Neuroleptic Medication and the Psychosocial Treatment of Psychotic Symptoms: Some Neglected Issues

2019 ◽  
pp. 235-264
Author(s):  
Jennifer C. Day ◽  
Richard P. Bentall
Keyword(s):  
Psychosocial Treatment ◽  
Psychotic Symptoms ◽  
Neuroleptic Medication

scholarly journals Experiences of taking neuroleptic medication and impacts on symptoms, sense of self and agency: a systematic review and thematic synthesis of qualitative data

2019 ◽  
Vol 55 (2) ◽  
pp. 151-164 ◽  
Author(s):  
Jemima Thompson ◽  
Jacki L. Stansfeld ◽  
Ruth E. Cooper ◽  
Nicola Morant ◽  
Nadia E. Crellin ◽  
...  
Keyword(s):  
Qualitative Data ◽  
Sense Of Self ◽  
Psychotic Symptoms ◽  
Neuroleptic Medication ◽  
Thematic Synthesis ◽  
Beneficial Effects ◽  
Loss Of Autonomy ◽  
Cognitive Slowing ◽  
Qualitative Literature

Abstract Purpose Neuroleptic (antipsychotic) drugs reduce psychotic symptoms, but how they achieve these effects and how the drugs’ effects are experienced by people who take them are less well understood. The present study describes a synthesis of qualitative data about mental and behavioural alterations associated with taking neuroleptics and how these interact with symptoms of psychosis and people’s sense of self and agency. Methods Nine databases were searched to identify qualitative literature concerning experiences of taking neuroleptic medication. A thematic synthesis was conducted. Results Neuroleptics were commonly experienced as producing a distinctive state of lethargy, cognitive slowing, emotional blunting and reduced motivation, which impaired functioning but also had beneficial effects on symptoms of psychosis and some other symptoms (e.g. insomnia). For some people, symptom reduction helped restore a sense of normality and autonomy, but others experienced a loss of important aspects of their personality. Across studies, many people adopted a passive stance towards long-term medication, expressing a sense of resignation, endurance or loss of autonomy. Conclusions Neuroleptic drugs modify cognition, emotions and motivation. These effects may be associated with reducing the intensity and impact of symptoms, but also affect people’s sense of self and agency. Understanding how the effects of neuroleptics are experienced by those who take them is important in developing a more collaborative approach to drug treatment in psychosis and schizophrenia.

Transient Recurrence of Auditory Hallucinations During Acute Dystonia

1989 ◽  
Vol 155 (1) ◽  
pp. 110-113 ◽  
Author(s):  
Leo P. W. Chiu
Keyword(s):  
Auditory Hallucinations ◽  
Psychotic Symptoms ◽  
Neuroleptic Medication ◽  
Dopaminergic Neurotransmission ◽  
Acute Dystonia ◽  
Schizophrenic Patients

Three schizophrenic patients who had transient recurrence of auditory hallucinations during acute dystonia precipitated by neuroleptic medication are reported. If it is accepted that psychotic symptoms result from dopaminergic overactivity, such phenomena suggest that acute dystonia might also have been caused by increased dopaminergic neurotransmission in these cases.

Psychotic Symptoms Preceding Ocular Deviation in a Patient with Tardive Oculogyric Crises

1992 ◽  
Vol 26 (4) ◽  
pp. 666-670 ◽  
Author(s):  
Perminder Sachdev ◽  
Wai Mun Tang
Keyword(s):  
Side Effect ◽  
Psychotic Symptoms ◽  
Anticholinergic Medication ◽  
Neuroleptic Medication ◽  
Ocular Deviation ◽  
Stereotypic Behaviour ◽  
Practical Implications

This report describes a patient with schizophrenia who developed episodes of ocular dystonia as a delayed side effect of neuroleptic medication. Each episode was preceded and accompanied by marked agitation, stereotypic behaviour and exacerbation of hallucinations. Both the psychotic and dystonic symptoms responded to anticholinergic medication. The theoretical and practical implications of this observation are discussed.

scholarly journals Substance misuse, psychiatric disorder and violent and disturbed behaviour

2000 ◽  
Vol 176 (4) ◽  
pp. 345-350 ◽  
Author(s):  
Michael Soyka
Keyword(s):  
Substance Misuse ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Epidemiological Studies ◽  
Male Gender ◽  
Psychosocial Treatment ◽  
Psychotic Symptoms ◽  
Future Research ◽  
Birth Cohorts ◽  
Increased Risk

BackgroundEpidemiological studies suggest schizophrenia and substance misuse to be associated with a higher rate of violence and crime.AimsThe literature was evaluated to assess whether people with schizophrenia who use substances have an increased risk for violence and disturbed behaviour.MethodA detailed Medline analysis was performed and relevant studies were reviewed.ResultsA large number of studies have linked substance misuse in schizophrenia with male gender, high incidence of homelessness, more pronounced psychotic symptoms, non-adherence with medication, poor prognosis, violence and aggression. The latter has been proved by clinical, epidemiological and longitudinal prospective studies of unselected birth cohorts. The increased risk for aggression and violent acts cannot be interpreted only as a result of poor social integration. Male gender, more severe psychopathology, a primary antisocial personality, repeated intoxications and non-adherence with treatment are important confounding variables.ConclusionSubstance misuse has been shown consistently to be a significant risk factor for violence and disturbed behaviour. Future research should try to evaluate possible pharmacological and psychosocial treatment approaches.

Plasma homovanillic acid, noradrenaline and psychotic symptoms in chronically medicated schizophrenic in patients

2001 ◽  
Vol 13 (2) ◽  
pp. 49-52
Author(s):  
Y. Kaneda ◽  
A. Fujii
Keyword(s):  
Informed Consent ◽  
Patient Group ◽  
Homovanillic Acid ◽  
Psychiatric Symptoms ◽  
Chronic Schizophrenia ◽  
Normal Subjects ◽  
Psychotic Symptoms ◽  
Neuroleptic Medication ◽  
Dsm Iv

SummaryObjective:The authors investigated plasma homovanillic acid (HVA) levels and noradrenaline (NA) in chronically medicated schizophrenic inpatients.Methods:The subjects were 55 inpatients who were diagnosed according to the DSM-IV criteria for schizophrenia. Nine normal subjects were compared to the patient group. Each patient gave informed consent for the research involved in this study. Psychiatric symptoms were assessed using the BPRS.Results:(1) The medicated schizophrenic inpatients had significantly greater plasma NA levels, and higher but nonsignificant plasma HVA levels than the normal subjects.(2) In patients, there was a positive but nonsignificant correlation between the plasma NA levels and positive symptomatology. In contrast, plasma HVA levels were not correlated with either positive or negative symptomatology.Conclusion:On the basis of these results, we hypothesize that, mainly because of their catecholaminergic dysfunction, there is an increase in plasma NA and a tendency for increased plasma HVA in patients with chronic schizophrenia, regardless of long-term neuroleptic medication.

scholarly journals Distress related to attenuated psychotic symptoms: Static and dynamic association with transition to psychosis, non-remission and transdiagnostic symptomatology in clinical high-risk patients in an international intervention trial

2020 ◽  
Author(s):  
B Nelson ◽  
H P Yuen ◽  
G P Amminger ◽  
G Berger ◽  
E Y H Chen ◽  
...  
Keyword(s):  
High Risk ◽  
Cognitive Style ◽  
Attributional Style ◽  
Dynamic Change ◽  
Secondary Analysis ◽  
Positive Association ◽  
Psychosocial Treatment ◽  
Psychotic Symptoms ◽  
Omega 3 ◽  
Significant Positive Association

Abstract This study examined whether distress in relation to attenuated psychotic symptoms (DAPS) is associated with clinical outcomes in an ultra-high-risk (UHR) for psychosis sample. We also investigated whether DAPS is associated with cognitive style (attributional style and cognitive biases) and whether amount of psychosocial treatment provided is associated with reduction in DAPS. The study was a secondary analysis of the ‘Neurapro’ clinical trial of omega-3 fatty acids. 304 UHR patients were recruited across ten early intervention services. Data from baseline assessment, regular assessments over 12 months and medium term follow up (mean=3.4 years) were used for analysis. Findings indicated: a positive association between DAPS assessed over time and transition to psychosis; a significant positive association between baseline and longitudinal DAPS and transdiagnostic clinical and functional outcomes; a significant positive association between baseline and longitudinal DAPS and non-remission of UHR status. There was no relationship between severity of DAPS and cognitive style. A greater amount of psychosocial treatment (cognitive-behavioural case management) was associated with an increase in DAPS scores. The study indicates that UHR patients who are more distressed by their attenuated psychotic symptoms are more likely to have a poorer clinical trajectory transdiagnostically. Assessment of DAPS may therefore function as a useful marker of risk for a range of poor outcomes. The findings underline the value of repeated assessment of variables and incorporation of dynamic change into predictive modelling. More research is required into mechanisms driving distress associated with symptoms and the possible bidirectional relationship between symptom severity and associated distress.

scholarly journals Out-patients' perceptions of the clinical and psychosocial effects of neuroleptic medication

1990 ◽  
Vol 14 (6) ◽  
pp. 331-332 ◽  
Author(s):  
Tom Chapman ◽  
Eric Mulvihill
Keyword(s):  
Side Effects ◽  
Clinical Effectiveness ◽  
Psychotic Symptoms ◽  
Psychosocial Effects ◽  
Neuroleptic Medication ◽  
Wide Range ◽  
Prevention Of Relapse

While research into the effectiveness of neuroleptic medication consistently demonstrates its value in improving psychotic symptoms, and in the prevention of relapse, the treatment continues to generate controversy. Indeed, McClelland (1989) has recently asserted that this treatment of choice is “an indispensable evil”; “indispensable” by virtue of its clinical effectiveness, and “evil” because of the wide range of adverse and distressing side effects experienced by patients.

Borderline personality disorder

2015 ◽  
Author(s):  
Anthony W. Bateman ◽  
Roy Krawitz
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Borderline Personality ◽  
Psychosocial Treatment ◽  
Psychotic Symptoms ◽  
Sociocultural Factors ◽  
History Of ◽  
Self Harm ◽  
Vulnerability Theory

Chapter 1 outlines borderline personality disorder (BPD), the history of BPD, its epidemiology, diagnosis and a thorough discussion of the elements of the DSM-IV-TR diagnostic criteria for BPD, and explores individual factors to help understand a person’s BPD (biological vulnerability theory, emotional sensitivity, mentalizing vulnerability, Beck’s core schemas, dichotomous (all or nothing) thinking, fluctuating competence, active passivity), and co-occurring conditions (depression, bipolar disorder, psychotic symptoms, dissociation, personality disorders). The chapter also discusses etiology (biological factors, psychological factors, nature and nurture, sociocultural factors), self-harm, prognosis, and psychosocial treatment outcome studies.

Clinical Management of Psychotic Disorders

2020 ◽  
Author(s):  
Eric Epping
Keyword(s):  
Side Effects ◽  
Psychotic Disorders ◽  
Multidisciplinary Treatment ◽  
Skills Training ◽  
Psychosocial Treatment ◽  
Mental Illnesses ◽  
Community Treatment ◽  
Psychotic Symptoms ◽  
Psychiatric Evaluation ◽  
Short Term

Psychotic disorders constitute a spectrum of mental illnesses that include symptoms of hallucinations, delusions, and/or disorganized thinking and behavior. Although some psychoses are short-term and reversible conditions, schizophrenia is the prototypical illness, which often develops in young adulthood and is typically chronic in its course. A complete medical and psychiatric evaluation is necessary to evaluate patients presenting with psychotic symptoms and to differentiate primary from secondary causes. Treatment of psychosis includes treatment of identifiable causal conditions, acute management of potentially harmful behaviors, prescribing antipsychotic medication, and psychotherapeutic and psychosocial interventions. A variety of antipsychotic medications are available for treatment, which must be individualized to maximize symptom reduction and to minimize short-term and long-term side effects. Long-acting injectable medications are available to improve medication adherence. In some cases, medications to counteract side effects may need to be prescribed. In more severe cases, electroconvulsive therapy may be indicated. Psychotherapy such as cognitive-behavioral therapy can reduce the severity of hallucinations and delusions. Integrated care that also includes family psychoeducation, skills training, and/or assertive community treatment is an essential part of a comprehensive multidisciplinary treatment program for the management of patients with psychotic disorders.   This review contains 5 Figures, 10 tables, and 33 references. Key words: antipsychotic, dopamine, psychosis, psychosocial treatment, schizophrenia serotonin

‘Psychosocial’ interventions with families and their effects on the course of schizophrenia: a review

1984 ◽  
Vol 14 (3) ◽  
pp. 629-642 ◽  
Author(s):  
Christine Barrowclough ◽  
Nicholas Tarrier
Keyword(s):  
Positive Result ◽  
Social Factors ◽  
Psychosocial Intervention ◽  
Expressed Emotion ◽  
Psychosocial Interventions ◽  
Psychosocial Treatment ◽  
Neuroleptic Medication ◽  
Treatment Regimes ◽  
Recent Interest ◽  
Discharge From Hospital

SynopsisRecent interest in the way social factors influence the course of schizophrenia has led to attempts to monitor and manipulate these factors. The work on the Expressed Emotion of the relative has been especially influential in this area. A number of studies have now been conducted in which a psychosocial intervention has been employed in an attempt to prevent relapse after discharge from hospital. These studies are reviewed with an emphasis on their methodological adequacy and on the nature of the intervention used. Recent studies have demonstrated a positive result for psychosocial interventions used in combination with neuroleptic medication. However, analysis of these studies does not allow us to conclude that we can identify the ‘active ingredients’ in these psychosocial treatment regimes. Although there is cause for optimism, further investigation is required.

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