A Clinical Introduction to Psychosis: Foundations for Clinical Psychologists and Neuropsychologists

Cover
A Clinical Introduction to Psychosis: Foundations for Clinical Psychologists and Neuropsychologists
Copyright
Dedication
Contributors
Preface
Acknowledgements
Section 1: The Basics
1
What Is Psychosis?
	Introduction
	Multiple Conceptualisations of Psychosis
		A Neurobiological View of Psychosis
		Phenomenological Perspective and Self-Disturbance Model of Psychosis
		Cognitive Approaches to Psychosis
		Socio-Developmental Perspectives on Psychosis
	Diagnosing Psychosis
		Categorical Approaches: A Brief Introduction
			Advantages of Categorical Systems
			Problems and Pitfalls With Categories (and Diagnostic Systems)
		Dimensional Approaches: A Brief Introduction
			Advantages and Disadvantages of Dimensional/Continuum Approaches
		Additional Considerations
			Diagnosing Psychosis Across Cultures
			Psychosis as a Transdiagnostic Phenomenon
		Conclusions on Diagnosis
	Clinical Staging Model of Psychosis
	Recommendations on Communicating a Diagnosis of Psychosis to Patients
		Communication Models
	Conclusion-The Way Forward
	Additional Reading
	Links to resources for patients, families, carers, and clinicians
	Definition of Key Terms
2
Models of Schizophrenia. A Selective Review of Genetic, Neuropharmacological, Cognitive, and Social Approaches
	Introduction
	Genetic Contributions to Schizophrenia
		Contributions of Rare CNVs
		Single-Nucleotide Polymorphisms (SNPs)
		Summary
	Pharmacological Models
		Dopamine System
		Glutamate System
		Summary
	Cognitive Models of Schizophrenia
		Representational Guidance of Behaviour and the Working Memory Hypothesis
		Stored Regularities, Context, and Predictions
		Executive Functions: Response Monitoring and Control of Action
		Summary
	Social Environmental Approach: Social Disconnection, Social Defeat, and Social Isolation
		Summary
	Integrative Summary and Clinical Implications
	Suggestions for Further Reading
	Quiz Questions
	Answers to quiz questions:
	Definition of Key Terms
3
Understanding the Impact of Mental Health Stigma and the Role of Clinicians as Allies
	Introduction
	Understanding Stigma
		Stereotypes
	Public Stigma
		Prejudice and Discrimination
	Self-Stigma
	Label Avoidance
		Effects of Familiarity
	Affirming Attitudes and Behaviours
	Strategies to Combat Public Stigma
		Protest
		Education
			Biogenetic Versus Biopsychosocial Perspective
		Contact
	Strategies to Combat Self-Stigma
	Conclusion
	Quiz Questions
	Answers to quiz questions:
	Self-Directed Learning Suggestions
	Definition of Key Terms
4
Culture and Psychosis in Clinical Practice
	Introduction
	Psychosis in Historical Context
	The Cultural Shaping of Psychosis
		Diagnosis and Reported Rates of Psychosis
		Attributed Aetiology
		Common Symptoms
		Insight
		Treatment and Outcome
		Stigma
		Recovery
	Lost in Translation: Lack of Culturally Adapted Assessments
	Filling in the Gaps: Fostering Clinical Cultural Competence
	Culturally Informed Interventions and Resources
		Culturally Adapted Interventions
		Resources
	Conclusion
	Additional Resources
	Definition of Key Terms
5
The Recovery Model and Psychosis
	Introduction
	Historical Views and Emergence of the Recovery Movement
	Multiple Definitions of Recovery
		Objective and Subjective Definitions of Recovery
		Views of Recovery Internationally
	Ongoing Research on Recovery
	Recovery-Oriented Practice
		Limitations
		Case Examples
	Conclusion
	Definition of Key Terms
Section 2: Assessment
6
Assessment in Psychosis
	Introduction
	Preparing for the Assessment
	Assumptions and Expectations
	Clinical Symptoms and Wider Anomalous Experiences
	Personal Understanding
	Cognitive and Communication Difficulties
	Risk and Safety
	Common Scales in the Assessment of Psychosis
		Interview-Based Psychosis Symptom Measures
			Positive and Negative Syndrome Scale (PANSS)
			Scale for the Assessment of Positive Symptoms (SAPS)
			Scale for the Assessment of Negative Symptoms (SANS)
			Psychotic Symptom Ratings Scales (PSYRATS)
			Structured Interview for Psychosis-Risk Syndromes/Scale of Prodromal Symptoms
			DSM-5 Clinician-Rated Dimensions of Psychosis Symptom Severity
		Self-Report Psychosis Symptom Measures
			Peters et al. Delusions Inventory (PDI)
			Launay-Slade Hallucinations Scale (LSHS)
			Cardiff Anomalous Perceptions Scale (CAPS)
			Scales Measuring Paranoid Ideation
		Scales Measuring Appraisals of Psychotic Symptoms
			Beliefs About Voices Questionnaire
			Beliefs About Paranoia Scale
			Voice Power Differential Scale
		Scales Measuring Insight
			Schedule for the Assessment of Insight (SAI)
			Birchwood Insight Scale (BIS)
			VAGUS Insight into Psychosis Scale
		Scales Measuring Psychosis-Related Experiences
			Oxford Liverpool Inventory of Experiences (O-LIFE Scale)
			Sensed Presence Questionnaire (SenPQ)
	Conclusion
	Self-Directed Reading
	Quiz Questions
	Answers to quiz questions:
7
Negative Symptoms and Their Assessment in Schizophrenia and Related Disorders
	Introduction: Negative Symptoms Defined
	Clinical Importance
	Clinical Interview Assessments
	General Considerations
	Self-Report Assessment
	Laboratory Assessment
	Future Directions
	Further Reading
	Definition of Key Terms
8
Assessing Cognition and Social Cognition in Schizophrenia & Related Disorders
	Assessing Social Cognition
		Introduction
		Factors That Affect Social Cognitive Abilities
		Measurement of Social Cognitive Abilities
			Common Tools
			Alternative Methods of Assessing Social Cognitive Abilities
		Measurement of Social Cognitive Biases
			Common Tools
			Alternative Methods of Assessing Social Cognitive Bias
	Assessing Basic Cognition
		Introduction
		Factors That Affect Cognitive Abilities
		Measurement of Basic Cognitive Abilities
			Common Tools and Batteries
			Alternative Methods of Assessing Cognitive Ability
		Measurement of Cognitive Bias
			Common Assessment Tools
			Alternative Methods of Assessing Cognitive Bias
	Common Assessment Challenges and Opportunities
	Quiz Questions
	Answers to quiz questions:
	Self-Directed Reading
	Links to Resources
	Definition of Key Terms
9
Assessing Social Functioning Across the Life Course of Psychosis
	Introduction
	Defining Social Functioning
	Measuring Social Functioning
	Social Functioning in a Changing Social Context
	Measures of Social Functioning
	Utility of Social Functioning Measures in Clinical Practice
		Benefits of Assessment in Clinical Practice
	Ensuring Ecological Validity: Service User Involvement
	Summary
	Quiz Questions
	Answers to quiz questions:
	Recommended Readings
	Definition of Key Terms
10
Trauma, Posttraumatic Stress, and Psychosis
	Introduction: Trauma and Posttraumatic Stress in Psychosis
	What Is Trauma?
		How Common Is Trauma in Psychosis?
	How Does Trauma Impact on Mental Health?
		PTSD in Psychosis
		Trauma-Related Psychosis
	Posttraumatic Stress in Psychosis: A Problem-Focused Approach
		PTSD: Re-experiencing Symptoms
		PTSD: Negative Beliefs and Mood
		PTSD: Survival Strategies and Emotion Regulation
		Trauma-Related Psychosis: Voices and Other Hallucinatory Experiences
		Trauma-Related Psychosis: Paranoia
		Trauma-Related Psychosis: Experiential and Expressive Negative Symptoms
	Blurred Boundaries: Posttraumatic Stress in Psychosis
	A Trauma-Focused Cognitive-Behavioural Model of PTSp
	Assessment and Formulation
	Conclusions
	Acknowledgements
	Definition of Key Terms
11
Effectively Assessing Sleep and Circadian Rhythms in Psychosis
	Introduction
	The Basic Principles of Sleep-Introducing the Two-Process Model
	The Suprachiasmatic Nucleus
	Individual Differences in Circadian Timing
	The Architecture of Sleep
	Sleep and Circadian Rhythm Disruption
	Sleep, Circadian Rhythms, and Psychosis
	Specific Sleep Disorders Commonly Recognised Within Psychosis and How to Assess Them
		Insomnia Disorder
			Diagnosis
				Assessment
				Assessment Tools
					Sleep History
					Sleep Diary and Questionnaires
			Differential Diagnoses
		Circadian Rhythm Disorders
			Background
			Assessment
		Obstructive Sleep Apnea
			Background
			Diagnosis and Assessment
		Restless Leg Syndrome
		Parasomnias (Nightmares; Sleep Paralysis; Night Terrors)
	Closing Remarks
	Quiz Questions
	Answers to quiz questions:
	Key Reading
	Acknowledgements
	Definition of Key Terms
12
Benefits, Assessment, and Preferences of Physical Activity in Psychosis
	Introduction
	Benefits of Physical Activity for People Living With Psychosis
	Influencing Factors and Preferences of Physical Activity in People Living With Psychosis
	Assessment of Physical Activity in People Living With Psychosis
	Conclusion
	Quiz Questions
	Answers to quiz questions:
	Self-Directed Learning
	Definition of Key Terms
13
Screening and Assessment of Substance Use Disorder in Psychosis
	Epidemiology
		Prevalence
		Specific Types and Patterns of Substance Use Disorder
		Onset and Course
		Demographic and Clinical Correlates
	Overview of Assessment
	Detection
	Classification
		Diagnostic Criteria for Substance Use Disorders
			Impact of Substance Use on Functioning
			Physical Dependence
			Psychological Dependence
		Measures
		Functional Assessment
		Patterns of Substance Use
		Consequences of Substance Use
		Psychosocial Functioning
		Reasons and Motives for Substance Use
		Insight and Motivation to Change
	Functional Analysis
		Theoretical Basis for the Functional Analysis
		Treatment Planning Based on the Functional Analysis
	Summary and Conclusions
	Definition of Key Terms
Section 3: Linking Assessment to Treatment
14
Clinical Case Formulation
	Introduction
		What Is Formulation?
		Brief Overview of Key Models of Formulation and Evidence Base
		What Information to Include in Your Formulation
		Sharing and Collaboratively Developing Formulations
		Using Formulations to Select Intervention Strategies
	Conclusions
	Additional Self-Directed Reading
	Definition of Key Terms
Section 4: Therapies
15
Cognitive Behavioural Therapies for Psychosis
	Introduction
		Therapy Overview
		Key Principles of CBTp (Therapy Approach)
		Format and Elements of CBTp
			Engagement and Assessment
			Goal Setting
			Formulation
			Interventions
				Self-Regulation of Psychotic Symptoms (Enhancing Coping Strategies)
				Specific Belief Change
				Normalising Unusual or Anomalous Experiences
				Cognitive Biases
				Working With Emotion
				Negative Symptoms
				Relapse Management
		Efficacy and Effectiveness of CBTp
			Factors Affecting Outcomes
			Cultural Adaptation
			Symptom-Specific Approaches
		Delivery of CBTp and Challenges to Implementation
			Fundamental Principles of CBTp
			Implementation in Routine Practice
	Conclusion and Future Directions
	Quiz Questions
	Answers to quiz questions:
	Recommended Readings
	Links to Resources (Table 15.1)
	Definition of Key Terms
16
Third-Wave CBT Interventions for Psychosis
	Introduction
	Person-Based Cognitive Therapy
		Adaptations of Mindfulness Practice for Psychosis
		Evidence Base
		Limitations
	Metacognitive Therapy (MCT)
		Adaptations for Individuals With Psychosis
		Evidence Base
		Limitations
	Acceptance and Commitment Therapy (ACT)
		Adaptations for Individuals With Psychosis
		Evidence Base
		Limitations
	Compassion-Focused Therapy (CFT)
		Adaptations for Individuals With Psychosis
		Evidence Base
		Limitations
	Concluding Remarks
	Quiz Questions
	Answers to quiz questions:
	Self-Directed Learning
17
Cognitive Remediation to Improve Functional Outcome
	Introduction
	Empirical Support for CR
	Measurement of Functional Outcome
	What Is the Impact of CR on Functional Outcome?
	Maximising the Impact of CR on Functional Outcome
	Techniques to Enhance Generalisation of Cognitive Gains
	Approaches to Personalise Treatment
	Future Directions: Challenges and Opportunities
		Challenge 1: Integration of Neuroscience Informed Approaches to Personalise Treatment
		Challenge 2: Integration of New Technologies
		Challenge 3: Integration of CR With Other Recovery-Oriented Treatments
		Challenge 4: Improve Personalisation of CR
		Challenge 5: Identify How CR Can Be Most Effective for First-Episode Psychosis
		Challenge 6: Implementation in Large and Small Systems of Care
	Conclusion
	Additional Self-Directed Reading
	Links to Resources
	Quiz Questions
	Answers to quiz questions:
	Definition of Key Terms
18
Promoting Psychosocial Functioning and Recovery in Schizophrenia Spectrum and Other Psychotic Disorders
	Introduction
	Psychosocial Interventions for Improving Functioning in Psychosis and Schizophrenia Spectrum Disorders
	Early Intervention and Psychological Interventions for Improving Functioning in First-Episode Psychosis
	Online, Social Media, and Mobile-Based Technologies to Maximise Social Recovery
	Virtual Reality Technology to Maximise Social Recovery
	Future Directions for Social Recovery Interventions and Social Functioning Improvement
		Generalisation
		Empowerment and Self-Efficacy
		Integration of Programs
		Fidelity of Treatment Delivery and Dissemination
		Identification of Risk Factors of Poor Functional Recovery
	Conclusions
	Quiz Questions
	Answers to quiz questions:
	Recommended Readings
	Definition of Key Terms
19
Trauma Therapies in Psychosis
	Introduction
	Trauma-Informed and Trauma-Focused Therapies
	Research Findings
		Trauma-Focused Therapies in Psychosis, What Do We Know Now?
		Are Trauma-Focused Therapies Safe in Psychosis?
	Treating Posttraumatic Stress in Psychosis
	Trauma-Focused Cognitive-Behaviour Therapy for PTSp: A Phased Approach
		Phase One: Assessment, Formulation, Goal Setting, and Psychoeducation
		Phase Two: Memory Work (Contextualising and Elaborating Memories)
		Phase Three: Work on Beliefs, Appraisals, Responses, Survival Strategies, Emotion Regulation, and Triggers
	Conclusion
	Acknowledgements
	Definitions of Key Terms
20
Better Sleep: Evidence-Based Interventions
	Introduction
	Evidence-Based Psychological Interventions for Disrupted Sleep in Patients With Psychosis
	Overview of Treatment
		What Drives Healthy Sleep? How Can We Use This to Successfully Treat Sleep Disturbance?
		Principles of the Treatment Approach
		Promoting Engagement and Motivation
		Assessment, Formulation, and Goal Setting
		Intervention Strategies
		Insomnia
		Nightmares
		Review of Outcome
		Future Implementation
	Case Studies
	Insomnia
		Stimulus Control: Bed Equals Sleep
		Setting the Sleep Window
		Reducing Presleep Hyperarousal
		Increasing Daytime Activity
	Insomnia and Circadian Rhythm Disruption
		Understanding Sleep
		Setting the Sleep Window
		Circadian Entrainment: Light and Technology
		Setting the Scene for Sleep
	Insomnia, Oversleeping and Daytime Fatigue
		Stabilising the Sleep Window: Reducing Oversleeping and Increasing Daytime Activity
		Daytime Fatigue
	Insomnia in the Context of Reduced Need for Sleep
		Optimising Engagement in Therapy
		Reducing Hyperarousal Though a Graded Wind-Down Routine
		Reducing Light Exposure at Night
		Measuring Progress
	Nightmares
		Psychoeducation
		IR
		Reducing Presleep Hyperarousal
		Managing Night-Time Distress
		Strategies the Next Day
		Monitoring and Managing Risk
	Summary
	Quiz Questions
	Answers to quiz questions:
	Additional Resources for Self-Directed Learning
	Definition of Key Terms
21
Get Moving: Physical Activity and Exercise for Mental Health
	Introduction
	Physical Activity vs. Exercise-What's the Difference?
		`F.I.T.T Principles
		Fitness vs. Fatness
		Sleep and Exercise: A Bidirectional Relationship
	Barriers to Exercise in a Mental Health Setting
		Contraindications to Exercise
	Motivation to Exercise
	Exercise Professionals in Mental Health Settings
	Creating a Culture That Promotes Positive Physical Health
	Conclusion
	Quiz Questions
	Answers to quiz questions:
	Self-Directed Learning Resources
	Definition of Key Terms
22
Treating Comorbid Substance Use and Psychosis
	Introduction
	Convergence in `Recovery
	Reasons for Substance Use Among People With Psychosis
	Overview of Psychological Management of Substance Use Problems Among People With Psychosis
		Psychostimulants
		Tobacco
		Caffeine
		Cocaine and Methamphetamine
		Alcohol
		Cannabis
	Reviews of Mixed Substance Misuse Studies
	Guidelines for Co-Existing Psychosis and Substance Misuse
	Common Elements Across the Guidelines
	Treatment Manuals
	Adopting a Tiered Health Promotion Intervention
	Stages of Change
	Motivational Interviewing
	Case Study: Renee (A Hypothetical Case Presentation)
		Initial Presentation
		Assessment
		Presenting Problems
		Intervention
	Barriers and Facilitators
	Clinician Attitudes to Working With Clients With Substance Use Disorders
	Quiz Questions
	Answers to quiz questions:
	End-of-Chapter Self-Directed Learning
		Current Controversies
		Websites and Online Resources
	Recommended Readings
	Definition of Key Terms
23
A Brief Guide to Medications for Psychosis
	Introduction
		Mode of Action
		Pharmacokinetics of Medication
	Treatment of First-Episode Psychosis
		Treatment Response
		When Can You Stop Antipsychotic Medication?
	Treatment-Resistant Schizophrenia (TRS)
		Clozapine
		Other Pharmacological Strategies for Treatment-Resistant Schizophrenia
		Medication in the At-Risk Mental State
	Medication for Affective Psychoses
	Adverse Effects of Antipsychotic Medications
		Movement Disorders
		Metabolic Adverse Effects
		Raised Prolactin
		Other Adverse Effects
		Other Neurological Adverse Effects
	Conclusions
	Disclosures
	Additional Self-Directed Reading
	Links to Resources
	Definition of Key Terms
24
Getting in Early: Early Intervention Services for Psychosis
	Introduction
	Clinical Staging Models and Early Intervention in Psychosis
	Guidelines and Consensus Statements on Early Psychosis
	Identifying and Treating People at Risk of Developing Psychosis
		How Are People at High Risk of Psychosis Identified?
		Psychosis Proneness
		Basic Symptoms
		Ultra-High Risk
		How Are People at High Risk of Psychosis Treated and What Have Been the Results?
	Is Early Intervention in Psychosis Effective?
	Implementing Early Psychosis Services: 3 Case Studies
		Australia
		England
		United States
		Challenges in Implementing Early Intervention Services
	Family and Carers
	Early Intervention Service Teams and the Place of Psychologists
	Conclusion
	Self-Directed Learning
	Books
	Guidelines
	First person accounts of psychosis
	Quiz Questions
	Answers to quiz questions:
	Definition of Key Terms
Section 5: New Directions in Research and Practice
25
Beyond Belief-New Approaches to the Treatment of Paranoia
	Introduction
		What Is Paranoia?-Some Lived Experiences
		What Is Paranoia?-Common Defining Features on a Continuum
		Conceptualising Paranoia or `Fears of Harm From Others
		Are `Persecutory Delusions or `Fears of Harm From Others Beliefs?
	Assessment and Engagement for Therapy
	Current Research Findings Pointing to New Treatment Approaches
	Digital Approaches: Virtual Reality, Apps, and Blended Therapy
	SlowMo: A Blended Digital Therapy for Fears of Harm From Others
		SlowMo Face-to-Face Sessions Supported by Webapp
		The SlowMo App
		An Illustration
	Conclusions
	And Finally
	Resources-Open Access
	Acknowledgements
	Definition of Key Terms
26
Being a Scientist-Practitioner in the Field of Psychosis: Experiences From Voices Clinics
	Introduction
	The Development of the Melbourne, Sussex, and Perth Voices Clinics
		Melbourne's Voices Clinic: Initial Implementation of an Evidence-Based Model
		Melbourne's Voices Clinic: As a Specialist Clinic and Centre for Research
		Sussex Voices Clinic: Increasing Access to Evidence-Based Interventions (for Clients and Clinicians)
		Sussex Voices Clinic: As a Centre for Research
		Perth Voices Clinic: A Specialist Service in Development
		Perth Voices Clinic: As a Centre for Education and Training
		Perth Voices Clinic: As a Centre for Research
	Consumer Perspective on Voices Clinics
		Summary
	Challenges for the Voices Clinics
		Ethics of Combining Research and Practice
		Balancing Empirically Supported Treatment With Innovations in Practice
		Consumer Perspective
	Where to From Here
		The Final Stage of `Translational Research
	Additional Suggested Reading on the Scientist-Practitioner Model
	Definitions of Key Terms
27
The Therapeutic Use of Digital Technologies in Psychosis
	Introduction
	Types of Digital Technologies
	Use of Digital Technology Amongst People With Psychosis
	Benefits and Use of Technology in Psychosis Populations
	Specific Uses of Digital Technology for Psychosis Treatment and Management
		Clinical Assessment
			Digital Tools for Assessment in Session
			Real-Time, Real-World Assessment
			Passive Sensors for Assessment
			Digital Technology to Better Characterise Psychotic Phenomena
		Symptom Monitoring and Relapse Prevention
			Digital Dairies
			Monitoring Signs of Relapse
		Symptom Self-Management
			Websites and Self-Directed Programs
			Momentary Interventions
		Using Technology to Enhance Standard Interventions
			Video Material
			Augmented and Virtual Reality
		Improving Cognition and Supporting Daily Functioning
		Facilitating Social Relationships
	Immediate Uses of Technology in Psychosis Treatment
	Clinical Issues and Cautions
		Evidence Base of Current Digital Technologies
		Barriers to Technology Adoption for Psychosis
		Ethical Issues
			Security, Privacy, and Confidentiality
			Decision Making
	Future Directions
	Further Reading
	Quiz Questions
	Answers to quiz questions:
	Definition of Key Terms
28
Tracking Language in Real Time in Psychosis
	Introduction
	Defining Language and Its Relevance to Psychosis
	Understanding and Tracking Psychosis Through Language: Past and Present
		Clinical Ratings and Self-Report Approaches
		Psycholinguistic Approaches
	Language and Psychosis as Dynamic Phenomena
	Tracking Psychosis Through Language: Future Directions
		Towards `Real Time Assessment
		Towards `Real-Time Objective Assessment of Speech in Psychosis: The Requirements
			Collection
			Analytics
			Reporting
	Conclusion
	Quiz Questions
	Answers to quiz questions:
	End-of-Chapter Self-Directed Learning
	Acknowledgments
	Definition of Key Terms
29
Integrating Lived Experience Perspectives Into Clinical Practice
	Introduction
	Historical Background of a Movement
		`Nothing About Us Without Us
	What Is Important (and Why?)
		Lived Experience, Language, and Concepts
			Lived Experience
			Language
				`Each Narrative Counts
			Concepts
				Peer Support
				Recovery
				Empowerment
				Experiential Knowledge and Experiential Expertise
				Dignity and Respect
				Social Inclusion
				Self-Determination
				The Individual's Choice and Shared Decision Making
		The Purpose
			`A Voice and a Choice
				The Need for Involving People With Lived Experience
	How Can This Be Realised?
		Peer Support Work
		Participatory Research
		Advocacy and Political Action
			Incorporating Consumer and Provider Perspectives Into Practice
				Incorporating Consumer Priorities
				Values and a Scientist-Practitioner-Based Profession
				Addressing Power Imbalances
				Stigma and Disclosure Among Professionals
	What Are Good Examples of Peer Support?
		Disclosure Decisions: Honest, Open, Proud
		Peer Support Groups
		Wellness Recovery Action Planning: WRAP
	Discussion and Conclusion: What Is the Future?
	RECOMMENDED READINGS
	Definition of Key Terms
Index
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