A review of psychotherapeutic models and treatments for psychosis

How important are informed consent, informed choice, and patient-doctor relationships, when prescribing antipsychotic medication?

BACKGROUND

Antipsychotic medications (APs) are used for people with psychosis diagnoses and, increasingly for other problems and groups.

AIMS

This study examines how APs are prescribed, from the perspective of recipients.

METHODS

757 people, from 30 countries, responded to questions about their experiences with APs, in an online survey.

RESULTS

Most (70%) were told nothing about adverse effects. Fewer than 2% recalled being told about the risks of diabetes, suicidality, sexual dysfunction, or reduced life span. None recalled being told about reduced brain volume or withdrawal effects. Only 28% recalled being offered other treatments; with only 14% offered talking therapies. 46% were not told how long to take the APs; and, of those who were told something, 48% were told to take them forever. Most respondents (76%) were not told how APs work. Only 19% were satisfied with the prescribing process, and only 25% reported a good, or very good, relationship with the prescriber. Information, satisfaction with the process, and the prescriber relationship were all positively related to three self-reported outcomes: reduction of problems the drugs were prescribed for, general helpfulness, and quality of life.

CONCLUSIONS

Steps need to be taken to ensure people prescribed antipsychotics are fully informed, especially about adverse effects and alternatives.

Contrasting characteristics of psychosis in outpatients with borderline personality disorder or schizophrenia at a tertiary care institution

Summary and objectives

Borderline personality disorder (BPD) and schizophrenia can present with psychotic symptoms, such as delusions and hallucinations. This study, conducted at a tertiary care center, compared the characteristics of psychotic symptoms in patients diagnosed with BPD and patients diagnosed with schizophrenia, as well as the prevalence of self-harm, suicide attempts, and hospitalizations within these groups.

Method

In this comparative study, 50 individuals diagnosed with BPD and 50 with Schizophrenia, aged between 18 and 45 years, were assessed for intensity of psychotic symptoms with the Psychotic Symptom Assessment Scale (PSYRATS) and the Cardiff Abnormal Perceptions Scale (CAPS). Data were analyzed with IBM SPSS v25.0.

Results

On the PSYRATS, the schizophrenia group scored higher in auditory hallucinations and in the number of voices, while in the BPD group the auditory hallucinations score was correlated with the number of suicide attempts (P=0.025). On the CAPS, the BPD group showed higher scores on positive abnormal perceptions in all dimensions compared to the schizophrenia group (P=0.002).

Conclusions

Our study suggests that patients with BPD experienced a more intense burden of psychotic-like experiences compared to those with Schizophrenia, with a greater frequency, interference, and distress reported. Although patients with Schizophrenia had higher scores on the PSYRATS, the BPD group's scores were also notable, and a correlation was identified between auditory hallucinations and suicide attempts in the BPD group.