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Preface
Preface to the English edition
PART I: The psychotic crisis and the schizophrenic disability
1. Reason -- a thin veil over chaos
Regression in the service of the ego
Fantasy and play The intimate relationship Sexuality Religion Magical thinking Intoxication
Normal vs abnormal thinking -- there is a grey area to protect
Summary
2. Losing contact with reality
Six experiences, six diagnoses
'A mental rape' On the loss of the good childhood Telepathy, thought-control and voices in the wind On developmental regression Arteriosclerosis and confusion at night On the other side of 'The Doors of Perception'
Can we understand the development of psychosis?
Summary
3. The concept of psychosis, delusions and hallucinations
The concept of psychosis
Misinterpretations
Delusions
Scope Contents Degree of bizarre thinking Schizophrenic delusions Delusional psychosis as a waking nightmare
Hallucinations
1. Vocal hallucinations 2. Visual hallucinations 3. Tactile hallucinations 4. Olfactory hallucinations and hallucinations of taste
Summary
4. The ego, the self and psychosis
The ego and the self
The self-object differentiation Object constancy
Acute psychosis as a suspension of a 'you' relationship
Summary
5. Phases of acute psychoses -- a crisis model
A. Prodromal phase
B. Pre-psychosis
C. Psychosis -- early phase
D. Psychosis -- late phase
E. Post psychotic phase -- new orientation
Summary
6. Neuro-biological vulnerability factors
From a model of illness to a stress-vulnerability model
A. Genetic vulnerability factors
The spectrum of schizophrenia One gene or many genes? The dopamine hypothesis Types of personality and vulnerability for psychosis Affective vulnerability
B. Neural developmental disorders
The hypofrontality theory Early abnormalities in childhood development Pathology in the structure of the cells Pregnancy and birth complications as risk factors The phospholipid hypothesis Are brain damage findings specific to schizophrenia?
Summary
7. Psychodynamic vulnerability factors
Early trauma and problems in growing up
Theories of vulnerability and personality development -- neuro-psychodynamic
Personality disorders
Personality disorders and psychosis Narcissistic personality Is alexithymia a vulnerability factor for psychosis?
Family structure and schizophrenia
'Expressed emotion' (EE)
A comprehensive neuro-dynamic model of psychotic vulnerability
8. Factors which trigger psychosis
Psychological stress and vulnerability
Stress or crisis?
Non-specific stressors which trigger psychosis
Lack of sleep Isolation Somatic disturbances or dysfunction The influence of alcohol, drugs and poison Other causes
Specific triggering situations of psychosis and conflict
Developmental and transitional crises Loss and separation 'Unresolvable' conflicts Major depression Narcissistic injury
Summary
9. Protective factors
Psychosocial protective factors
1. A functioning network 2. Meaningful employment or creative activities 3. Experiences of coherence and meaning
Summary
10. Psychotic disorders I
The first episode psychosis -- three clinical types
Diagnosing the psychotic syndromes
Brief psychotic disorder
Affective psychosis
The delusional disorder
Psychotic disorder not otherwise specified
Dissociative (hysterical) 'psychoses'
11. Psychotic disorders II: schizophrenia -- the sickness of the self
The historical development of the concept of schizophrenia
Dementia praecox versus affective disorders ('The Kraepelinian School') Fundamental symptoms ('The Bleuler School') Basic symptoms ('The Phenomenological School') Positive and negative symptoms Schizophrenia spectrum disorders and schizotypal personality disorder Schizophrenia as state and trait-phenomenon Schizophrenia as an illness or as a functional disability
Schizophrenic syndromes
Epidemology Symptoms Subgroups Stages in the development of a schizophrenic psychosis
Schizophreniform disorder
Schizo-affective disorder - cycloid psychosis
Conclusion
12. Autism spectrum disorders and childhood psychoses
Key features of the autistic syndrome
Epidemiology and aetiology
Asperger's syndrome
Epidemiology
Schizophrenia in children and other psychoses
13. Delirium, confusion, organic psychosis
Characteristic symptoms of delirium according to DSM-IV and
ICD-10
Causes of confusional states
Common confusional states in hospitals
The boundary between confusion and psychosis
14. The two critical periods in psychosis and the potential for recovery
The first critical period: prodromal symptoms and untreated psychosis
The second critical period: the recovery process -- rebuilding hope
What needs to be healed? Requirements in treatment 1. 'The low turning point' 2. 'Woodshedding' 3. A Fluctuating course
15. Cognitive functional disorders and the psychotic thought process
What is a thought disorder?
State- and trait-phenomena
Neuro-cognition and schizophrenia
Are cognitive disorders primary or secondary?
Schizophrenic thought disorders
The 'concrete' attitude The difference between schizophrenic and traumatic brain damage To 'de-symbolise the metaphors' Lack of 'theory of mind' A semiotic theory Thinking with fractals
Summary
16. The construction of the identity of a 'chronic schizophrenic'
Factors which hinder recovery
PTSD and post psychotic depression Prescribing pitfalls The process of stigmatisation Institutional treatment
A strategy against mental pain?
The autistic defence 'Negative symptoms'
Summary
17. Towards a bio-psycho-social model of psychoses
A model for the ego's reality integrating function
The self's psychotic construction of reality
Is it possible to influence the psychotic development psychologically?
Anti-psychotic medication primarily inhibits receptors rather than psychosis
Summary
PART II: In support of recovery
18. Traditions of thought in the history of psychiatric ideas
A magical-demonic way of thinking and the need for hope
The teachings of the four humours and psycho-pharmacological treatment
Plato's theory of the passions and the psychoanalytic theory of the unconscious
The questionings of the enlightenment and the radical criticism of psychiatry
19. Attitudes in 20th century treatment of psychosis
The first decades: Keeping and guarding
1930 -- 1960: The era of 'heroic treatments'
Inducing fever as a form of treatment Insulin coma Lobotomy Convulsive treatment: From cardiazol to ECT Sterilisation
The last fifty years -- neuroleptics, social psychiatry and psychotherapy
'Anti-psychiatry' Social psychiatry and neuroleptics facilitate the discharge of people from hospital 'The therapeutic community' The new psycho-pharmacology When the cure is worse than the condition Psychoanalysis and psychotherapy
Democratisation and public control
20. The requirements, demands and organisation of treatment for psychosis
On being admitted to an emergency psychiatric ward -- through a patient's eyes
Counter-productive aspects of current hospital care
A functioning care organisation
The nature and treatment of acute psychosis
21. The assessment and treatment of patients with an acute psychotic episode
The need-adapted care of psychosis
1. Providing immediate help 2. Crisis intervention: family meetings and formulating the problem 3. Continuity and accessibility 4. A lowest optimal neuroleptic dose 5. Suitable over night care
Diagnostic formulation and investigations
Sub-specialist team for first episode psychosis
The Soteria projects EPPIC The Parachute project The OPUS trial
Late phase of psychosis -- supporting the healthy part of the personality
The recovery phase -- to strengthen the ego and reduce vulnerability
When the patient is free from psychosis Persistent psychotic symptoms
22. Psychosis and suicide
Incidence
Suicidality during the development of psychosis
Suicidal acts among patients suffering from schizophrenia
Working with patients at high risk of suicide -- ethical problems
What does it meant to 'do the best you can'?
The emotional needs of the staff -- the importance of protection against 'burn out'
23. People with long term psychosis in the community
The Wisconsin project
From the principle of care for the ill to the principle of normalisation
Personal 'ombudsman' (representative)
Supported accommodation
When a person is unable to care for themselves at home Reactions of local residents to a new residential home
The problem of substance misuse -- a dual diagnosis
24. Pharmacological treatment of psychosis
Receptor pharmacology
Anti-psychotic medication
Neuroleptics that block dopamine Serotonin blocking 'atypical' neuroleptics Methods of administration Dose-effect studies...Direct effects of neuroleptics The anti-psychotic effect: Does the inhibition of receptors provide a psychological 'breathing space'? The treatment of extra pyramidal symptoms
Sedating and sleep inducing drugs
Anti-depressant medication and treatment with lithium
Summary of directives for the pharmacological treatment of psychosis
25. Psychological treatments of psychosis
The psychoanalytical tradition
The cognitive-behavioural therapeutic tradition (CBT)
Towards a synthesis of dynamic psychology and cognitive methods
Residential homes offering psychotherapeutic care
Art therapy
Knowledge of the body and physiotherapy
Family meetings, family therapy and psychoeducation
26. Preventing psychosis
Primary prevention -- to forestall the occurrence of an illness
Secondary prevention -- to obtain effective assistance early on during the onset of the illness
Ethical aspects Early intervention with first episode psychosis
Tertiary prevention -- to reduce the handicap derived from the psychotic illness
27. On being a relative
The adult relative or sibling
The 'over-involved' parent
On being the child of a mentally ill parent
Epilogue
Appendix: classification
ICD-10 and DSM-IV
Psychoses in relation to other mental disorders
An overview and comparison between the classification systems for psychosis in DSM-IV and ICD-10
Library of Congress Subject Headings for this publication:
Psychoses.