The Community Assessment of Psychic Experiences-Positive scale (CAPE-P15) accurately classifies and differentiates psychotic experience levels in adolescents from the general population

Background There is increasing interest in studying psychotic symptoms in non-clinical populations, with the Community Assessment of Psychic Experiences-Positive scale (CAPE-P15) being one of the self-screening questionnaires used most commonly for this purpose. Further research is needed to evaluate the ability of the scale to accurately identify and classify positive psychotic experiences (PE) in the general population. Aim To provide psychometric evidence about the accuracy of the CAPE-P15 for detecting PE in a sample of Chilean adolescents from the general population and classifying them according to their PE severity levels. Method We administered the CAPE-P15 to a general sample of 1594 students aged 12 to 19. Based on Item Response Theory (IRT), we tested the accuracy of the instrument using two main parameters: difficulty and discrimination power of the 15 items. Results We found that the scale provides very accurate information about PE, particularly for high PE levels. The items with the highest capability to determine the presence of the latent trait were those assessing perceptual anomalies (auditory and visual hallucinations), bizarre experiences (a double has taken the place of others; being controlled by external forces), and persecutory ideation (conspiracy against me). Conclusions The CAPE-P15 is an accurate and suitable tool to screen PE and to accurately classify and differentiate PE levels in adolescents from the general population. Further research is needed to better understand how maladaptive psychological mechanisms influence relationships between PE and suicidal ideation (SI) in the general population.

LSD, madness and healing: Mystical experiences as possible link between psychosis model and therapy model

Background For a century, psychedelics have been investigated as models of psychosis for demonstrating phenomenological similarities with psychotic experiences and as therapeutic models for treating depression, anxiety, and substance use disorders. This study sought to explore this paradoxical relationship connecting key parameters of the psychotic experience, psychotherapy, and psychedelic experience. Methods In a randomized, double-blind, placebo-controlled, crossover design, 24 healthy volunteers received 50 μg d-lysergic acid diethylamide (LSD) or inactive placebo. Psychotic experience was assessed by aberrant salience (Aberrant Salience Inventory, ASI), therapeutic potential by suggestibility (Creative Imagination Scale, CIS) and mindfulness (Five Facet Mindfulness Questionnaire, FFMQ; Mindful Attention Awareness Scale, MAAS; Experiences Questionnaire, EQ), and psychedelic experience by four questionnaires (Altered State of Consciousness Questionnaire, ASC; Mystical Experiences Questionnaire, MEQ; Challenging Experiences Questionnaire, CEQ; Ego-Dissolution Inventory, EDI). Relationships between LSD-induced effects were examined. Results LSD induced psychedelic experiences, including alteration of consciousness, mystical experiences, ego-dissolution, and mildly challenging experiences, increased aberrant salience and suggestibility, but not mindfulness. LSD-induced aberrant salience correlated highly with complex imagery, mystical experiences, and ego-dissolution. LSD-induced suggestibility correlated with no other effects. Individual mindfulness changes correlated with aspects of aberrant salience and psychedelic experience. Conclusions The LSD state resembles a psychotic experience and offers a tool for healing. The link between psychosis model and therapeutic model seems to lie in mystical experiences. The results point to the importance of meaning attribution for the LSD psychosis model and indicate that psychedelic-assisted therapy might benefit from therapeutic suggestions fostering mystical experiences.

Working in the woodlands: a mixed methods evaluation of Green Care in first episode psychosis

AimsRecognition of the essential role of nature-based activities for general wellbeing is expanding. Previous evaluation of nature-based activities has shown that those with greater mental health needs may benefit proportionally more compared to the general population. Currently, there is limited evidence of the benefits of green care for those with severe and enduring mental illness, including psychosis.We aim to establish benefits and difficulties encountered during a 10-session green care programme for 18-30 year olds who have experienced first episode of psychosis (FEP) using a mixed methods approach.MethodThis was a service evaluation of the Woodland Group, run by Circle of Life Rediscovery (CLR) and commissioned by Sussex Partnership NHS Foundation Trust in Autumn 2019 for 10 half-day sessions. All participants were aged 18–30 years, referred from Early Intervention in Psychosis service and had experienced FEP. Patients were supported by EIS staff with a ratio of at least 3:1. Sessions consisted of a welcome and agenda setting, ice-breaking activity, core nature-based activity (such as roasting chestnuts, maintaining the woodland area) and a ‘sense meditation’.Quantitative data for this evaluation were collected through routinely collected 15-item Questionnaire on the Process of Recovery (QPR), and a semi-structured intervention experience questionnaire. Qualitative data were collected via a focus group within the final session of the Woodlands Group. Thematic analysis was performed by the three co-authors.ResultSession attendance ranged between 3-15. 4/8 patients showed reliable improvement on QPR outcome measures, 1 showed deterioration and 3 showed no change. Mean QPR scores showed modest increase from average 3.4 (week 1) to 3.8 (week 10). 100% of respondents would recommend this group to others. Thematic analysis identified themes of connection with nature and others, development of a sense of wellbeing and ‘peacefulness’ and new perspectives on psychotic experience.ConclusionThis small, retrospective evaluation is the first to investigate green care interventions for young people experiencing FEP. Our results reflect the positive informal feedback from participants and supporting staff following attendance at the Woodlands Group. Limitations include small sample size, incomplete data, and reliance on patient-reported outcomes. These findings show promise for green care activities within EIS and represents a sustainable intervention in mental health care.

Dissociachotic: Seeing the Nonpsychosis We Share

The potential for growth within a relationship between individuals experiencing “psychotic” and “nonpsychotic” realities in based in acceptance of a shared human vulnerability. Through the human-to-human relationship, acceptance of the mutual experience of ontological insecurity and fear of nihilation can facilitate the emergence of a “nonpsychotic” reality. Interconnectedness, that occurs through the process of growth within a loving, nongoal–orientated relationship, leads to a negation of the need for an altered state to exist to defend the threat of nihilation in the person experiencing “psychosis,” and the person in a “nonpsychotic” state to resist the attempt to change the legitimate reality the other person is experiencing. The ensuing changes to the liminal space occupied by a person said to be in a “psychotic” state, when being together in a coexisting same experience, can lead to mutual growth and the evaporation of the so labelled “psychotic” state. This demonstrates the “psychotic” experience is more consistent with a dissociative response to threat in relationship and could be reframed as a “Dissociachotic”—a form of dissociation that has been mislabelled as a unique condition of “psychosis” due to its specific representation of creating safety for a person experiencing threat in relationship.

Health Conditions and Psychotic Experiences: Cross-Sectional Findings From the American Life Panel

Background: People with psychotic disorders have poor health, but studies have shown that people who have a milder and more prevalent form of psychosis (psychotic experiences) are also at risk for health problems. More research is needed to examine a broad range of health conditions to discover new relations with psychotic experiences.Methods: We analyzed cross-sectional data from the American Life Panel, a nationally representative sample of the United States adult population. Using multivariable logistic regression, we examined the associations between health conditions (categories of conditions, specific conditions, count of conditions) and lifetime psychotic experiences.Results: Approximately 71% of the weighted sample reported at least one health condition, and around 18% reported a lifetime psychotic experience. Using multivariable logistic regression, we found that several health conditions were associated with psychotic experiences, including pain due to other causes, neck pain, other injury, any gastrointestinal/kidney problem, liver diseases/cirrhosis, any nervous/sensory problem, migraine, nerve problem causing numbness/pain, any other disorder, specifically sleep disorder, chronic fatigue syndrome, and chronic pain. Further, the count of specific health conditions and the count of categories were associated with greater odds of psychotic experiences.Conclusion: We found that numerous health conditions were associated with psychotic experiences.

Transliminality: Comparing Mystical and Psychotic Experiences on Psycho-Phenomenological Grounds

On a phenomenal level, no differences between the mystical and the initial sequence of psychotic experience are to be found. Both are characterized by transliminality (i.e., an experience of consciousness transcending both the psychophysical and the rational realms). However, the situation is different if we integrate psychodynamic implications before and after those experiences into the comparison. One difference on this level is that the mystical experience (if it meets sufficient ego stability) primarily offers personality-strengthening potential. In contrast, transliminality, which occurs in the course of psychotic experience (if it encounters insufficient ego-stability or a pronounced vulnerability), primarily offers personality-weakening potential. However, if the therapeutic process succeeds in setting ego-stabilizing impulses (or eliminating thought and affect disorders which are typical for psychoses of the schizophrenic spectrum), a conscious incorporation of the transliminal experience into the further therapeutic process proves to be helpful, too. The essential philosophical and therapeutic significance of the connections analyzed here are reflected on with the help of philosophical and psycho(patho)logical phenomenology, in particular with the writings of Husserl’s and Pfänder’s pupil Gerda Walther, combined with current theorems of responsive phenomenology. Walther’s insights into the (dys-)functionalities of ego-center (“Ichzentrum”), self (“Einbettung des Ichzentrums”), and basic essence (“Grundwesen”) in mystical and psychotic experience, with respect to their (meta-)transcendental relationship with divine essence (“göttlicher Wesensgrund”) provoke further research questions on the constitutive and therapeutic implications of transliminality in the context of mystical and psychotic experience.