Richard Bentall

Traumatic experiences and post-traumatic stress are highly prevalent in people with psychosis, increasing symptom burden, decreasing quality of life and moderating treatment response. A range of post-traumatic sequelae have been found to mediate the relationship between trauma and psychotic experiences, including the “traditional” symptoms of post-traumatic stress disorder. The International Classification of Diseases-11th Edition recognizes a more complex post-traumatic presentation, complex PTSD, which captures both the characteristic symptoms of PTSD alongside more pervasive post-traumatic sequelae known as ‘disturbances in self-organization’. The prevalence and impact of cPTSD and DSOs in psychosis remains to be explored. In the first study of this kind, 144 participants with psychosis recruited from North West United Kingdom mental health services completed measures assessing trauma, PTSD and cPTSD symptoms and symptoms of psychosis. Forty-percent of the sample met criteria for cPTSD, compared to 10% who met diagnostic criteria for PTSD. PTSD and DSOs mediated the relationship between trauma and positive symptoms, controlling for dataset membership. Both PTSD and DSOs mediated the relationship between trauma and affective symptoms but did not explain a significant proportion of variance in negative symptoms. Cognitive and excitative symptoms of psychosis did not correlate with trauma, PTSD or DSO scores. These findings indicate the possible value of adjunct therapies to manage cPTSD symptoms in people with psychosis, pending replication in larger epidemiological samples and longitudinal studies.

It is proposed that happiness be classified as a psychiatric disorder and be included in future editions of the major diagnostic manuals under the new name: major affective disorder, pleasant type. In a review of the relevant literature it is shown that happiness is statistically abnormal, consists of a discrete cluster of symptoms, is associated with a range of cognitive abnormalities, and probably reflects the abnormal functioning of the central nervous system. One possible objection to this proposal remains--that happiness is not negatively valued. However, this objection is dismissed as scientifically irrelevant

The status of delusions as beliefs has taxed some of the greatest minds in psychopathology. In their paper, Mullen and Gillett (2014) reflect on this issue, addressing a number of ways in which delusions have been conceptualized, on the whole finding them inadequate. They are particularly concerned that regarding delusions simply as false factual beliefs leads to undue emphasis on criteria such as conviction, resistance to counterargument, and falsity, arguing that, in fact, these criteria do not distinguish between delusions and other highly valued ideas (e.g., religious or political convictions, although these are not discussed). Mullen and Gillett make some telling points, and their paper certainly deserves ..

Current research suggests that there are three major groups of psychiatric conditions: the externalizing disorders (characterized by behavioural problems and lack of inhibition); the internalizing disorders (characterized by depression and anxiety) and the psychotic disorders (characterized by hallucinations and delusions, and typically leading to diagnoses such as schizophrenia and bipolar disorder). Abnormal conscious experience is evident in the latter two groups and especially the psychoses. Research shows that depression is associated with selective attention to negative information and a tendency to ruminate (brood about negative lief events). Anxiety is associated with vigilance for threatening information and abnormal meta‐cognitive beliefs (beliefs and worries about the content of consciousness). In the case of the psychotic disorders, research suggests that hallucinations are associated with difficulties in source monitoring (discriminating between self‐generated and external stimuli) and trauma‐linked dissociative states. Some delusional beliefs appear to be associated with anomalous experiences and, although a range of cognitive biases are involved, may arise partly as an attempt to make sense of these experiences.