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Understanding Psychosis and Schizophrenia (Revised)

Understanding Psychosis and Schizophrenia (Revised)

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Quick Overview

Revised version 2017

This publication is licensed under a Creative Commons CC BY-ND 4.0 International Licence.

This report provides an overview of the current state of knowledge about why some people hear voices, experience paranoia or have other experiences seen as 'psychosis'. It also describes what can help. A parallel report is available entitled Understanding Bipolar Disorder - Why People Experience Extreme Mood States, and What Can Help.

In recent years we have made huge progress in understanding the psychology of what had previously often been thought of as a largely biological problem, an illness. Much has been written about the biological aspects: this report aims to redress the balance by concentrating on the psychological and social aspects, both in terms of how we understand these experiences and also what can help when they become distressing.

We hope that this report will contribute to a fundamental change that is already underway in how we as a society think about and offer help for 'psychosis' and 'schizophrenia'.





Executive Summary

Note on Terminology

Part 1: What is 'psychosis'?

Section 1: What this report is about: Experiences sometimes called psychosis
1.1 What does it mean to experience psychosis?
1.2 Everyone's experiences are different
1.3 Our different cultures

Section 2: How common are these experiences?
2.1 How many people have 'psychotic' experiences? How many are given a diagnosis of schizophrenia?
2.2 People who do not use mental health services

Section 3: Are these experiences best understood as mental illness?
3.1 Can psychotic experiences be separated from normal ones?
3.2 Many 'normal' people have unusual experiences
3.3 Are mental health diagnoses reliable - can clinicians agree?
3.4 Are mental health diagnoses meaningful? Do they refer to real 'things'?

     3.4.1 Naming something doesn't make it real
     3.4.2 What a diagnostic label does not tell you
     3.4.3 Experiences are on a continuum and don't fall into neat categories
     3.4.4 The ever-expanding reach of mental health diagnoses
     3.4.5 Has the idea of schizophrenia arisen as a result of the 'clinician's illusion'?

3.5 The advantages and disadvantages of seeing things as mental illness 3.6 Recent recommendations to move away from using diagnoses
3.6 Recent recommendations to move away from using diagnoses

Section 4: How do these experiences affect people's lives?
4.1 Variability in outcomes
4.2 Which outcomes matter?
4.3 Influences on outcome
4.4 The myth that psychosis leads to violence

Part 2: Causes: why do so many people have these experiences and when do they become distressing?

Section 5: Biology - our brains
5.1 Genetics
5.2 Neurochemical theories
5.3 Brain structure and function
5.4 Conclusions

Section 6: Life experiences and how they affect us
6.1 Life events and trauma
6.2 Relationships
6.3 Inequality, poverty and social disadvantage

Section 7: The way we make sense of the world: the psychology of 'psychosis'
7.1 The psychological link between life events and psychosis
7.2 Hearing voices, inner speech and memories
7.3 How we develop beliefs and reach conclusions
7.4 The relationship between emotions and psychosis
7.5 How psychotic experiences can lead to distress and disability

     7.5.1 How we make sense of our experiences
     7.5.2 Positive aspects of psychosis
     7.5.3 Spirituality

Part 3: What can help

Section 8: Arriving at a shared understanding of the problem
8.1 Formulation
8.2 Deciding what is likely to help

Section 9: Self-help, and help from family, friends and communities
9.1 Support from friends and family

     9.1.1 How services can help friends and family to support people

 Family meetings (sometimes called 'Family Interventions')

9.2 Self-help and mutual support

     9.2.1 The Hearing Voices Network
     9.2.2 Complementary approaches
     9.2.3 Peer support
     9.2.4 Recovery colleges: An educational approach to offering help
     9.2.5 The service user/survivor movement

Section 10: Practical and emotional help from professionals
10.1 Making sure basic needs are met
10.2 Emotional support
10.3 Work and employment
10.4 Help with organisation and motivation
10.5 Getting help early
10.6 Help at times of crisis
10.7 Keeping safe

     10.7.1 Self neglect, self harm and suicide
     10.7.2 Risk to other people
     10.7.3 Risk of harm from services
     10.7.4 Compulsion: using mental health legislation

Section 11: Talking - psychological help
11.1 Cognitive behaviour therapy (CBT)

     11.1.1 Effectiveness of cognitive behaviour therapy
     11.1.2 Less formal support drawing on CBT related ideas

11.2 Cognitive remediation
11.3 Trauma focused therapy and psychodynamic approaches
11.4 Acceptance and commitment therapy and Mindfulness
11.5 Narrative therapy
11.6 Voice dialoguing
11.7 Helping families
11.8 Increasing Access to Psychological Therapy
11.9 Finding an approach that suits you
11.10 Conclusions

Section 12: Medication
12.1 How can medication help?
12.2 Problems with 'antipsychotic' medication

     12.2.1 Effectiveness
     12.2.2 Unwanted effects

12.3 Collaborative decisions about medication

     12.3.1 Weighing up benefits and risks
     12.3.2 Finding the type of medication that suits you best
     12.3.3 Working out when to take medication
     12.3.4 Finding the right dose

Part 4: What we need to do differently

Section 13: What mental health services need to do differently
13.1 We need to move beyond the 'medical model'
13.2 We need to replace paternalism with collaboration

     13.2.1 Listening
     13.2.2 Accepting views other than the illness model
     13.2.3 Collaboration rather than just 'involvement'

13.3 We need to stop 'prescribing' and start supporting people to choose

     13.3.1 Trying things out
     13.3.2 Talking therapy
     13.3.3 Medication or no medication
     13.3.4 Professional help or self-help

13.4 We need to make rights and expectations explicit
13.5 We need to reduce the use of compulsion and mental health legislation

     13.5.1 Changing the culture of psychiatric hospitals
     13.5.2 Is mental health legislation inherently discriminatory?
     13.5.3 Is forced medication ever justified? We need to change the way we do research We need to change how mental health professionals are trained and supported

13.6 We need to change the way we do research
13.7 We need to change how mental health professionals are trained and supported

Section 14: What we all need to do differently
14.1 We need take on board that we're all in this together - there is no 'us' and 'them'
14.2 We need to focus on prevention

     14.2.1 Prevention: towards a safer society
     14.2.2 Prevention: towards a more equal society
     14.2.3 Prevention: reducing discrimination and oppression
     14.2.4 Prevention: reducing harmful drug use and addressing its causes
     14.2.5 Prevention: what we can each do to protect our mental health

14.3 We need to campaign against prejudice and discrimination

Appendix: Useful books and websites

Details of Contributors



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