Phenomenology Of Psychosis Research Articles

Exploring Psychosis in Neurodegenerative Dementia: Connecting Symptoms to Neurobiology.

The following commentary discusses a review by Cressot et al. entitled: 'Psychosis in Neurodegenerative Dementias: A Systematic Comparative Review'. The authors describe the epidemiology and phenomenology of psychosis across neurodegenerative dementias. Dementia with Lewy bodies had the highest reported prevalence of psychosis at 74% followed by Alzheimer's disease, 54% and frontotemporal degeneration, 42%. Detailed characterization of psychosis shows differences in the types of hallucinations and delusions by dementia type. These findings suggest that different types of dementia related pathology are associated with high rates of psychosis with more specific symptom profiles than previously appreciated. Understanding the differences and variety of psychotic experiences across dementia types may have diagnostic and therapeutic implications for treating hallucinations and delusions in populations suffering from neurodegenerative diseases.

Dwelling with Multiplicity: Negotiating Borders in the Lifeworld of First Episode Psychosis

This paper explores intersections of cure, harm, diagnostic practices, and lifeworlds of mental disability within the field of first episode psychosis. Drawing on findings from a collaborative art workshop developed within an ethnographic study of first episode psychosis, we contrast the experience and phenomenology of psychosis within the art workshops with the construction of psychosis in traditional clinical spaces. Engaging concepts of dwelling, borderlands, and lifeworld within this context, we detail how the workshops countered the ways in which institutional and methodological structuring of narratives of psychosis reinforce diagnostic boundaries. In contrast to the clinical setting, a fuller lifeworld was experienced through witnessing the aesthetics of artwork that was created within the project.

Experience of psychosis during the COVID-19 pandemic among hospitalized patients

ABSTRACT Background The content of auditory hallucinations (AHs) and delusions is malleable and reflects the social environment and the local culture. COVID-19 is a significant new feature of the social environment, yet research has not yet determined how the phenomenology of psychosis has changed since the COVID-19 outbreak. Methods Adult patients (N = 17) receiving care within an acute inpatient psychiatric care setting in Boston were recruited to participate in an hour-long Zoom interview about their psychosis phenomenology and the potential impact of COVID-19. Results Thematic analysis of interview data found that for many, ideas about COVID-19 were present in the content of their AHs and shaped their paranoid ideation. Some felt that the frequency and loudness of the AHs had increased. However, not all participants spoke in ways that suggested the virus had affected their experience. Discussion Results demonstrate that COVID-19 influenced the content of psychosis for many, but the effect of COVID-19 on psychosis was not uniform. The increased social isolation, financial insecurity, and socio-political climate of the period also seemed to negatively impact individuals with psychosis. Understanding how COVID-19 specifically has influenced psychosis helps to illustrate how societal and external factors may shape this experience.

The Phenomenology of Psychosis: Considerations for the Future

The Phenomenology of Psychosis: Considerations for the Future

Childhood Trauma and Psychotic Symptomatology in Ethnic Minorities With Schizophrenia

Abstract In response to recent findings implicating trauma in the phenomenology of psychosis, this study explored interactions between adverse childhood experiences (ACEs) and positive symptoms of psychosis in an understudied patient population, comprising individuals of African and Latino ancestry. Endorsement of ACEs was compared between 90 schizophrenia cases and 240 nonpsychotic controls, matched for ethnicity, gender, and age. Relative to controls, cases reported significantly greater exposure to physical abuse, emotional abuse, sexual abuse, neglect, witnessing domestic violence, and household member incarceration. Analyses further evaluated associations between ACEs and subtypes of hallucinations, delusions, and subjective thought disorder. Among female cases, the number of hallucinatory symptoms present increased with increasing ACE score. Hallucinatory symptoms further correlated with individual ACE items. For instance, third-person voices were more common among women exposed to childhood physical and emotional abuse. Interestingly, among women, grandiose delusions were negatively related to sexual abuse, perhaps reflecting the deleterious effects of sexual trauma on the development of a positive self-concept. Among male cases, no positive relationships with hallucinations were observed, but several delusional symptoms were correlated with childhood trauma experiences. The most statistically powerful ACE associations, in both males and females, were observed with experiences of thought broadcasting. This article further advocates for the consideration of ethnicity and gender as factors influencing trauma exposures and their clinical manifestations.

High frequency of psychosis in late-stage Parkinsońs disease

BackgroundPsychosis is a frequent non-motor symptom in Parkinson’s disease (PD). Estimates of the frequency of Parkinsońs disease psychosis (PDP) vary widely. Knowledge about the frequency and phenomenology of psychosis in late-stage (LS) PD patients is limited.This study aimed to determine the frequency of psychosis in LSPD patients through clinical diagnostic interview (CDI) (gold standard), according to NINDS/NIMH diagnostic criteria for PDP. The secondary objectives were to characterize the phenomenology, to test selected instruments and assess their adequacy in comparison to CDI, and to assess the psychiatric comorbidities. MethodsA cross-sectional study including LSPD patients (patients with ≥ 7 years from symptoms onset and Hoehn and Yahr scale score > 3 or a Schwab and England scale score < 50% in the ON condition) was conducted. Patients were subjected to psychiatric, neurological, and neuropsychological evaluations. Each patient was interviewed by a psychiatrist who performed a CDI. Results92 LSPD patients were included. 55.4% experienced psychotic symptoms according to NINDS/NIMH diagnostic criteria for PDP. Hallucinations were present in 94.1% and delusions in 29.4% of the psychotic patients. Visual hallucinations were the most common (88.23%) psychotic symptom. 72.5% of LSPD patients with psychotic symptoms had at least one comorbid psychiatric diagnosis. Lower frequency of psychosis was found when the assessment was performed only through selected instruments rather than CDI. ConclusionsA high frequency (55.4%) of psychotic symptoms and comorbid psychiatric (72.5%) diagnosis were found in LSPD patients. The use of CDI, in addition to structured scales may increase the sensitivity of detecting psychotic symptoms.

Nosology and Phenomenology of Psychosis in Movement Disorders.

Psychotic symptoms, such as delusions and hallucinations, are part of the clinical picture of several conditions presenting movement disorders. Phenomenology and epidemiology of psychosis in Parkinson's disease have received wide attention; however, the presence of psychosis in other movement disorders is, comparatively, less well known. To review psychotic symptoms present in different movement disorders. A comprehensive and structured literature search was performed to identify and analyze data on patients with movement disorders and comorbid psychosis. In monogenic parkinsonisms, such as PARK-GBA, PARK-LRRK2, and PARK-SNCA, visual hallucinations related to dopamine replacement therapy are frequent as well as are delusions in PARK-LRRK2 and PARK-SNCA, but not in PARK-GBA. Different types of delusions and hallucinations are found in Huntington's disease and other choreic disorders. In Tourette's syndrome, paranoid delusions as well as visual, olfactory, and auditory hallucinations have been described, which usually develop after an average of 10 years of disease. Delusions in ataxias are more frequent in ATX-TBP, ATX-ATN1, and ATX-ATXN3, whereas it is rare in Friedreich's ataxia. Psychosis is also a prominent and frequent clinical feature in Fahr's disease, Wilson's disease, neurodegeneration with brain iron accumulation, and some lysosomal storage disorders, whereas it is uncommon in atypical parkinsonisms and dystonia. Psychosis usually occurs at late disease stages, but may appear as onset symptoms of the disease, especially in Wilson's disease, Huntington's disease, late-onset Tays-Sachs, and Niemann-Pick. Psychosis is a frequent comorbidity in most hyper- and hypokinetic movement disorders. Appropriate recognition is relevant both in the early and late disease stages.

Identité, destin et schizophrénie

In his work « Phenomenology of Psychosis » Arthur Tatossian tends to report the basal alteration of patients to a constrained phenomenological reduction and deducts the drive of daily life as a sensitive point of the schizophrenic experience, vulnerability and mark of his destiny. This perspective reveals the challenge of the dynamics of human identity. Going beyond the spatial figure of a split, Alfred Kraus takes up the living format of the dynamics of « role », which regulates the relation of the subject to Self and others, and suggests to report symptoms and syndromes, another stake destined, to one of the variants dialectics of the balance between self and others. We return to the psychopathological intuition of the origins of psychiatric phenomenology to relate the disorder to a particular experience of the lived time, a modification of the relations between the temporal ecstasies that Bin Kimura describes as an excessive « futurisation » by accentuation of the possible and impatience to exist. These approaches inform in a novel way the system of care, and far from advocating objective therapeutic applications, generate implications that can enrich and enhance care projects.

The Neuropsychological Profile and Phenomenology of Late Onset Psychosis: A Cross-sectional Study on the Differential Diagnosis of Very-Late-Onset Schizophrenia-Like Psychosis, Dementia with Lewy Bodies and Alzheimer's Type Dementia with Psychosis.

Late onset psychosis not only occurs as a prodromal symptom to neurodegeneration, but it can also be associated with a non-progressive mild cognitive deficit. Studying the phenomenology of psychotic symptoms and the neuropsychological profile may serve as sensitive and non-invasive tools for differential diagnosis. We compared 57 individuals with very-late-onset schizophrenia-like psychosis (VLOSLP), 49 participants with Dementia with Lewy Bodies (DLB) and 35 patients with Alzheimer's type Dementia and psychosis (AD+P) concerning the phenomenology of psychotic symptoms and the neuropsychological profile using several measures of cognitive function in a cross-sectional study. Participants with DLB exhibited more visual hallucinations, especially those involving animals, and less partition/paranoid delusions than both other groups. VLOSLP showed more partition delusions and auditory hallucinations of human voices than both other groups. Hence, patients with DLB and VLOSLP showed greater dissimilarity in the phenomenology of psychosis, whereas individuals with AD+P held an intermediate position. Processing speed and executive function were comparably impaired among the three groups, as was expected considering a common underlying set of neurobiological abnormalities for psychosis. However, AD+P showed more strongly reduced learning and consolidation skills, whereas DLB was associated with prominent visuoconstructive deficits. Phenomenology of psychosis may prove especially informative when comparing individuals with DLB to those with VLOSLP. Neuropsychological profiles are able to further aid differential diagnosis of the three groups.

“It was definitely a sexual kind of sensation”: sex, sexual identity, and gender in the phenomenology of psychosis

ABSTRACT Purpose Over the past twenty years, few empirical studies have focused on manifestations of sex, sexual identity, and gender within the phenomenology of psychosis. The goal of the present analysis was to explore themes related to gender and sexuality among individuals diagnosed with a psychotic disorder. Methods We conducted a qualitative analysis of 25 in-depth phenomenological interviews and a secondary analysis of two focus groups with an additional 24 participants (total N = 49), all of whom reported past or current treatment for a psychotic disorder. Results Nearly three-quarters of interview participants and one quarter of focus group participants reported some kind of sex or gender-related content. Participants’ experiences were grouped under the following four themes: “shame and persecution,” “sexual or sexualized violence,” “power, agency, sexuality & gender,” and “positive experiences of the erotic.” Some participants described sexual experiences or content as a primary facet of their experiences, while for others it occupied a more secondary place. Many participants reported some degree of shame associated with sexual aspects of their experience. Conclusions We emphasize the clinical importance of validating and engaging with sex/sexual themes, and call for future research focused on implications vis-a-vis engagement, treatment, and social recovery.

At the verge of unthinkable anxiety: On the relevance of a neurophysiologically informed relational perspective on meaning-making in psychosis

This article examines the relevance of relationally oriented psychoanalytic phenomenology as a frame of reference for understanding psychotic states in schizophrenia. The etiology and structural characteristics of such states are examined from both a neurophysiological, and a relational and interpersonal point of view. Many findings indicate organic abnormalities in schizophrenia, acquired through an exposure to physical risk factors and genetic predisposition, but relational traumas also seem to have an impact on the form and content of psychotic states. This may happen through interruptions in the “use-dependent” maturation of the brain in a relational milieu. In addition, at the level of meaning-making, we find that the emotional and relational contexts—both past and present—give the substance or “raw material” for hallucinations and delusions. In a psychotic state, the person also tries to handle basic affects and relational needs, and to make meaning in states of overwhelming chaos and anxiety. Donald W. Winnicott's theory of “a holding environment”, Stephen Mitchell's theory of the relational matrix, and Stolorow, Atwood, and Orange's concepts of a “shattered world” and annihilation anxiety are used as a framework in the analysis of the phenomenology of psychosis. Two case illustrations, one from child psychotherapy and one from therapy with an adult patient, are used to illuminate the theoretical points of view.

Cognitive Affective Psychosis Syndrome in a Patient With Sporadic Olivopontocerebellar Atrophy

Cognitive Affective Psychosis Syndrome in a Patient With Sporadic Olivopontocerebellar Atrophy

Cognitive Affective Psychosis Syndrome in a Patient With Sporadic Olivopontocerebellar Atrophy

Cognitive Affective Psychosis Syndrome in a Patient With Sporadic Olivopontocerebellar Atrophy

From dopamine to salience to psychosis—linking biology, pharmacology and phenomenology of psychosis

How does an excess in a neurochemical lead someone to being paranoid about the intentions of their neighbour? And why does blocking a dopamine receptor improve this symptom? In this article we present a heuristic framework which attempts to link the biology, phenomenology and pharmacology of psychosis. Focussing on dopamine's role in reward prediction and motivational salience we propose that psychosis arises from an aberrant assignment of novelty and salience to objects and associations. Antipsychotics block dopamine receptors and decrease dopamine transmission, which leads to the attenuation of aberrant novelty and salience. This ‘salience’ framework accounts for existing data and questions several current assumptions about the speed of onset phenomenological effects of antipsychotics and their behavioral effects in animal models. We review new data to show that in contrast to the prevailing idea of a “delayed onset” of antipsychotic action, the improvement is evident in the first few days. Antipsychotics do not eradicate symptoms, but create a state of “detachment” from them. And the actions of antipsychotics in the conditioned avoidance response model, one of the best established animal models for identifying antipsychotic action, are consistent with the idea that they dampen aberrant as well as normal motivational salience. The article discusses the caveats, limitations as well as the clinical implications of the salience framework.

Psychosis in bipolar disorder: phenomenology and impact on morbidity and course of illness

Although psychosis is common in bipolar disorder, few studies have examined the prognostic significance of psychotic features. In addition, some studies suggest that the presence of mood-incongruent psychosis, in particular, is associated with poorer outcome compared with mood-congruent psychosis. We assesses the phenomenology and prevalence of mood-congruent and mood-incongruent psychotic symptoms in 352 patients with bipolar I disorder participating in the Stanley Foundation Bipolar Treatment Network. We compared the demographic and clinical features, and measures of psychosocial and vocational functioning in patients with and without a history of psychosis. The phenomenology of psychosis in this cohort of patients with bipolar disorder was similar to that reported in earlier studies and supported the lack of diagnostic specificity of any one type of psychotic symptom. There were no significant differences between patients with and without a history of psychosis on any demographic, psychosocial, vocational, or course of illness variables. Only family history of bipolar disorder was significantly more common in patients with nonpsychotic bipolar disorder compared to patients with a history of psychosis. Among bipolar patients with a history of psychosis, only the proportion of women and lifetime prevalence rates of anxiety disorders occurred significantly more in patients with mood-incongruent delusions. In this large cohort of outpatients with bipolar I disorder, neither a history of psychosis nor of mood-incongruent psychosis had prognostic significance at entry into the Network. The lack of observable prognostic impact may have been, in part, due to the relatively high morbidity and poor functional outcome of a substantial portion of the total cohort.

Psychosis as a state of aberrant salience: a framework linking biology, phenomenology, and pharmacology in schizophrenia.

The clinical hallmark of schizophrenia is psychosis. The objective of this overview is to link the neurobiology (brain), the phenomenological experience (mind), and pharmacological aspects of psychosis-in-schizophrenia into a unitary framework. Current ideas regarding the neurobiology and phenomenology of psychosis and schizophrenia, the role of dopamine, and the mechanism of action of antipsychotic medication were integrated to develop this framework. A central role of dopamine is to mediate the "salience" of environmental events and internal representations. It is proposed that a dysregulated, hyperdopaminergic state, at a "brain" level of description and analysis, leads to an aberrant assignment of salience to the elements of one's experience, at a "mind" level. Delusions are a cognitive effort by the patient to make sense of these aberrantly salient experiences, whereas hallucinations reflect a direct experience of the aberrant salience of internal representations. Antipsychotics "dampen the salience" of these abnormal experiences and by doing so permit the resolution of symptoms. The antipsychotics do not erase the symptoms but provide the platform for a process of psychological resolution. However, if antipsychotic treatment is stopped, the dysregulated neurochemistry returns, the dormant ideas and experiences become reinvested with aberrant salience, and a relapse occurs. The article provides a heuristic framework for linking the psychological and biological in psychosis. Predictions of this hypothesis, particularly regarding the possibility of synergy between psychological and pharmacological therapies, are presented. The author describes how the hypothesis is complementary to other ideas about psychosis and also discusses its limitations.

Psychosis in a Pediatric Mood and Anxiety Disorders Clinic: Phenomenology and Correlates

To examine the demographics and phenomenology of psychosis in a sample of children and adolescents referred to a mood and anxiety disorders clinic. Patients (N = 2,031) were assessed with the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present Episode version and classified as definite, probable, or nonpsychotic. Clinical and demographic characteristics of the groups were compared,and symptoms of psychosis were analyzed using factor analysis. Definite psychotic symptoms were seen in approximately 90 (4.5%) patients: 80% of these reported hallucinations (mainly auditory), 22% delusions, and 3.3% thought disorder. Of the patients with definite psychotic symptoms, 24% had bipolar disorder, 41% had major depression, 21% had subsyndromal depression, and 14% had schizophrenia spectrum disorders (schizophrenia and schizoaffective disorders). Factor analysis of the definite psychotic symptoms yielded 4 factors: hallucinations, thought disorder, delusions, and manic thought disorder. Psychotic patients had a higher frequency of comorbid disorders and suicidal ideation than nonpsychotic patients. Outpatient youngsters with mood disorders frequently present with psychotic symptoms, in particular auditory hallucinations. These patients commonly have comorbid psychiatric disorders and suicidal ideation.

39-172 - Clinical characteristics and phenomenology of psychosis in postpartum

39-172 - Clinical characteristics and phenomenology of psychosis in postpartum

Phenomenology of psychosis

The tension between two fundamentally different approaches to characterizing and treating psychopathology has increased during the last year. These are the traditional diagnostic-category approach and the symptom dimensional approach. Progress made in the symptom-dimensional approach has reached the