Interview with Dr Juliana Onwumere, lead educator for FutureLearn’s new course ‘Caring for People with Psychosis and Schizophrenia’ (starting 12 October). Juliana is a Lecturer at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London and Consultant Clinical Psychologist with the National Psychosis Unit, South London & Maudsley NHS Trust, UK.
What is psychosis, and how does it differ, as a medical condition, from popular perceptions of what it is?
Let’s be clear, psychosis is not about having a split personality, being lazy, lacking in intellectual capabilities, or being poor. Sadly, these are some of the common myths or negative stereotypes surrounding the condition. Psychosis is actually a very broad term used to describe a range of conditions affecting the mind, which can interfere with how a person thinks, feels and behaves. So, in psychosis, individuals may experience hallucinations (e.g. hearing voices, seeing images), have delusional beliefs about events, people and situations (e.g. belief of being persecuted by a secret organization), and difficulties in organising their thoughts and expressing themselves in a clear fashion.
Psychosis will be a core part of severe mental health problems and have different names such as schizophrenia, schizoaffective disorder, and psychotic depression. The exact name used can change over time and will depend upon lots of other factors such as the length of time that someone has had their difficulties for.
It is important to note that psychosis symptoms such as hallucinations, can also be found in other conditions affecting the body and mind; for example, dementia.
How many people have psychosis, and how well is it diagnosed? Is there much chance of mis-diagnosing psychosis?
Psychosis can affect anyone and approximately 3 in every 100 people during their lifetime will experience an episode of psychosis. If we look at specific conditions, some of the recent figures suggest that over 26 million people worldwide will be living with a diagnosis of schizophrenia.
An episode of psychosis will be diagnosed by a medical practitioner with specific training and expertise in mental health. This will commonly be a psychiatrist. There are lots of examples of good service initiatives in different areas such as the United Kingdom, Canada and Australia that have been designed to support the timely identification of individuals experiencing their very first episode of psychosis or at very high risk of developing psychosis. The presentation of individuals can change over time which can therefore also mean that the exact name or diagnosis they receive may also change.
What do we know about what causes psychoses? Is it just caused by genes?
We are learning a lot about causes and no, it is not just caused by genes.
Psychosis normally first starts in younger people often during adolescence and young adulthood. For many, this may be a period when a young person is going through significant life changes; for example, embarking upon a new relationship or going to college. Several different factors have now been identified as playing a key role in increasing the risk of developing psychosis and/or psychosis-like experiences, particularly in individuals who might already have a vulnerability. Some of these factors can include a history of trauma (e.g. the experience of being bullied and victimized), drug use (e.g. cannabis), and/or stressors commonly linked to everyday busy lifestyles.
Research on many of these factors remains ongoing but the bulk of evidence suggests that psychosis is unlikely to be attributed to any one single cause. The causes are likely to be due to a number of issues that can include genetics and biochemistry and psychological and social factors. The exact importance of any these factors will vary from one person to another.
What are the main treatments for psychosis? Can you ever recover?
Across the globe, medication will be one of the most common forms of treatment offered. Psychological therapies designed to support an individual with psychosis (and their families) to make sense of their experiences, work towards their life goals, and develop helpful coping strategies can also be common approach in some areas. Individuals with psychosis may be offered help in improving their everyday living skills (e.g. cooking) that may have been negatively affected as part of their difficulties.
To improve or recover can be an individual perspective and therefore mean different things to different people. If we put the exact ‘recovery’ definitions to one side, we do know that people with psychosis often improve with right support and right treatments to meet their needs. For example, following treatments individuals affected by psychosis might find that they are able to think more clearly and their unusual experiences decrease and/or become less bothersome and distressing. We also know that for some individuals, the amount of improvements they make and the pace of change might be slower than they or their relatives imagined and hoped for. Improvements might not always mean a return to the period before their difficulties first started.
Can those suffering from psychosis understand that they have it? If I had a psychosis, how would I know?
The extent to which an individual with psychosis may understand, believe or agree that they are experiencing difficulties will differ from one person to another. Some of the core features of psychosis will often mean that it is difficult for someone to be aware of how their experiences may be different from the reality of others around them. However, there will also be some people who will be able to report on their experiences; for example, “I was hearing lots of voices today”.
Self-diagnoses are rarely helpful with psychosis. If someone was concerned about the type of thoughts they were having, their moods and behaviours, it can helpful to speak to their general practitioner. It seems important to note that individual symptoms of hallucinations and delusional type beliefs are also commonly found within the general population and in themselves does not mean that someone has a mental health problem.
How can I help loved ones who have psychoses?
There are so many different ways to answer to this question but I think the best will be, it depends on your relative and their specific needs. The type of support a relative might require will vary over time and perhaps with different people. Sometimes the very simple things that we do can also serve as being the most helpful. Therefore, if you are relative of someone living with a psychosis condition, exploring opportunities to learn a little more about the conditions and talking to other people can be helpful. As part of this help, it is important to remember to also look after your own needs too. Our 2-week free online course ‘Caring for People with Psychosis and Schizophrenia’ starting on October 12 will explore the key issues related to caring for a relative with psychosis or schizophrenia.
What are the latest trends in research or our scientific understanding of psychoses?
I think developments in how we understand the different factors that can lead to psychosis; for example, the contribution of cannabis, the role of trauma, and how brain chemistry in terms of the glutamate neurotransmitter can impact. These developments are in the context of novel and innovative treatment approaches designed to target physical health and sleep outcomes.
What will I learn or be able to do as a result of taking this course?
The course is designed to explore some of the key issues facing those who may know or care for someone with psychosis conditions. It aims to provide an in-depth understanding of psychosis and its key symptoms such as hearing voices; links between cannabis use and developing psychosis; psychosis and physical health; medications and their effects, and carer needs including those of siblings. Some recent comments from learners involved in testing the course before its official start in October have included:
- I was also thinking about how it could be a great resource for carers groups where people can do it together and have discussions in person.
- I think that this course could be usefully used not just by carers but also for people who work with clients with psychosis.
Are there other resources I can go to, in the UK or elsewhere, to learn more and get support?
There are several national resources that will be relevant for the country that you are in. In the UK for example, some of the key resources and organisation are:
Mental Health Care: www.mentalhealthcare.org.uk
Rethink Mental Illness http://www.rethink.org
Mental Health Foundation http://www.mentalhealth.org.uk/
Royal College of Psychiatrists www.rcpsych.ac.uk
British Psychological Society: Understanding Psychosis and Schizophrenia https://www.bps.org.uk/system/files/user-files/Division%20of%20Clinical%20Psychology/public/understanding_psychosis_-_final_19th_nov_2014.pdf
To find out more, join this short free online course, Caring for People with Psychosis and Schizophrenia, starting 12 October on FutureLearn.