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Fusar‐Poli P, Estradé A, Stanghellini G, Venables J, Onwumere J, Messas G, Gilardi L, Nelson B, Patel V, Bonoldi I, Aragona M, Cabrera A, Rico J, Hoque A, Otaiku J, Hunter N, Tamelini MG, Maschião LF, Puchivailo MC, Piedade VL, Kéri P, Kpodo L, Sunkel C, Bao J, Shiers D, Kuipers E, Arango C, Maj M. The lived experience of psychosis: a bottom-up review co-written by experts by experience and academics. World Psychiatry 2022; 21:168-188. [PMID: 35524616 PMCID: PMC9077608 DOI: 10.1002/wps.20959] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Psychosis is the most ineffable experience of mental disorder. We provide here the first co-written bottom-up review of the lived experience of psychosis, whereby experts by experience primarily selected the subjective themes, that were subsequently enriched by phenomenologically-informed perspectives. First-person accounts within and outside the medical field were screened and discussed in collaborative workshops involving numerous individuals with lived experience of psychosis as well as family members and carers, representing a global network of organizations. The material was complemented by semantic analyses and shared across all collaborators in a cloud-based system. The early phases of psychosis (i.e., premorbid and prodromal stages) were found to be characterized by core existential themes including loss of common sense, perplexity and lack of immersion in the world with compromised vital contact with reality, heightened salience and a feeling that something important is about to happen, perturbation of the sense of self, and need to hide the tumultuous inner experiences. The first episode stage was found to be denoted by some transitory relief associated with the onset of delusions, intense self-referentiality and permeated self-world boundaries, tumultuous internal noise, and dissolution of the sense of self with social withdrawal. Core lived experiences of the later stages (i.e., relapsing and chronic) involved grieving personal losses, feeling split, and struggling to accept the constant inner chaos, the new self, the diagnosis and an uncertain future. The experience of receiving psychiatric treatments, such as inpatient and outpatient care, social interventions, psychological treatments and medications, included both positive and negative aspects, and was determined by the hope of achieving recovery, understood as an enduring journey of reconstructing the sense of personhood and re-establishing the lost bonds with others towards meaningful goals. These findings can inform clinical practice, research and education. Psychosis is one of the most painful and upsetting existential experiences, so dizzyingly alien to our usual patterns of life and so unspeakably enigmatic and human.
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Affiliation(s)
- Paolo Fusar‐Poli
- Early Psychosis: Interventions and Clinical‐detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,OASIS serviceSouth London and Maudsley NHS Foundation TrustLondonUK,Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly,National Institute for Health Research, Maudsley Biomedical Research CentreSouth London and MaudsleyLondonUK
| | - Andrés Estradé
- Early Psychosis: Interventions and Clinical‐detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Giovanni Stanghellini
- Department of Psychological, Territorial and Health Sciences“G. d'Annunzio” UniversityChietiItaly,Center for Studies on Phenomenology and Psychiatry, Medical Faculty“D. Portales” UniversitySantiagoChile
| | - Jemma Venables
- Early Psychosis: Interventions and Clinical‐detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
| | - Juliana Onwumere
- National Institute for Health Research, Maudsley Biomedical Research CentreSouth London and MaudsleyLondonUK,Department of Psychology, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,Bethlem Royal HospitalSouth London and Maudsley NHS Foundation TrustBeckenhamUK
| | - Guilherme Messas
- Mental Health DepartmentSanta Casa de São Paulo School of Medical SciencesSão PauloBrazil
| | | | - Barnaby Nelson
- OrygenParkvilleVICAustralia,Centre for Youth Mental HealthUniversity of MelbourneMelbourneVICAustralia
| | - Vikram Patel
- Department of Global Health and Social MedicineHarvard Medical SchoolBostonMAUSA,Department of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMAUSA
| | - Ilaria Bonoldi
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | | | - Ana Cabrera
- Asociación Española de Apoyo en PsicosisMadridSpain
| | - Joseba Rico
- Asociación Española de Apoyo en PsicosisMadridSpain
| | - Arif Hoque
- Young Person's Mental Health Advisory Group (YPMHAG)King's College LondonLondonUK
| | - Jummy Otaiku
- Young Person's Mental Health Advisory Group (YPMHAG)King's College LondonLondonUK
| | - Nicholas Hunter
- NHS South London and Maudsley (SLaM) Recovery CollegeLondonUK
| | | | - Luca F. Maschião
- Mental Health DepartmentSanta Casa de São Paulo School of Medical SciencesSão PauloBrazil
| | - Mariana Cardoso Puchivailo
- Mental Health DepartmentSanta Casa de São Paulo School of Medical SciencesSão PauloBrazil,Department of PsychologyFAE University CenterCuritibaBrazil
| | - Valter L. Piedade
- Mental Health DepartmentSanta Casa de São Paulo School of Medical SciencesSão PauloBrazil
| | - Péter Kéri
- Global Alliance of Mental Illness Advocacy Networks‐Europe (GAMIAN‐Europe)BrusselsBelgium
| | - Lily Kpodo
- South London and Maudsley NHS Foundation TrustLondonUK
| | | | - Jianan Bao
- OASIS serviceSouth London and Maudsley NHS Foundation TrustLondonUK,Department of Forensic and Neurodevelopment Sciences, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - David Shiers
- Psychosis Research UnitGreater Manchester Mental Health TrustManchesterUK,Division of Psychology and Mental HealthUniversity of ManchesterManchesterUK,School of MedicineKeele UniversityStaffordshireUK
| | - Elizabeth Kuipers
- National Institute for Health Research, Maudsley Biomedical Research CentreSouth London and MaudsleyLondonUK,Department of Psychology, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,Bethlem Royal HospitalSouth London and Maudsley NHS Foundation TrustBeckenhamUK
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental HealthHospital General Universitario Gregorio Marañón School of Medicine, IiSGM, CIBERSAM, Complutense University of MadridMadridSpain
| | - Mario Maj
- Department of PsychiatryUniversity of Campania “L. Vanvitelli”NaplesItaly
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Parry S, Varese F. Whispers, echoes, friends and fears: forms and functions of voice-hearing in adolescence. Child Adolesc Ment Health 2021; 26:195-203. [PMID: 32652853 DOI: 10.1111/camh.12403] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Despite the high prevalence of voice-hearing in childhood, research with adolescents aged under 16 years is scarce. Theoretical connections between clinical and developmental conceptualizations of voice-hearing are limited, resulting in missed opportunities to explore unusual sensory experiences with young people. METHODS Demographic, contextual and qualitative data were collected through a web-based survey with 68 adolescents (M = 14.91; SD = 2.77) from Australia, Canada, Ireland, New Zealand, Spain, the United Kingdom and United States of America. A Foucauldian-informed narrative analysis captured phenomenologically meaningful individual accounts and systemically informed narratives. Analytic layers attended specifically to the form and function of voices, including relational, protective, distressing and nuanced experiences, offering new insights into individual, systemic and cultural interpretative narratives surrounding voice-hearing to inform research, policy and tailored support. RESULTS The average self-reported age of onset of voices was 9 years, 5 months. Reciprocal relationships with pleasant voices were evidenced through the narratives and characterization of voices, while distressing voices were described without reciprocity and the voices held greater power over the young person. Positive aspects of negative voices were discussed and are illustrated with a continuum matrix reflecting interpretation and related affect. CONCLUSIONS Voice-hearing is a heterogeneous and often complex relational experience for young people, with structural inequalities, relational traumas and social isolation attributed causes of voice-hearing. Developing personal meaning-making mitigated voice-related distress through contextualizing the origin of the voices in past experiences, without attribution to mental illness. Recommendations are proposed for assessment, formulation and relational interventions that recognize the potential impact of the voice-child-other relationship upon psychosocial functioning and wellbeing.
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Affiliation(s)
- Sarah Parry
- Department of Psychology, Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Berardelli I, Rogante E, Sarubbi S, Erbuto D, Lester D, Pompili M. The Importance of Suicide Risk Formulation in Schizophrenia. Front Psychiatry 2021; 12:779684. [PMID: 34975579 PMCID: PMC8716825 DOI: 10.3389/fpsyt.2021.779684] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 11/02/2021] [Indexed: 12/31/2022] Open
Abstract
Suicide is a cause of early mortality in nearly 5% of patients with schizophrenia, and 25-50% of patients with schizophrenia attempt suicide in their lifetime. Evidence points to numerous individual, clinical, social, and psychological risk factors for suicide in patients with schizophrenia. Although recognizing suicidal risk factors in schizophrenia is extremely important in suicidal risk assessment, we have recently witnessed a change in suicide risk management that shifts the focus from suicide risk assessment to suicide risk formulation. Suicide risk formulation is dependent on the data gathered in the suicide risk assessment and assigns a level of suicide risk that is indispensable for the choice of treatment and the management of patients with a high suicidal risk. In this article, we extend the suicide risk formulation model to patients with schizophrenia. Suicide risk formulation results from four different areas that help clinicians collect as much information as possible for the management of suicidal risk. The four distinct judgments comprise risk status (the risk relating to the specific group to which the patient belongs), risk state (the risk for the person compared with his baseline or another reference point in the course of his life), available resources (on whom the person can count during a crisis) and foreseeable events (which can exacerbate the crisis). In schizophrenia, the suicide risk formulation model allows the clinician to evaluate in depth the clinical context of the patient, the patient's own history and patient-specific opportunities for better choosing and applying suicide prevention strategies.
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Affiliation(s)
- Isabella Berardelli
- Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Elena Rogante
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Salvatore Sarubbi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Denise Erbuto
- Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - David Lester
- Psychology Program, Stockton University, Galloway, NJ, United States
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health, and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Abstract
Alterations in self-experience are increasingly attended to as relevant and important aspects of schizophrenia, and psychosis more broadly, through a burgeoning self-disorders (SD) literature. At the same time, issues of self, subject, and subjectivity within schizophrenia-spectrum illnesses have also gained attention from researchers across the social sciences and humanities, and from ethnographic research especially. This paper examines the subjective experience of disruptions in self-identity within a cohort of first episode psychosis (FEP) service users, critically engaging with the SD literature and bringing it into conversation with social sciences and humanities scholarship on self and schizophrenia. Drawing findings from an ongoing ethnographic study of young peoples' experiences with psychosis, we explore meanings of mental distress relating to psychotic episodes and attend to issues of self, identity, and subjectivity. We critique the division between "normal" and "pathological" self-experience that is endorsed within the SD literature, arguing against the notion that fragmentation of self-experience in schizophrenia-spectrum illnesses is indicative of psychopathology. We highlight how experiences categorized as psychosis are also important and complete aspects of one's social world and inner life and explore the ways in which at least some aspects of disruptions of self-identity stem from clinical situations themselves-in particular, from asymmetries of power within the mental health system. Relating our findings to feminist, postcolonial, and disability studies' approaches to the "self," we emphasize the complex interplay between interpersonal, cultural, and structural aspects of self-experience within FEP.
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Affiliation(s)
- Suze G Berkhout
- c/o Post-Graduate Medical Education, Department of Psychiatry, The University of Toronto, 8th Floor, 250 College St., Toronto, ON, M5T 1R8, Canada.
| | - Juveria Zaheer
- Department of Psychiatry, The University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, The University of Toronto, Toronto, Canada
| | - Gary Remington
- Department of Psychiatry, The University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, The University of Toronto, Toronto, Canada
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Impact of antipsychotic treatment on methylation status of Interleukin-6 [IL-6] gene in Schizophrenia. J Psychiatr Res 2018; 104:88-95. [PMID: 30005373 DOI: 10.1016/j.jpsychires.2018.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 06/03/2018] [Accepted: 07/06/2018] [Indexed: 12/14/2022]
Abstract
Immunopathogenesis of schizophrenia has emerged as one of the predominant research paradigms in recent times. Based on the altered serum levels as well as gene expression, IL-6 has been considered as a peripheral biomarker of schizophrenia. However, the precise mechanism underlying the altered expression of IL6 in schizophrenia is inadequately known. Given the profound influence of environmental factors on schizophrenia risk, it is important to understand the effect of epigenetic changes on schizophrenia risk. Further, it is not known whether epigenetic changes modulate the expression of IL6 and its subsequent effects on the risk and progression of schizophrenia. In this study, we analysed and compared the methylation status of IL6 promoter sequence from -1200bp to +27bp in antipsychotic-naïve/free schizophrenia patients (N = 47) and matched healthy controls (N = 47) using bisulfite sequencing method. In addition, we also examined the methylation status in these patients at least after 3-months of treatment with antipsychotics (N = 40). At baseline, a state of hypomethylation was observed in the IL6 promoter of schizophrenia subjects in comparison to healthy controls. This state of hypomethylation was shown to be reversed by the administration of antipsychotics. In summary, our observations emphasize a significant role for IL-6 promoter methylation in schizophrenia pathogenesis as well as treatment with antipsychotic medications.
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Abstract
The turn of qualitative inquiry suggests a more open, plural conception of psychology than just the science of the mind and behavior as it is most commonly defined. Historical, ontological and epistemological binding of this conception of psychology to the positivist method of natural science may have exhausted its possibilities, and after having contributed to its prestige as a science, has now become an obstacle. It is proposed that psychology be reconceived as a science of subject and comportment in the framework of a contextual hermeneutic, social, human behavioral science. Thus, without rejecting quantitative inquiry, psychology recovers territory left aside like introspection and pre-reflective self-awareness, and reconnects with traditions marginalized from the main stream. From this perspective psychology might also recover its credibility as a human science in view of current skepticism.
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Abstract
Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most well-established and at the same time controversial disorders to the extreme of being placed in doubt. In the first of two parts, the established position is critically reviewed, beginning with showing fallacious reasoning on which the diagnosis is based, lacking clinical proof. Similarly, a certain rhetoric and metaphysics in genetic and neurobiological research is highlighted, where, for example, a meager accumulation of data is offered as robust conclusions, and correlates and correlations as causes and bases. However, that may be, the controversy is silenced in a dialog of the deaf between “defenders” and “critics.” with no way out in sight in empirical and scientific terms. A new meta-scientific position is necessary to analyze the science of ADHD itself and its social uses. In this respect, the second part introduces Aristotle’s four causes, material, formal, efficient, final, as an instrument of enquiry. According to this analysis, ADHD is not the pretended clinical entity as presented, but a practical entity providing a variety of functions. The implications would be rather different from the usual.
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Bianucci R, Charlier P, Perciaccante A, Lippi D, Appenzeller O. The "Ulysses syndrome": An eponym identifies a psychosomatic disorder in modern migrants. Eur J Intern Med 2017; 41:30-32. [PMID: 28377064 DOI: 10.1016/j.ejim.2017.03.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 03/28/2017] [Indexed: 11/18/2022]
Abstract
Due to civil wars, violence and persecutions, between 2015 and 2016, more than 1.4 million people, from the Middle East and Africa, fled their counties and migrated to Europe. The vast majority of migrants, who have already experienced enormous level of stressors, are faced with dangerous, often lethal, migratory journeys. Those who survive are exposed to adaptation stressors such as different languages, isolation, lack of work opportunities, diminished social status and a sense of failure in the new countries of residence. These are stressors that go far beyond the usual adaptation stresses to new cultures and migrants experience permanent crises with an imminent risk of developing the "Ulysses syndrome". As a consequence, many individuals often develop symptoms such as irritability, nervousness, migraine, tension headache, insomnia, tiredness, fear, loss of appetite and generalized ill-defined discomfort. If left untreated these symptoms, originally described by Hofer in the 17th century, may degenerate into a severe psychosomatic disorder leading to reactive depression. Here we expand the concept of Ulysses' syndrome and illustrate new initiatives aimed at reducing the level of stressors in migrants and at promoting their successful integration in their new countries.
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Affiliation(s)
- Raffaella Bianucci
- Warwick Medical School, Microbiology and Infection Division, The University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, United Kingdom; Department of Public Health and Pediatric Sciences, Legal Medicine Section, University of Turin, Italy; UMR 7268, Laboratoire d'Anthropologie bio-culturelle, Droit, Etique & Santé (Adés), Faculté de Médecine de Marseille, France.
| | - Philippe Charlier
- Section of Medical and Forensic Anthropology (UVSQ & Paris-Descartes University EA 4569), Montigny-Le-Bretonneux, France; CASH & IPES, Nanterre, France
| | | | - Donatella Lippi
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Otto Appenzeller
- New Mexico Health Enhancement and Marathon Clinics Research Foundation, 361 Big Horn Ridge Dr, Albuquerque, NM, USA; New Mexico Museum of Natural History and Science, 1801 Mountain Road NW, Albuquerque, NM, USA
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