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The Early Assessment and Support Alliance (EASA) is a community of young people who have experienced psychosis, mental health professionals, and allies. Have you or someone you know experienced psychosis? If so, you’re not alone. We're here to help.
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Hearing Voices?

Hearing voices for the first time? Seeing things that might not be there? Having unusual thoughts you didn’t used to have that are causing problems?

You might be experiencing psychosis. We’re here to help. Reach out to us at our website and we’ll refer you to the early intervention program nearest to you.

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Working across the world to spread positive and hopeful messages about the experience of hearing voices. If you hear voices, know someone who does or want to find out more about this experience - then this site is for you. Welcome to the Intervoice Website Because hearing voices is a much stigmatised experience we wanted to create a safe place where you can find out more about hearing voices and to create an interactive online community where you can let us know about your point of view or experience. We have put together the most extensive international resource on hearing voices you can find on the web. This information includes both ways of overcoming the difficulties faced by people who hear voices, as well as the more positive aspects of the experience and its cultural and historical significance. Here, you will find a very different way of thinking about the meaning of hearing voices. We understand “voices” to be real and meaningful, something that [...]
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A large U.S. survey found that users of LSD and similar drugs were no more likely to have mental-health conditions than other respondents

Data from population surveys in the United States challenge public fears that psychedelic drugs such as LSD can lead to psychosis and other mental-health conditions and to increased risk of suicide, two studies have found.

In the first study, clinical psychologists Pål-Ørjan Johansen and Teri Suzanne Krebs, both at the Norwegian University of Science and Technology in Trondheim, scoured data from the US National Survey on Drug Use and Health (NSDUH), an annual random sample of the general population, and analysed answers from more than 135,000 people who took part in surveys from 2008 to 2011.

Of those, 14% described themselves as having used at any point in their lives any of the three ‘classic’ psychedelics: LSD, psilocybin (the active ingredient in so-called magic mushrooms) and mescaline (found in the peyote and San Pedro cacti). The researchers found that individuals in this group were not at increased risk of developing 11 indicators of mental-health problems such as schizophrenia, psychosis, depression, anxiety disorders and suicide attempts. Their paper appears in the March issue of the Journal of Psychopharmacology.

The findings are likely to raise eyebrows. Fears that psychedelics can lead to psychosis date to the 1960s, with widespread reports of “acid casualties” in the mainstream news. But Krebs says that because psychotic disorders are relatively prevalent, affecting about one in 50 people, correlations can often be mistaken for causations. “Psychedelics are psychologically intense, and many people will blame anything that happens for the rest of their lives on a psychedelic experience.”

The three substances Johansen and Krebs looked at all act through the brain’s serotonin 2A receptor. The authors did not include ketamine, PCP, MDMA, fly agaric mushrooms, DMT or other drugs that fall broadly into the category of hallucinogens, because they act on other receptors and have different modes of biochemical action. Ketamine and PCP, for example, act on the NMDA receptor and are both known to be addictive and to cause severe physical harms, such as damage to the bladder.

“Absolutely, people can become addicted to drugs like ketamine or PCP, and the effects can be very destructive. We restricted our study to the ‘classic psychedelics’ to clarify the findings,” says Johansen.

The ‘acid casualty’ myth

“This study assures us that there were not widespread ‘acid casualties’ in the 1960s,” says Charles Grob, a paediatric psychiatrist at the University of California, Los Angeles. He has long has advocated the therapeutic use of psychedelics, such as administering psilocybin to treat anxiety in terminal-stage cancer. But he has concerns about Krebs and Johansen’s overall conclusions, he says, because individual cases of adverse effects use can and do occur.

For example, people may develop hallucinogen persisting perception disorder (HPPD), a ‘trip’ that never seems to end, involving incessant distortions in the visual field, shimmering lights and coloured dots. “I’ve seen a number of people with these symptoms following a psychedelic experience, and it can be a very serious condition,” says Grob.

Krebs and Johansen, however, point to studies that have found symptoms of HPPD in people who have never used psychedelics.

The second of the new two studies, also published in the Journal of Psychopharmacology, looked at 190,000 NSDUH respondents from 2008 to 2012. It also found that the classic psychedelics were not associated with adverse mental-health outcomes. In addition, it found that people who had used LSD and psilocybin had lower lifetime rates of suicidal thoughts and attempts.

“We are not claiming that no individuals have ever been harmed by psychedelics,” says author Matthew Johnson, an associate professor in the Behavioral Pharmacology Research Unit at Johns Hopkins University in Baltimore, Maryland. “Anecdotes about acid casualties can be very powerful—but these instances are rare,” he says. At the population level, he says, the data suggest that the harms of psychedelics “have been overstated”.

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Does psychosis mean that a person is more likely to be violent against others?

No.  People who experience psychosis are more likely to become fearful and withdraw.  They are not more violent than the norm, and are more likely to be victimized by others.

Although most people with untreated psychosis are more likely to be victims than to cause harm, psychosis is a high-risk condition needing treatment.

In its most acute stage, it is important for people with psychosis to be monitored closely by others until they are stabilized and begin to recover.   Hospitalization is often necessary at this stage.

Psychosis is associated with a higher risk of suicide, and any statements or actions which suggest this might be a risk for an individual should be watched closely. Psychosis by its nature removes the person’s ability to judge what is safe and what is not, and distortions in the person’s information processing may lead them to believe that situations are safe when they are not.  

For example, people experiencing acute psychosis have been known to consume poison thinking it wouldn’t harm them or jump off a roof thinking they could fly.  It is not a good idea for a person with an acute psychosis to drive, and they may at times be unsafe in traffic situations when they are walking or riding a bicycle.

There are a small number of situations where a person may be at risk of harming others, and where the need for treatment is particularly important:

a. A person who develops paranoia and a belief that a specific individual is trying to hurt them may feel the need, if they feel the threat is imminent, to act out of self protection.

b. A person who is experiencing mania (the “high” side of the bipolar cycle, where the person stops sleeping and is driven to constantly move, talk, etc.) may lose a normal sense of boundaries and may get in trouble for inappropriate behavior.  Unfortunately, a person in an acutely manic state will usually become extremely impulsive and may not recognize the existence of legal limits around issues such as inappropriate touch and trespassing.

c. A person who has a psychosis and also uses alcohol, methamphetamine, or other mood-altering chemicals, may be much more susceptible than normal to the effects of these drugs.

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“To break the stigma, we have to talk about it. I was diagnosed with major depressive disorder at 13. At age 20 I had a psychotic episode and was diagnosed with bipolar I disorder. It was terrifying. The mind and brain experience illness just like any other organ or body system, but many who suffer are shamed into silence and hide their struggle. I'm guilty of it too. Would you be ashamed to say you have diabetes? High blood pressure? Living a healthy, fulfilling life is still possible. Let's talk about it.” -Katya, survivor and not ashamed

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Trauma and Psychosis: An Essential Link

Research has consistently and strongly supported a link between trauma and psychosis

Key findings

  • Environmental factors and stressors increase the risk of – and may even cause – psychosis (Read et al., 2005: Schäfer & Fisher, 2011: Morrison, Frame, & Larkin, 2003).
  • They may also severely exacerbate the severity and frequency of symptoms (Schafer & Fisher, 2011; Read, Perry, & Moskowitz, 2001; Ucok & Bıkmaz, 2007).
  • Conversely, experiencing psychosis itself can be traumatizing. This is especially true when other stressors are related, such as family distress and loss of friends (Spauwen et al., 2006; Read et al., 2005; Morrison, Frame, & Larkin, 2003).
  • Trauma and psychosis are heavily linked and can interplay in a vicious cycle (Read, Perry, & Moskowitz, 2001; Schafer & Fisher, 2011).

Thus, the research supports the necessity of a trauma-informed approach in the treatment of psychosis.

What is a trauma-informed approach?

According to SAMHSA, a trauma-informed approach is achieved when the person, program, or system:

  1. Realizes the widespread impact of trauma and understands the potential paths for recovery;
  2. Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved within the system;
  3. Responds by fully integrating knowledge about trauma into policies, procedures, and practices; and
  4. Seeks to actively resist re-traumatization (SAMHSA, 2014).

  Trauma-specific interventions generally recognize:

  1. The survivor’s need to be respected, informed, and connected;
  2. The interrelation between trauma and co-occurring symptoms, such as substance abuse, anxiety, depression, and psychosis.
  3. The need to work collaboratively and in an empowering manner, involving the family and system when appropriate (SAMHSA, 2014).

They also incorporate trauma awareness into every level of engagement and treatment.

The following vignette illustrates how a trauma-informed approach may be utilized in an early intervention for psychosis program:

Jeffrey has been experiencing hallucinations and very strange thoughts. He schedules an initial appointment with an early psychosis program. Shannon, the intake coordinator, knows that trauma and psychosis are highly correlated. She asks about trauma as a part of her biopsychosocial formulation. 

“I’m assessing to see if you’ve ever experienced psychological trauma,” Shannon explains. “While that definition is different from person to person, it usually means feeling so overwhelmed or hurt by something that it still affects your ability to feel safe. It can be a reaction to one really bad experiences, or a series of events over the years.”

Jeffrey explains that he was once involuntarily hospitalized after experimenting with LSD and seeing some “weird stuff.” He says that he still has nightmares and intense intrusive flashbacks.

After Jeffrey is admitted to the program, Shannon asks for his permission to share his trauma history with the treatment team. In doing so, she acknowledges the potential sensitivity of the content and invites Jeffrey’s participation in the treatment process. Jeffrey agrees.

Miguel, his primary care clinician, lets Jeffrey know that he can discuss trauma only if he feels comfortable and ready to do so. When the relationship has been built and Jeffrey is ready, they talk in a safe space. Miguel uses active listening to gain information without judgment and validates Jeffrey’s experiences and emotions.

With Jeffrey’s permission, he invites Jeffrey’s parents in for a family session. He knows that family involvement and support can be important for trauma recovery. Miguel provides psychoeducation about the impact of trauma and starts treatment planning.

“Trauma,” he says, “is not something that people can just make go away. Healing will be a long process. What we can do now is work together to create a crisis plan for Jeffrey. It’s possible that another hospitalization could re-traumatize him, so we’re going to find alternatives. We’re also going to develop some strategies to help him manage just in case another hospitalization occurs.”

Miguel collaborates with Jeffrey and his parents in developing a list of resources that will serve as alternatives to hospitalization. He also acknowledges that hospitalization may be necessary due to the psychosis. Jeffrey’s mom states she will accompany Jeffrey to the E.R., if necessary. Jeffrey agrees to that this would help.  

After this session, Miguel has weekly appointments with Jeffrey. He continues to be sensitive and patient. He utilizes the Trauma Affect Regulation: Guide for Education and Therapy (TARGET) model to design interventions. Finally, he listens to Jeffrey’s feedback and invites Jeffrey to be a leader in his own treatment process.

References:

Morrison, A., Frame, L., & Larkin, W. (2003). Relationships between trauma and psychosis: A review and integration. British Journal of Clinical Psychology, 42, 331-353.

Read, J., Perry, B.D., Moskowitz, A., Connolly, C. (2001). The contribution of early traumatic events to schizophrenia in some patients: a neurodevelopmental model. Psychiatry, 64 (4), 319-343.

Read, J., van Os, J., Morrison, A., & Ross, C.  (2005). Childhood trauma, psychosis, and schizophrenia: a literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavia, 112, 330-350.

Schäfer, I., & Fisher, H. (2011). Childhood trauma and psychosis—what is the evidence? Dialogues in Clinical Neuroscience - Vol 13 . No. 3 . 2011, 13(3), 360-365.

Spauwen, J., Krabbendam, L., Wittchen, H., & Van Os, J. (2006). Impact of psychological trauma on the development of psychotic symptoms: Relationship with psychosis proneness. The British Journal of Psychiatry, 188, 527-533.

Trauma-Informed Approach And Trauma-Specific Interventions. (2014, January 1). Retrieved from http://beta.samhsa.gov/nctic/trauma-interventions

Ucok, S., Bıkmaz, S. (2007). The effects of trauma in patients with first-episode schizophrenia. Acta Psychiatrica Scandinavia, 116, 371-377.

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Date set for EASA Intro Training!

The training will be Oct 22nd-23rd in Klamath Falls.  Check email for more information!

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