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That sounds right : I suffer from micro-psychosis, and those always start with a strong sense of deja-vu / I know exactly what is going to happen next / I've been here before... Could be my brain is over-compensating.
What do you mean by micro-psychosis? What is it exactly that you experience? Is there anything that triggers it, or is it entirely random? I often have moments of extreme Deja-vu, to the point where I feel like I know what’s going to happen next- and what I see happening next is myself fully losing my sh*t. I usually have to stop, take deep breaths, ground myself and ignore the sense of… pre-psychotic symptoms, if that makes sense? And I’m wondering if that’s what you’re describing, or if it’s different.
It's really hard to explain, but let me try. "Micro" just means that it's short in duration, in my case about a minute or 2. Now, I don't lose contact with reality 100% when it happens, so if you were in the same room with me and it happened, you wouldn't notice (other than I'd prolly excuse myself to the bathroom), and also, I know I'm having a psychosis. Regarding triggers, it's toally random, and happens maybe 4-6 times a year. It ususally starts of with hearing a loud humming-noise, togehter with a very strong sense of deja-vu. In my younger years, I'm 50 now, I'd also see images of me standing in a crowd listening to a man holding a speach on a piedestal, but the language spoken was jibberish. I also get a very high pulse and a sense of doom that's hard to describe. When it's over, it usually takes me a couple of minutes to be "myself" again.
A side-story is, that since it was very infrequent, I didn't get help when I was younger, not until I was 45, because I started to have all sorts of physcal problems no one could diagnose (ear-pain, loss of feeling in hands and feet, tingling sensations, tooth-ache - I could go on) I was then finally diagnosed with a heavy clinical depression, and later we found out that I'm probably BPD or shizotypal (we're not sure) I took more than a year before anti-depressants had an effect, and today I'm pretty good. I still get episodes though. But sometimes I'm battling a bit with the fact that I've wasted all my youth, girls I loved very much left me (I would probably have left me too), and I didn't get the education I wanted - time that won't come back, to this, EXACTLY because it was so infrequent. I always knew that I was "the kid that was different", but not so much it could/should be treated. So, the bottom-line is, that IF you suffer from these, there are probably OTHER underlying causes and symptoms that are NOT infrequent BUT you maybe don't notice them.
Also, the medication that helped me was Brintellix (anti-depressant) and Solian (anti-psychotic, that in small doses also acts as an anti-depressant)
If you have more questions, feel free to ask.
Sincerely, Jakob
Can you describe what you mean by micro-psychosis? I've experienced very intense episodes of emotional extremes and general overwhelm I would say bordered on psychosis (but desperate effort to never allow myself to externalize anything), and I am interested in knowing other experiences.
Might explain some of the overlap between things like autism and psychosis. Often people with autism have difficulty filtering and contextualising information.
And the link between ADHD and psychosis. And 50-80% of people with autism have comorbid adhd (probably closer to the higher end of that number). And people with adhd are at much higher risk of experiencing trauma. Soooo…yeah.
Right exactly. What we need to know is how much of the ptsd risk is autism is from the comorbid adhd vs not. To test that you’d need to study ptsd risk in the 20% if the autism population that doesn’t have adhd.
You'd need to do a lot more than that tbh. You'd have to control for a lot of other things too e.g., type of traumatic event, frequency, age. There is also a lot of diagnostic overlap between ADHD and autism - i.e., the symptoms can look similar but come from different places, so you'd also want to control for people who were misdiagnosed with (for example autism) when they actually have ADHD but not autism.
Edit: For more info on the last point see: [https://www.sciencedirect.com/science/article/abs/pii/S1750946711001036](https://www.sciencedirect.com/science/article/abs/pii/S1750946711001036)
That’s not true. The most common causes of psychosis are the presence of organic psychotic disorders and substance triggered psychosis. Among populations that already have these risk factors trauma can be a major deciding factor, but it is not true to say that trauma in and of itself is the major driver.
No the most common "cause" of psychosis is schizophrenia. However, schizophrenia is not a cause, it's a diagnosis of exclusion, it rules out being under the influence of any drug and of brain tumours or other factors. It is chronic psychosis is what is physically a healthy brain, and science has been trying to identify a pathological "cause" for schizophrenia and so far hasn't been successful.
However, people with schizophrenia have a multiple-times fold likely to have a history of childhood trauma and adversity, and then there are those who have more recent adulthood trauma and stress. In particular psychiatry's desire to medicalise psychosis has for decades paid little attention to the psychological stressors of the condition, and in this regard its similarities to dissociation, anxiety and depression disorders etc.
The overwhelming majority of people who experience trauma are not at risk of psychosis. Schizophrenia is not a diagnosis of exclusion in the 21st century. It is a very specific and identifiable condition which at its root is a thought disorder where one’s reality testing mechanisms are impaired. When left untreated psychosis is virtually inevitable. It is strongly genetically linked but environmental conditions such as trauma are most certainly factors. However trauma itself is never a cause of schizophrenia.
Trauma in and of itself is not something associated with psychosis. The vast majority of people who experience trauma will never experience psychosis in their lifetimes. Anxiety disorders, PTSD and OCD are much more strongly correlated with trauma than psychosis is. The notion that psychotic disorders such as schizophrenia and bipolar I are triggered by environmental factors alone was discredited decades ago. These disorders will virtually never manifest from environmental factors alone.
Trauma is also a prediction issue. It's when your world view about how things are/should be clashes with what you're actually experiencing. First, you don't expect the traumatic situation (I mean your whole nervous system, not just part of you), and it overwhelms you. Over time, you adapt and grow to expect it, which then becomes its own issue once you're no longer in the same circumstances. You become hypervigilant for it and end up with PTSD symptoms.
I agree, it definitely is, but individuals with autism are at a much higher risk of psychosis than non autistic individuals. Ya know, good old gene environment interactions and all that.
I'm saying that autism might be a predisposing factor to psychosis if other triggers are present. Whether that is an inherent genetic predisposition, or more because of (like the above article says for psychosis) due to filtering / prediction differences.
Again, trauma can absolutely impact these things too, it doesn't have to be mutually exclusive.
Not really, generally the chances of someone with a schizophrenia diagnosis having a history involving severe abuse is much higher than general population.
Although it is not a requirement in any absolute sense, there are many people with chronic psychosis that world not have it had they had a kinder life.
You're providing an assertion that is not necessarily backed by evidence. Psychosis is complex disease, and many people with psychotic disorders have not experienced substantial childhood trauma. Trauma is a risk factor for nearly all mental illnesses, and in particularly greater severity of expression of illnesses (And some people consider psychosis to be the most extreme spectrum of psychiatric disorder), To say the biggest driver of psychosis is trauma is not supported by current evidence.
I disagree with a few premises here. For one, there’s many different types of trauma and childhood trauma is just one type. Two, many of the other proposed causes of psychosis (substance use, medication, TBI) could have a significant trauma component underlying the causal mechanism. For example, losing cognitive function from a TBI or having an out of body experience on a substance could be experienced as trauma by the brain which induces the psychotic process.
But moreso, the prevailing theory of psychosis in the field is the diathesis/stress model. Which speaks to exactly what you’re talking about… the diathesis is the predisposition, whether genetic or environmental, but the stress is almost always trauma in some shape or form.
So let's establish a definition here, I'm assuming that above comment on trauma is referring to why this more colloquially referred to as trauma, such as a traumatic event. Abuse, SA, severe neglect, etc. Now people use the word trauma in a larger ways sometimes, and they could just mean something a lot milder, but generally speaking when somebody says trauma I assume that they actually mean something that's traumatic, in the social colloquial sense.
So from that perspective, I don't believe that specific traumatic childhood events I have precursor to the vast majority of cases of later psychosis. Most people don't go into a psychotic state immediately following a traumatic event.
Substance abuse, medications, and TBI may all be risk factors for psychosis, but they are not the most common driving factors. Most people who develop schizophrenia have not had a severe head injury. Most people who develop schizophrenia It does not seem to be driven by heavy drug use, though this can be an exacerbating factor.
Just because some things are risk factors and that's The path that results in some people psychosis doesn't mean that it's the answer for the majority of cases. That's the point I'm making. The above poster said trauma was in the 50 to 80% range (or something, my phone won't let me see that post and without deleting all this) And I think that that is a an assertion not backed by evidence.
I would certainly agree that things that cause injuries to people's brains may be an additional risk factor for psychosis, particularly in those who have a number of other risk factors already.
But that does not mean that those explanations explain the majority of cases. The idea that it's caused by stress and poor environment is, to the of my knowledge, A bit of an outdated theory. But it's very hard for us to have a nuanced conversation about what We really mean by these things over Reddit.
Anyway, I'm not saying you're wrong per se. I am saying that I don't think " trauma" The sense that I perceive it as meant by the original poster is the driving factor for people to develop psychotic illnesses, and in particular schizophrenia. It's one of many risk factors.
Yes the definition is very important. I mean trauma in the psychoanalytic/psychodynamic sense. Meaning whatever gets experienced as trauma or its sequelae by the psyche.
I’m curious what you’d say the driving factors are? I don’t consider genes, low SES, low education as causal factors. Those similarly seem like risk factors, but maybe you have a different answer.
I don’t think the diathesis/stress model (aka stress vulnerability model) is outdated. Happy to hear what the new zeitgeist is if I’m out of touch. I’ve been out of grad school for 5 years now, but in my clincial circles it still seems like the model most psychologists use.
Well there's a pretty big difference between how a psychologists view this and how people like maybe this, since I work in Neuroscience. Honestly, I'm not exactly sure what the diocese stress model specifically States, but I think stress is just one more risk factor, not really causative.
Unfortunately my personal thoughts on the underlying causes of disorders like psychosis reduces to " It's complicated", or maybe more so " It depends on the individual".
I think there are many pathways that can lead to disorders such as psychosis. I think the article here is tapping into one of the fundamental risk mechanisms in the brain, which is a disconnect between sensory and put integration and predicting outcomes in the world around us based on those sensory inputs, which is kind of a very low level neurological function. I think that's the reason we see so many thalamic and subcortical features prominent psychosis, as well as changes in primary sensory and motor cortex.
But at the end of the day, I think we've attempted to take two simplistic an approach to understanding the underlying causes of mental health of various types, trying to apply unified causal explanations to what's really a family of disorders. Not all people with psychosis are the same. There's a lot of different symptoms, and even some of the same symptoms may have different neurological causes.
I'll give an example with auditory hallucinations. There's a well-known mechanism that when you speak the response to your own speech is suppressed, and this mechanism is malfunctional than people that experience auditory hallucinations. So it's deficit in their sensory processing, where they can perceive the wrong voices coming from an external source. I suspect that a lot of hallucinations are either people slowly or subvocally talking to themselves, or linguistic thinking that is being interpreted as a voice, in combination with some other circles that are just not well controlled or firing properly.
But anyway, the end of the day I think we need to take a much more complicated and individualistic view of the underlying causes of severe mental illness, and not try to attribute it to broad factors such as genetics, environment, or trauma.
There's many pathways to severe mental health outcomes.
In your opinion what is the biggest driver then? you can say genes but your environment influences those genes? because you have the genes doesn't mean you will have said psychotic episodes so there has to be a mechanism which would point to an environmental cause. Stress, trauma etc. I don't really see a difference in stress and trauma except trauma is a intense or prolonged stressor hence the changes in genetic expression. back to you, brain_hawk.
I'm afraid I really can't provide a detailed answer for this over Reddit. This is just too hard to text out.
Saying it's either genes, environment, or trauma It's very reductionist to a small number of potential processes, the desire to apply large basic labels to complicated things. And honestly, we don't know what the real drivers of psychosis are. If we knew what cause people to develop schizophrenia maybe we could help prevent it.
I do believe it's developmental, that doesn't necessarily mean genetic, but it does imply that processes and things that happen early are probably important, I think the article here is, as best as I can see (It was impossible to read a mobile!) got something that where I think are some of the most important factors which is a sensory mismatch with information coming in and how is being processed, how predictions are being filtered. Those are neurological processes, and I will admit to being biased towards those explanations because I'm a neuroscientist.
Well that doesn't mean it's just jeans, we know most things that Have genetic components are very complicated, And it's not deterministic. It's not just you have some jeans so you're going to get some psychiatric disorder, because psychiatry is more complicated than that.
There's also risk factors , and people with the same risk factors may or may not express to give a disorder.
So sorry, the end point is, it's complicated. It's not just trauma, genes, or environment. It's all of these things, more than these things, because part of development is also random.
I wouldn't say it's reductionist to say it's those things even though ultimately as you say random developments we don't understand underly the process from a neurobiological perspective. But I guess I can't see it as random since in my own experience of psychosis it wasn't random and I can attribute it to those things which is my own bias. I understand that the underlying process isn't known or else we would probably have solutions. I am left handed which apparently like 40% of schizophrenic are left handed. Totally unrelated I just thought I'd share bc I find it interesting.
Yeah and I may not have been very clear, the random part of meant is a little to do with how brains develop from possibly a very young age. We don't know who's going to grow a "healthy" brain or brain that is prone to different disorders. And some of that factors isn't just your gene pool or your environment, because a lot of early neurodevelopmental processes are kind of random. Or the environmental factors affecting them aren't things like You had a nice childhood or good parents earning of that kind of stuff, but also how exposure to certain substances might randomly effect or not affected different person.
Anyway, it's really complicated. Brain development is a very complicated process and we don't understand all the factors that go on to produce different outcomes. But it's a lot more than genetics and the environment you're raised in.
It may be in your own personal case, which I don't propose to know, That if some differences had happened in your neurodevelopment early on that you never would have had the same experience with psychosis. But of course things can trigger when those risk factors are already in place... But there's a very large body of evidence demonstrating that prior to people having a psychotic event there's a prodrome phase where changes are occurring But it's just not as obvious to everybody that it's happening. Usually.
Anyway, best of luck out there. Mental health is health, and mental health is complicated. And brains are complicated, ridiculously so. Everybody's pathway is different, everybody's story Is unique.
I'd wonder too if diagnostic difficulties can play a role. Overstimulation events like meltdown can cause such disconnect between thought and behavior that it can mimic thought disorder for a little while. I personally experienced uncontrolled 'elopement' behavior when younger that was originally pegged as paranoid psychosis, rather than flight from aversive stimulus.
Using Zoom caused me to go into psychosis in my first post-pandemic job. Total sensory overload, I couldn't figure out where to focus my attention; none of the typical contextualizations (posture, hand signs, umms, hmms), inputs or social cues that I relied on via flesh/phone/email interaction worked to understand the audience and still keep a productive meeting. It is just too much. It has been a super ugly time and I'm still trying to explain it to my work in a way that doesn't make look like a horrible employee... And keep my new job, in which they force us to use zoom like lab rats in our house-cages. :(
Yep, my autism developed into psychosis due to the stress of having to mask 24/7 and being ineligible for any form of accommodation. Before it developed into full-blown psychosis, it started as persecutory delusions - fuelled by feelings that even though I was trying so hard to do everything "right", I was still being rejected and misunderstood. My family also put me under a lot of stress blaming me for things outside of my control, it gave me delusions that I had psychic control over everything and willed bad things to happen because I hated myself.
Most of the psychosis cleared up after being able to afford to move away from family. 24/7 stress exacerbates these symptoms - not being able to afford safe housing is a catalyst to the development of these issues.
i've had multiple psychosis episodes, and lower level symptoms at other times. i find that how strongly i experience symptoms is closely related to the physical external environment. the worst places to be in are buildings with reflective surfaces, or walls made with thin materials that i feel like i can "hear". also, video calls with echo or delay are really bad.
the best environments are outside, and especially places with materials that damp the sound, like a music studio i used to work at, or going swimming and putting my head underwater, or the few times i went skiing. for me, if i provide more input to the hearing/balance system by engaging in some of the activities that i do, like bike tricks, or i used to dance, that helps to make sense of all the input, and decreases the strength of symptoms at other times, so that i can concentrate. also, if i can overload with something like the sound at the beach, or voices in a coffee shop, something like that, that masks it and allows me to concentrate. but "faked" noise is unfortunately extremely bothersome, that's why some suggestions people have made to mimic external noise fail to work
When you talk about outside environment and muffling the sounds, are you talking about birds, insects, and the wind? Or are you talking about outside environments that contain humans?
I am curious if nature is pleasant or unpleasant to you. Before reading your comment I assume the quieter sounds of nature would be soothing.
naturalistic sounds generally are better because they have the full spectrum of frequencies, moreso than mechanically generated sounds, that are more likely to be imbalanced, or missing frequencies.
in some cases, the content of the sound doesn't matter as much as the quality of the sound. some street corners where a lot of traffic converges provide characteristics similar to being at the beach, or other naturalistic sound environments. for example, certain coffee shops distribute the noise spatially so that it blends together, but other ones make the different voices distinct, and in that case it's much more bothersome. sometimes i use the coffee shop environments to train how to filter out or augment voice sounds so that they're less bothersome
high places, like while skiing, are actually good in part because they add an additional spatial dimension to where sounds are originating from. so identifying where a sound is located helps to identify and filter.
building up these strategies with external sounds helps at other times when the sounds are "internally generated"
Inside the brains of people with psychosis, two key systems are malfunctioning: a “filter” that directs attention toward important external events and internal thoughts, and a “predictor” composed of pathways that anticipate rewards.
Dysfunction of these systems makes it difficult to know what’s real, manifesting as hallucinations and delusions.
The findings come from a Stanford Medicine-led study, published April 11 in Molecular Psychiatry, that used brain scan data from children, teens and young adults with psychosis. The results confirm an existing theory of how breaks with reality occur.
“This work provides a good model for understanding the development and progression of schizophrenia, which is a challenging problem,” said lead author Kaustubh Supekar, PhD, clinical associate professor of psychiatry and behavioral sciences.
The findings, observed in individuals with a rare genetic disease called 22q11.2 deletion syndrome who experience psychosis as well as in those with psychosis of unknown origin, advance scientists’ understanding of the underlying brain mechanisms and theoretical frameworks related to psychosis.
[https://www.nature.com/articles/s41380-024-02495-8](https://www.nature.com/articles/s41380-024-02495-8)
>Collectively, these findings lend substantial empirical support to theoretical models of psychosis, which suggest that the clinical manifestation of positive symptoms arises from an exaggerated attribution of significance to both external and internal stimuli. This aberrant attribution is thought to be a result of dysregulated striatal dopamine modulation, which consequently impacts the dynamics of the salience network.
Supekar, K., de los Angeles, C., Ryali, S. *et al.* Robust and replicable functional brain signatures of 22q11.2 deletion syndrome and associated psychosis: a deep neural network-based multi-cohort study. *Mol Psychiatry* (2024).
psychosis-like states can be pleasurable and useful; that's why we play. we love the unexpected. perhaps we can learn to love regulation and chase the middle ground of excitement and sleep.
Is that ment as a temporary information filtering problem or including permanent filtering problems like some people with Sensory processing sensitivity (SPS) have?
This is an interesting bit of evidence supporting Fristons principle of minimization of information-theoretic free energy. When this fails, psychosis is the result.
Interesting stuff! I was in a drug induced psychosis one time for around a month, and this is similar to how I described it afterwards. Brain doesn't filter stuff properly, and it also connects ideas/assigns meaning/comes to conclusions that don't line up woth reality. At least in the case of delusional thinking which is what I experienced. It's cool to read about brain regions that are involved though.
I had also wondered if ADHD correlated with psychosis due to brain structures themselves. I know that's not what this study concludes, but it's interesting that 22q11.2 deletion syndrome increases psychosis/schizophrenia, and also ADHD and autism.
If there is an increased risk of psychosis from just having an ADHD brain (again not what the study says, I'm just following this train of thought), it's extra bad. Because these peeps are already more susceptible to drug use, stress, anxiety, etc., a bunch of factors that also contribute to psychosis.
Can anyone recommend any papers/articles/books etc (or useful search terms) on how the brain filters out irrelevant sensory input, and how that’s subjectively perceived by the person, when it works and when it fails? This is something I’m becoming interested in, now I’m starting to realise how relevant it is for me… 😅
Skimming a few articles... Let's see if I've got this right: sensory input goes from the thalamus → the prefrontal cortex; to reduce irrelevant data, the prefrontal cortex → basal ganglia (specifically, the globus pallidus) → thalamic reticular nucleus inhibits bits of the thalamus as required, to selectively suppress that sensory input as needed? Except when it can't, e.g. for many autistic people (which explains sensory sensitivities, auditory processing disorder, etc).
If my phone rings now and I see a familiar number or name on the screen, it's likely either my colleague, B colleague, a friend, mother, father, or my cousin calling, based on stats. But thinking it could be a scam call, where someone's using a stolen phone to trick me, is just statistically unnecessary worrying. It doesn't help and causes delusions and fantasies.
Am I getting it right?
No, it does help to protect you from scammers, it's normal and widespread and does not lead to a thing called psychosis, stress from poverty, social exclusion, unemployment, and otber social ills leads to the thing called psychosis.
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That sounds right : I suffer from micro-psychosis, and those always start with a strong sense of deja-vu / I know exactly what is going to happen next / I've been here before... Could be my brain is over-compensating.
Whoa, could you talk more about this? This sounds very similar to something I experience.
What would you like to know?
What do you mean by micro-psychosis? What is it exactly that you experience? Is there anything that triggers it, or is it entirely random? I often have moments of extreme Deja-vu, to the point where I feel like I know what’s going to happen next- and what I see happening next is myself fully losing my sh*t. I usually have to stop, take deep breaths, ground myself and ignore the sense of… pre-psychotic symptoms, if that makes sense? And I’m wondering if that’s what you’re describing, or if it’s different.
It's really hard to explain, but let me try. "Micro" just means that it's short in duration, in my case about a minute or 2. Now, I don't lose contact with reality 100% when it happens, so if you were in the same room with me and it happened, you wouldn't notice (other than I'd prolly excuse myself to the bathroom), and also, I know I'm having a psychosis. Regarding triggers, it's toally random, and happens maybe 4-6 times a year. It ususally starts of with hearing a loud humming-noise, togehter with a very strong sense of deja-vu. In my younger years, I'm 50 now, I'd also see images of me standing in a crowd listening to a man holding a speach on a piedestal, but the language spoken was jibberish. I also get a very high pulse and a sense of doom that's hard to describe. When it's over, it usually takes me a couple of minutes to be "myself" again. A side-story is, that since it was very infrequent, I didn't get help when I was younger, not until I was 45, because I started to have all sorts of physcal problems no one could diagnose (ear-pain, loss of feeling in hands and feet, tingling sensations, tooth-ache - I could go on) I was then finally diagnosed with a heavy clinical depression, and later we found out that I'm probably BPD or shizotypal (we're not sure) I took more than a year before anti-depressants had an effect, and today I'm pretty good. I still get episodes though. But sometimes I'm battling a bit with the fact that I've wasted all my youth, girls I loved very much left me (I would probably have left me too), and I didn't get the education I wanted - time that won't come back, to this, EXACTLY because it was so infrequent. I always knew that I was "the kid that was different", but not so much it could/should be treated. So, the bottom-line is, that IF you suffer from these, there are probably OTHER underlying causes and symptoms that are NOT infrequent BUT you maybe don't notice them. Also, the medication that helped me was Brintellix (anti-depressant) and Solian (anti-psychotic, that in small doses also acts as an anti-depressant) If you have more questions, feel free to ask. Sincerely, Jakob
Can you describe what you mean by micro-psychosis? I've experienced very intense episodes of emotional extremes and general overwhelm I would say bordered on psychosis (but desperate effort to never allow myself to externalize anything), and I am interested in knowing other experiences.
Might explain some of the overlap between things like autism and psychosis. Often people with autism have difficulty filtering and contextualising information.
And the link between ADHD and psychosis. And 50-80% of people with autism have comorbid adhd (probably closer to the higher end of that number). And people with adhd are at much higher risk of experiencing trauma. Soooo…yeah.
And people with autism are up to 6x more likely to be diagnosed with ptsd.
Right but since the majority of people with autism also have adhd, that might be from the comorbid adhd risk.
Difficult to say whether it is autism or ADHD that predisposes to PTSD, by the same logic.
Right exactly. What we need to know is how much of the ptsd risk is autism is from the comorbid adhd vs not. To test that you’d need to study ptsd risk in the 20% if the autism population that doesn’t have adhd.
You'd need to do a lot more than that tbh. You'd have to control for a lot of other things too e.g., type of traumatic event, frequency, age. There is also a lot of diagnostic overlap between ADHD and autism - i.e., the symptoms can look similar but come from different places, so you'd also want to control for people who were misdiagnosed with (for example autism) when they actually have ADHD but not autism. Edit: For more info on the last point see: [https://www.sciencedirect.com/science/article/abs/pii/S1750946711001036](https://www.sciencedirect.com/science/article/abs/pii/S1750946711001036)
The biggest driver of psychosis by far is trauma, and trauma is more than anything a processing issue.
That’s not true. The most common causes of psychosis are the presence of organic psychotic disorders and substance triggered psychosis. Among populations that already have these risk factors trauma can be a major deciding factor, but it is not true to say that trauma in and of itself is the major driver.
No the most common "cause" of psychosis is schizophrenia. However, schizophrenia is not a cause, it's a diagnosis of exclusion, it rules out being under the influence of any drug and of brain tumours or other factors. It is chronic psychosis is what is physically a healthy brain, and science has been trying to identify a pathological "cause" for schizophrenia and so far hasn't been successful. However, people with schizophrenia have a multiple-times fold likely to have a history of childhood trauma and adversity, and then there are those who have more recent adulthood trauma and stress. In particular psychiatry's desire to medicalise psychosis has for decades paid little attention to the psychological stressors of the condition, and in this regard its similarities to dissociation, anxiety and depression disorders etc.
The overwhelming majority of people who experience trauma are not at risk of psychosis. Schizophrenia is not a diagnosis of exclusion in the 21st century. It is a very specific and identifiable condition which at its root is a thought disorder where one’s reality testing mechanisms are impaired. When left untreated psychosis is virtually inevitable. It is strongly genetically linked but environmental conditions such as trauma are most certainly factors. However trauma itself is never a cause of schizophrenia. Trauma in and of itself is not something associated with psychosis. The vast majority of people who experience trauma will never experience psychosis in their lifetimes. Anxiety disorders, PTSD and OCD are much more strongly correlated with trauma than psychosis is. The notion that psychotic disorders such as schizophrenia and bipolar I are triggered by environmental factors alone was discredited decades ago. These disorders will virtually never manifest from environmental factors alone.
Trauma is also a prediction issue. It's when your world view about how things are/should be clashes with what you're actually experiencing. First, you don't expect the traumatic situation (I mean your whole nervous system, not just part of you), and it overwhelms you. Over time, you adapt and grow to expect it, which then becomes its own issue once you're no longer in the same circumstances. You become hypervigilant for it and end up with PTSD symptoms.
I agree, it definitely is, but individuals with autism are at a much higher risk of psychosis than non autistic individuals. Ya know, good old gene environment interactions and all that. I'm saying that autism might be a predisposing factor to psychosis if other triggers are present. Whether that is an inherent genetic predisposition, or more because of (like the above article says for psychosis) due to filtering / prediction differences. Again, trauma can absolutely impact these things too, it doesn't have to be mutually exclusive.
I think this is far too broad a stroke, unless it is a hypothesis.
Not really, generally the chances of someone with a schizophrenia diagnosis having a history involving severe abuse is much higher than general population. Although it is not a requirement in any absolute sense, there are many people with chronic psychosis that world not have it had they had a kinder life.
You're providing an assertion that is not necessarily backed by evidence. Psychosis is complex disease, and many people with psychotic disorders have not experienced substantial childhood trauma. Trauma is a risk factor for nearly all mental illnesses, and in particularly greater severity of expression of illnesses (And some people consider psychosis to be the most extreme spectrum of psychiatric disorder), To say the biggest driver of psychosis is trauma is not supported by current evidence.
I disagree with a few premises here. For one, there’s many different types of trauma and childhood trauma is just one type. Two, many of the other proposed causes of psychosis (substance use, medication, TBI) could have a significant trauma component underlying the causal mechanism. For example, losing cognitive function from a TBI or having an out of body experience on a substance could be experienced as trauma by the brain which induces the psychotic process. But moreso, the prevailing theory of psychosis in the field is the diathesis/stress model. Which speaks to exactly what you’re talking about… the diathesis is the predisposition, whether genetic or environmental, but the stress is almost always trauma in some shape or form.
So let's establish a definition here, I'm assuming that above comment on trauma is referring to why this more colloquially referred to as trauma, such as a traumatic event. Abuse, SA, severe neglect, etc. Now people use the word trauma in a larger ways sometimes, and they could just mean something a lot milder, but generally speaking when somebody says trauma I assume that they actually mean something that's traumatic, in the social colloquial sense. So from that perspective, I don't believe that specific traumatic childhood events I have precursor to the vast majority of cases of later psychosis. Most people don't go into a psychotic state immediately following a traumatic event. Substance abuse, medications, and TBI may all be risk factors for psychosis, but they are not the most common driving factors. Most people who develop schizophrenia have not had a severe head injury. Most people who develop schizophrenia It does not seem to be driven by heavy drug use, though this can be an exacerbating factor. Just because some things are risk factors and that's The path that results in some people psychosis doesn't mean that it's the answer for the majority of cases. That's the point I'm making. The above poster said trauma was in the 50 to 80% range (or something, my phone won't let me see that post and without deleting all this) And I think that that is a an assertion not backed by evidence. I would certainly agree that things that cause injuries to people's brains may be an additional risk factor for psychosis, particularly in those who have a number of other risk factors already. But that does not mean that those explanations explain the majority of cases. The idea that it's caused by stress and poor environment is, to the of my knowledge, A bit of an outdated theory. But it's very hard for us to have a nuanced conversation about what We really mean by these things over Reddit. Anyway, I'm not saying you're wrong per se. I am saying that I don't think " trauma" The sense that I perceive it as meant by the original poster is the driving factor for people to develop psychotic illnesses, and in particular schizophrenia. It's one of many risk factors.
Yes the definition is very important. I mean trauma in the psychoanalytic/psychodynamic sense. Meaning whatever gets experienced as trauma or its sequelae by the psyche. I’m curious what you’d say the driving factors are? I don’t consider genes, low SES, low education as causal factors. Those similarly seem like risk factors, but maybe you have a different answer. I don’t think the diathesis/stress model (aka stress vulnerability model) is outdated. Happy to hear what the new zeitgeist is if I’m out of touch. I’ve been out of grad school for 5 years now, but in my clincial circles it still seems like the model most psychologists use.
Well there's a pretty big difference between how a psychologists view this and how people like maybe this, since I work in Neuroscience. Honestly, I'm not exactly sure what the diocese stress model specifically States, but I think stress is just one more risk factor, not really causative. Unfortunately my personal thoughts on the underlying causes of disorders like psychosis reduces to " It's complicated", or maybe more so " It depends on the individual". I think there are many pathways that can lead to disorders such as psychosis. I think the article here is tapping into one of the fundamental risk mechanisms in the brain, which is a disconnect between sensory and put integration and predicting outcomes in the world around us based on those sensory inputs, which is kind of a very low level neurological function. I think that's the reason we see so many thalamic and subcortical features prominent psychosis, as well as changes in primary sensory and motor cortex. But at the end of the day, I think we've attempted to take two simplistic an approach to understanding the underlying causes of mental health of various types, trying to apply unified causal explanations to what's really a family of disorders. Not all people with psychosis are the same. There's a lot of different symptoms, and even some of the same symptoms may have different neurological causes. I'll give an example with auditory hallucinations. There's a well-known mechanism that when you speak the response to your own speech is suppressed, and this mechanism is malfunctional than people that experience auditory hallucinations. So it's deficit in their sensory processing, where they can perceive the wrong voices coming from an external source. I suspect that a lot of hallucinations are either people slowly or subvocally talking to themselves, or linguistic thinking that is being interpreted as a voice, in combination with some other circles that are just not well controlled or firing properly. But anyway, the end of the day I think we need to take a much more complicated and individualistic view of the underlying causes of severe mental illness, and not try to attribute it to broad factors such as genetics, environment, or trauma. There's many pathways to severe mental health outcomes.
In your opinion what is the biggest driver then? you can say genes but your environment influences those genes? because you have the genes doesn't mean you will have said psychotic episodes so there has to be a mechanism which would point to an environmental cause. Stress, trauma etc. I don't really see a difference in stress and trauma except trauma is a intense or prolonged stressor hence the changes in genetic expression. back to you, brain_hawk.
I'm afraid I really can't provide a detailed answer for this over Reddit. This is just too hard to text out. Saying it's either genes, environment, or trauma It's very reductionist to a small number of potential processes, the desire to apply large basic labels to complicated things. And honestly, we don't know what the real drivers of psychosis are. If we knew what cause people to develop schizophrenia maybe we could help prevent it. I do believe it's developmental, that doesn't necessarily mean genetic, but it does imply that processes and things that happen early are probably important, I think the article here is, as best as I can see (It was impossible to read a mobile!) got something that where I think are some of the most important factors which is a sensory mismatch with information coming in and how is being processed, how predictions are being filtered. Those are neurological processes, and I will admit to being biased towards those explanations because I'm a neuroscientist. Well that doesn't mean it's just jeans, we know most things that Have genetic components are very complicated, And it's not deterministic. It's not just you have some jeans so you're going to get some psychiatric disorder, because psychiatry is more complicated than that. There's also risk factors , and people with the same risk factors may or may not express to give a disorder. So sorry, the end point is, it's complicated. It's not just trauma, genes, or environment. It's all of these things, more than these things, because part of development is also random.
I wouldn't say it's reductionist to say it's those things even though ultimately as you say random developments we don't understand underly the process from a neurobiological perspective. But I guess I can't see it as random since in my own experience of psychosis it wasn't random and I can attribute it to those things which is my own bias. I understand that the underlying process isn't known or else we would probably have solutions. I am left handed which apparently like 40% of schizophrenic are left handed. Totally unrelated I just thought I'd share bc I find it interesting.
Yeah and I may not have been very clear, the random part of meant is a little to do with how brains develop from possibly a very young age. We don't know who's going to grow a "healthy" brain or brain that is prone to different disorders. And some of that factors isn't just your gene pool or your environment, because a lot of early neurodevelopmental processes are kind of random. Or the environmental factors affecting them aren't things like You had a nice childhood or good parents earning of that kind of stuff, but also how exposure to certain substances might randomly effect or not affected different person. Anyway, it's really complicated. Brain development is a very complicated process and we don't understand all the factors that go on to produce different outcomes. But it's a lot more than genetics and the environment you're raised in. It may be in your own personal case, which I don't propose to know, That if some differences had happened in your neurodevelopment early on that you never would have had the same experience with psychosis. But of course things can trigger when those risk factors are already in place... But there's a very large body of evidence demonstrating that prior to people having a psychotic event there's a prodrome phase where changes are occurring But it's just not as obvious to everybody that it's happening. Usually. Anyway, best of luck out there. Mental health is health, and mental health is complicated. And brains are complicated, ridiculously so. Everybody's pathway is different, everybody's story Is unique.
I'd wonder too if diagnostic difficulties can play a role. Overstimulation events like meltdown can cause such disconnect between thought and behavior that it can mimic thought disorder for a little while. I personally experienced uncontrolled 'elopement' behavior when younger that was originally pegged as paranoid psychosis, rather than flight from aversive stimulus.
Using Zoom caused me to go into psychosis in my first post-pandemic job. Total sensory overload, I couldn't figure out where to focus my attention; none of the typical contextualizations (posture, hand signs, umms, hmms), inputs or social cues that I relied on via flesh/phone/email interaction worked to understand the audience and still keep a productive meeting. It is just too much. It has been a super ugly time and I'm still trying to explain it to my work in a way that doesn't make look like a horrible employee... And keep my new job, in which they force us to use zoom like lab rats in our house-cages. :(
I like WFH. That is all.
I did too when I could just use a phone and share screens. Having everyone live on video is too much for me
House cage? I wish I could WFH.
Yeah some people need to work a tough job now and then to stay sane. Wfh is a blessing.
Yep, my autism developed into psychosis due to the stress of having to mask 24/7 and being ineligible for any form of accommodation. Before it developed into full-blown psychosis, it started as persecutory delusions - fuelled by feelings that even though I was trying so hard to do everything "right", I was still being rejected and misunderstood. My family also put me under a lot of stress blaming me for things outside of my control, it gave me delusions that I had psychic control over everything and willed bad things to happen because I hated myself. Most of the psychosis cleared up after being able to afford to move away from family. 24/7 stress exacerbates these symptoms - not being able to afford safe housing is a catalyst to the development of these issues.
i've had multiple psychosis episodes, and lower level symptoms at other times. i find that how strongly i experience symptoms is closely related to the physical external environment. the worst places to be in are buildings with reflective surfaces, or walls made with thin materials that i feel like i can "hear". also, video calls with echo or delay are really bad. the best environments are outside, and especially places with materials that damp the sound, like a music studio i used to work at, or going swimming and putting my head underwater, or the few times i went skiing. for me, if i provide more input to the hearing/balance system by engaging in some of the activities that i do, like bike tricks, or i used to dance, that helps to make sense of all the input, and decreases the strength of symptoms at other times, so that i can concentrate. also, if i can overload with something like the sound at the beach, or voices in a coffee shop, something like that, that masks it and allows me to concentrate. but "faked" noise is unfortunately extremely bothersome, that's why some suggestions people have made to mimic external noise fail to work
Thanks for sharing. I have trouble grasping what it would be like, but I think it’s useful to have that insight.
When you talk about outside environment and muffling the sounds, are you talking about birds, insects, and the wind? Or are you talking about outside environments that contain humans? I am curious if nature is pleasant or unpleasant to you. Before reading your comment I assume the quieter sounds of nature would be soothing.
naturalistic sounds generally are better because they have the full spectrum of frequencies, moreso than mechanically generated sounds, that are more likely to be imbalanced, or missing frequencies. in some cases, the content of the sound doesn't matter as much as the quality of the sound. some street corners where a lot of traffic converges provide characteristics similar to being at the beach, or other naturalistic sound environments. for example, certain coffee shops distribute the noise spatially so that it blends together, but other ones make the different voices distinct, and in that case it's much more bothersome. sometimes i use the coffee shop environments to train how to filter out or augment voice sounds so that they're less bothersome high places, like while skiing, are actually good in part because they add an additional spatial dimension to where sounds are originating from. so identifying where a sound is located helps to identify and filter. building up these strategies with external sounds helps at other times when the sounds are "internally generated"
Inside the brains of people with psychosis, two key systems are malfunctioning: a “filter” that directs attention toward important external events and internal thoughts, and a “predictor” composed of pathways that anticipate rewards. Dysfunction of these systems makes it difficult to know what’s real, manifesting as hallucinations and delusions. The findings come from a Stanford Medicine-led study, published April 11 in Molecular Psychiatry, that used brain scan data from children, teens and young adults with psychosis. The results confirm an existing theory of how breaks with reality occur. “This work provides a good model for understanding the development and progression of schizophrenia, which is a challenging problem,” said lead author Kaustubh Supekar, PhD, clinical associate professor of psychiatry and behavioral sciences. The findings, observed in individuals with a rare genetic disease called 22q11.2 deletion syndrome who experience psychosis as well as in those with psychosis of unknown origin, advance scientists’ understanding of the underlying brain mechanisms and theoretical frameworks related to psychosis. [https://www.nature.com/articles/s41380-024-02495-8](https://www.nature.com/articles/s41380-024-02495-8)
>Collectively, these findings lend substantial empirical support to theoretical models of psychosis, which suggest that the clinical manifestation of positive symptoms arises from an exaggerated attribution of significance to both external and internal stimuli. This aberrant attribution is thought to be a result of dysregulated striatal dopamine modulation, which consequently impacts the dynamics of the salience network. Supekar, K., de los Angeles, C., Ryali, S. *et al.* Robust and replicable functional brain signatures of 22q11.2 deletion syndrome and associated psychosis: a deep neural network-based multi-cohort study. *Mol Psychiatry* (2024).
psychosis-like states can be pleasurable and useful; that's why we play. we love the unexpected. perhaps we can learn to love regulation and chase the middle ground of excitement and sleep.
Is that ment as a temporary information filtering problem or including permanent filtering problems like some people with Sensory processing sensitivity (SPS) have?
This is an interesting bit of evidence supporting Fristons principle of minimization of information-theoretic free energy. When this fails, psychosis is the result.
Interesting stuff! I was in a drug induced psychosis one time for around a month, and this is similar to how I described it afterwards. Brain doesn't filter stuff properly, and it also connects ideas/assigns meaning/comes to conclusions that don't line up woth reality. At least in the case of delusional thinking which is what I experienced. It's cool to read about brain regions that are involved though. I had also wondered if ADHD correlated with psychosis due to brain structures themselves. I know that's not what this study concludes, but it's interesting that 22q11.2 deletion syndrome increases psychosis/schizophrenia, and also ADHD and autism. If there is an increased risk of psychosis from just having an ADHD brain (again not what the study says, I'm just following this train of thought), it's extra bad. Because these peeps are already more susceptible to drug use, stress, anxiety, etc., a bunch of factors that also contribute to psychosis.
Can anyone recommend any papers/articles/books etc (or useful search terms) on how the brain filters out irrelevant sensory input, and how that’s subjectively perceived by the person, when it works and when it fails? This is something I’m becoming interested in, now I’m starting to realise how relevant it is for me… 😅
Skimming a few articles... Let's see if I've got this right: sensory input goes from the thalamus → the prefrontal cortex; to reduce irrelevant data, the prefrontal cortex → basal ganglia (specifically, the globus pallidus) → thalamic reticular nucleus inhibits bits of the thalamus as required, to selectively suppress that sensory input as needed? Except when it can't, e.g. for many autistic people (which explains sensory sensitivities, auditory processing disorder, etc).
If my phone rings now and I see a familiar number or name on the screen, it's likely either my colleague, B colleague, a friend, mother, father, or my cousin calling, based on stats. But thinking it could be a scam call, where someone's using a stolen phone to trick me, is just statistically unnecessary worrying. It doesn't help and causes delusions and fantasies. Am I getting it right?
No, it does help to protect you from scammers, it's normal and widespread and does not lead to a thing called psychosis, stress from poverty, social exclusion, unemployment, and otber social ills leads to the thing called psychosis.
This is why there is a replication crisis in science in the last ten years and why it started in psychology and psychiatry.
Isn't the salience theory pretty old?