007  Schizophrenia Bulletin </li></ul><ul><li>UK, 8580 </li></ul><ul><li>People who had exper...
‘ Child Maltreatment and Psychosis:  A Return to a Genuinely Integrated Bio-Psycho-Social Model’ J Read, et al., 2008,  Cl...
Theories about HOW child abuse/neglect leads to psychosis <ul><li>COGNITIVE </li></ul><ul><li>PSYCHODYNAMIC </li></ul><ul>...
Theories about HOW child abuse/neglect leads to psychosis <ul><li>COGNITIVE </li></ul><ul><li>PSYCHODYNAMIC </li></ul><ul>...
Positive  Negative Paranoid Depressed Normal Internality Scores* Kaney & Bentall (1989) found that paranoid patients made ...
Brain differences between two groups do NOT prove the ‘brain disease’ hypothesis.  The brain is designed to respond to the...
 
Similarities found in brains of severely abused children and adult ‘schizophrenics’ : <ul><li>Overactivity of hypothalamic...
ATTACHMENT RESEARCH Parental Bonding Instrument (PBI) and Psychosis/’Schizophrenia’ <ul><li>High rates of ‘affectionless c...
Attachment and psychosis/’schizophrenia’ <ul><li>Mickelson et al., (1997) </li></ul><ul><li>USA survey of over 8,000 </li>...
More subtle types of childhood maltreatment <ul><li>Averages from six studies of people diagnosed ‘schizophrenic’ </li></u...
Parental Loss <ul><li>Morgan et al., 2007 </li></ul><ul><li>390 people with a first episode of psychosis, compared to a co...
Antipsychotic Drugs <ul><li>Adverse Effects </li></ul><ul><li>Traditional antipsychiotics: </li></ul><ul><li>Tardive Dyski...
Cochrane review of Risperidone   (Rattehalli, Jayaram, & Smith, 2010).  <ul><li>“ Risperidone appears to have a marginal b...
Books on Psychological Treatments <ul><li>Psychotherapies for the Psychoses: Theoretical, Clinical and Cultural Integratio...
 
 
Cognitive therapy for hallucinations and delusions <ul><li>Focus on stated needs </li></ul><ul><li>Focus on one ‘symptom’ ...
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Debra Lampshire, Making Sense of Psychosis

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  • Our most recent study confirms previous studies (such as the work of Colin Ross in Houston, Texas) showing that child abuse is significantly related to the positive symptoms of schizophrenia, particularly hallucinations. Note that the relatively rare tactile hallucinations were found ONLY in patients who had been abused as children. We did not , however, confirm previous findings that paranoid delusions, ideas of reference or thought insertion were significantly more common in those subjected to child abuse, although all these findings were in the expected direction (but did not attain statistical significance). We again found many examples of the specific content of symptoms being abuse related, the most poignant being where the voices heard are the c=voices of the perpetrator telling patients to kill themselves. WE also found that for 14% of the abused but only 3% of the non-abused patients their hallucinations or delusions involved the theme of a struggle between good and evil, often between God and Satan. ( a statistically significant difference) There were no differences in terms of negative symptoms. Please note the difference in terms of having two or more DSM ’Characteristic Symptoms’ The number required for a diagnosis of schizophrenia.
  • Transcript of "Debra Lampshire, Making Sense of Psychosis "

    1. 1. NZPsS Conference – 2011 www.isps.org ispsnz@gmail.com MAKING SENSE OF MADNESS What does psychology have to offer mad people ? DEBRA LAMPSHIRE The psychology of psychosis: A research summary JOHN READ Understanding the process of supported recovery SARAH DE WATTIGNAR Creative engagement in therapy for psychosis JEREMY CLARK
    2. 3. <ul><li>The psychology of </li></ul><ul><li>psychosis: </li></ul><ul><li>A research summary </li></ul><ul><li>JOHN READ </li></ul>
    3. 4. No single cause. As for other mental health problems - causes, usually in combination, include: <ul><li>Genetic predisposition ?? </li></ul><ul><li>Brain differences – structural and functional ( can be caused by environment) </li></ul><ul><li>Maternal prenatal health and stress </li></ul><ul><li>Birth complications </li></ul><ul><li>Rape and physical assault </li></ul><ul><li>War combat </li></ul><ul><li>Child abuse </li></ul><ul><li>Child neglect </li></ul><ul><li>Parental loss </li></ul><ul><li>Bullying </li></ul><ul><li>Poverty </li></ul><ul><li>Urban living </li></ul><ul><li>Ethnicity (poverty, isolation and racism) </li></ul><ul><li>Heavy early cannabis use </li></ul>
    4. 5. No evidence of genetic predisposition to schizophrenia (Hamilton, 2008, American Journal of Psychiatry) <ul><li>‘ The most comprehensive genetic association study of genes previously reported to contribute to the susceptibility to schizophrenia’ found that ‘none of the polymorphisms were associated with the schizophrenia phenotype at a reasonable threshold for statistical significance’ </li></ul><ul><li>‘ The distribution of test statistics suggests nothing outside of what would be expected by chance’ </li></ul>
    5. 6. <ul><li>POVERTY </li></ul><ul><li>England Kirkbride et al. 2006 </li></ul><ul><li>Rates of psychosis in South East London (poor area) more than double the rates of Nottingham or Bristol </li></ul><ul><li>Rates of psychosis for ethnic minorities three times higher than rest of population </li></ul>
    6. 7. Psychiatric inpatient admission rates - Auckland <ul><li>Wheeler, A. NZ Medical Journal 2005 </li></ul><ul><li> Inpatients Community Risk Ratio </li></ul><ul><li>European 60% 61% 1.0 </li></ul><ul><li>Maori 23% 11% 2.1 </li></ul><ul><li>Pacific </li></ul><ul><li>Nations 11% 11% 1.0 </li></ul><ul><li>Asian 4% 11% 0.3 </li></ul>
    7. 8. Diagnoses given to Auckland inpatients Wheeler, A. NZ Medical Journal 2005 <ul><li>Psychotic disorder (eg ‘schizophrenia’) </li></ul><ul><li>European 38 %   </li></ul><ul><li>Maori 62% </li></ul><ul><li>Pacific Nations 59% </li></ul><ul><li>Asian 59%  </li></ul>
    8. 9. Child Abuse and ‘Schizophrenia’ symptoms <ul><li>200 outpatients </li></ul><ul><li> Child No </li></ul><ul><li>Hallucinations Abuse Abuse </li></ul><ul><li>Auditory 43% 18% p<.0005 </li></ul><ul><li>Command 13% 2% p<.005 </li></ul><ul><li>Visual 17% 4% p<.005 </li></ul><ul><li>Tactile 12% 0% </li></ul><ul><li>p<.001 </li></ul><ul><li>Read J, et al. 2003 </li></ul>
    9. 10. Dutch general population (n = 4045) free from psychotic symptoms, followed for 3 years (Janssen et al., 2004) <ul><li>Controlled for: age, sex, education, discrimination, ethnicity, urbanicity, unemployment, marital status, other mental health problems, psychosis in relatives , drug use.: </li></ul><ul><li>Those abused as children 9 times more likely to develop ‘pathology level psychosis’ </li></ul><ul><li>Those suffering most severe level of abuse 48 times more likely to develop psychosis </li></ul>
    10. 11. Read, van Os, Morrison, Ross (2005) ‘Childhood trauma, psychosis and schizophrenia: A literature review with theoretical and clinical implications’ Acta Psychiatrica Scandinavica, 112, 330-50 <ul><li>‘ Symptoms considered indicative of psychosis and schizophrenia, particularly hallucinations, are at least as strongly related to childhood abuse and neglect as many other mental health problems’. </li></ul><ul><li>‘ Recent large-scale general population studies indicate the relationship is a causal one, with a dose effect.’ </li></ul>
    11. 12. 2007 <ul><li>Shevlin et al. 2007 Schizophrenia Bulletin </li></ul><ul><li>UK, 8580 </li></ul><ul><li>People who had experienced three types of trauma (sexual abuse, physical abuse etc.) were 18 times more likely to be psychotic than non-abused people </li></ul><ul><li>People who had experienced five types of trauma were 193 times more likely to be psychotic </li></ul>
    12. 13. ‘ Child Maltreatment and Psychosis: A Return to a Genuinely Integrated Bio-Psycho-Social Model’ J Read, et al., 2008, Clinical Schizophrenia <ul><li>Ten out of eleven recent general population studies have found, even after controlling for other factors (including family history of psychosis), that child maltreatment is significantly related to psychosis. </li></ul><ul><li>Eight of these studies tested for, and found, a dose-response. </li></ul><ul><li>This paper advocates a return to the original stress-vulnerability model proposed by Zubin and Spring in 1977, in which heightened vulnerability to stress is not necessarily genetically inherited, but can be acquired via adverse life events. </li></ul>
    13. 14. Theories about HOW child abuse/neglect leads to psychosis <ul><li>COGNITIVE </li></ul><ul><li>PSYCHODYNAMIC </li></ul><ul><li>DISSOCIATION </li></ul><ul><li>‘ TRAUMAGENIC NEURODEVELOPMENTAL’ </li></ul><ul><li>ATTACHMENT </li></ul>
    14. 15. Theories about HOW child abuse/neglect leads to psychosis <ul><li>COGNITIVE </li></ul><ul><li>PSYCHODYNAMIC </li></ul><ul><li>DISSOCIATION </li></ul><ul><li>‘ TRAUMAGENIC NEURODEVELOPOMENTAL’ </li></ul><ul><li>ATTACHMENT </li></ul>
    15. 16. Positive Negative Paranoid Depressed Normal Internality Scores* Kaney & Bentall (1989) found that paranoid patients made very stable and global attributions for negative events. More importantly, they showed an extreme self-serving bias . Attributional Style (Rieger p 158) * High scores mean self-blaming, low scores mean the cause is something to do with other people or circumstances. 10 20 30 40
    16. 17. Brain differences between two groups do NOT prove the ‘brain disease’ hypothesis. The brain is designed to respond to the environment
    17. 19. Similarities found in brains of severely abused children and adult ‘schizophrenics’ : <ul><li>Overactivity of hypothalamic-pituitary-adrenal (HPA) axis </li></ul><ul><li>Abnormalities in neurotransmitter systems (especially dopamine) </li></ul><ul><li>Hippocampal damage </li></ul><ul><li>Cerebral atrophy </li></ul><ul><li>Reversed Cerebral Asymmetry </li></ul>
    18. 20. ATTACHMENT RESEARCH Parental Bonding Instrument (PBI) and Psychosis/’Schizophrenia’ <ul><li>High rates of ‘affectionless control’ (high overprotection + low care) in: </li></ul><ul><li>Australia </li></ul><ul><li>Austria </li></ul><ul><li>Canada </li></ul><ul><li>England </li></ul><ul><li>Italy </li></ul><ul><li>Norway </li></ul><ul><li>USA </li></ul>
    19. 21. Attachment and psychosis/’schizophrenia’ <ul><li>Mickelson et al., (1997) </li></ul><ul><li>USA survey of over 8,000 </li></ul><ul><li>‘ Schizophrenia’ significantly related to both </li></ul><ul><li>avoidant (p < .001) </li></ul><ul><li>and </li></ul><ul><li>anxious (p < .01) </li></ul><ul><li>attachment styles </li></ul>
    20. 22. More subtle types of childhood maltreatment <ul><li>Averages from six studies of people diagnosed ‘schizophrenic’ </li></ul><ul><li>Emotional Abuse ….. 47% </li></ul><ul><li>Emotional Neglect … 51% </li></ul><ul><li>Physical Neglect …… 41% </li></ul><ul><li>(Read et al., 2008, Clinical Schizophrenia) </li></ul>
    21. 23. Parental Loss <ul><li>Morgan et al., 2007 </li></ul><ul><li>390 people with a first episode of psychosis, compared to a control group </li></ul><ul><li>2.4 times more likely to have been separated from one or both parents before age 16 </li></ul><ul><li>3.1 times more likely to have had a parent die </li></ul><ul><li>12.3 times more likely to have had their mother die </li></ul>
    22. 24. Antipsychotic Drugs <ul><li>Adverse Effects </li></ul><ul><li>Traditional antipsychiotics: </li></ul><ul><li>Tardive Dyskinesia (20-50%) </li></ul><ul><li>irreversible in two-thirds </li></ul><ul><li>Neuroleptic Malignant Syndrome (often fatal) (1-2%) </li></ul><ul><li>New ‘atypical’ antipsychotics: </li></ul><ul><li>F.D.A. ‘no safer or more effective’ </li></ul><ul><li>Agranulocytosis </li></ul><ul><li>Weight gain </li></ul><ul><li>Diabetes </li></ul><ul><li>Sexual dysfunction </li></ul><ul><li>Neurodegeneration </li></ul><ul><li>Mortality ? </li></ul>
    23. 25. Cochrane review of Risperidone (Rattehalli, Jayaram, & Smith, 2010). <ul><li>“ Risperidone appears to have a marginal benefit in terms of clinical improvement compared with placebo in the first few weeks of treatment but the margin of improvement may not be clinically meaningful. </li></ul><ul><li>Global effects suggests that there is no clear difference between risperidone and placebo </li></ul><ul><li>Risperidone causes many adverse effects and, these effects are important and common. </li></ul><ul><li>People with schizophrenia or their advocates may want to lobby regulatory authorities to insist on better studies being available before wide release of a compound with the subsequent beguiling advertising.” </li></ul>
    24. 26. Books on Psychological Treatments <ul><li>Psychotherapies for the Psychoses: Theoretical, Clinical and Cultural Integration. Gleeson, J., et al.,(eds.) (2008) </li></ul><ul><li>Cognitive Therapy of Schizophrenia . Kingdon, D. & Turkington, D. (2005). </li></ul><ul><li>Cognitive Therapy for Psychosis: A Formulation-based Approach . Morrison, A. (2004). </li></ul><ul><li>Psychoses: An Integrative Perspective. Cullberg J (2006) </li></ul><ul><li>Evolving Psychosis: Different Stages, Different Treatments. Johannessen, J-O, et al.(eds) (2006) </li></ul><ul><li>Soteria: Through Madness to Deliverance. Mosher L et al (2004) </li></ul><ul><li>Therapeutic Communities for Psychosis: Philosophy, History and Clinical Practice. Gale J, et al. (2008) </li></ul>
    25. 29. Cognitive therapy for hallucinations and delusions <ul><li>Focus on stated needs </li></ul><ul><li>Focus on one ‘symptom’ </li></ul><ul><li>Assess frequency, intensity, conviction, distress etc </li></ul><ul><li>Develop a shared formulation of the problem </li></ul><ul><li>Use cognitive approach to gently explore alternative interpretations for delusions </li></ul><ul><li>Help client understand hallucinations are internal events </li></ul><ul><li>Stay focused on: </li></ul><ul><li>a. the relationship </li></ul><ul><li>b. self-esteem </li></ul><ul><li> c. the relationship !! </li></ul>

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