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Unravelling psychosis: Psychosocial epidemiology, mechanism and meaning.

Bebbington, PE; (2015) Unravelling psychosis: Psychosocial epidemiology, mechanism and meaning. Shanghai Archives of Psychiatry , 27 (2) pp. 70-81. 10.11919/j.issn.1002-0829.215027. Green open access

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Abstract

This paper reviews a revolution in our understanding of psychosis over the last 20 years. To a major extent, this has resulted from a process of cross-fertilization between psychosocial epidemiology and cognitive behavior therapy for psychosis (CBT-p). This encouraged complementary strategies for the acquisition and analysis of data. These include the use of a range of dependent variables related to psychosis, and the exploitation of data from cross-sectional and longitudinal epidemiological surveys, virtual reality experiments, experience sampling methodology, and treatment trials. The key element is to investigate social and psychological measures in relation to each other. This research has confirmed the role of the external social world in the development and persistence of psychotic disorder. In addition, several psychological drivers of psychotic experiences have been identified. There is now persuasive evidence that the influence of social factors in psychosis is significantly mediated by non-psychotic symptoms, particularly mood symptoms and other attributes of affect such as insomnia. Psychotic symptoms are also driven by reasoning biases such as jumping to conclusions and belief inflexibility, though little is known about social influences on such biases. It is now clear that there are many routes to psychosis and that it takes many forms. Treatment of all kinds should take account of this: the dependence of CBT-p on a detailed initial formulation in terms of psychological processes and social influences is an example of the required flexibility. Individual mediators are now being targeted in specific forms of CBT-p, with good effect. This in turn corroborates the hypothesized role of non-psychotic symptoms in mediation, and attests to the power of the approaches described.

Type: Article
Title: Unravelling psychosis: Psychosocial epidemiology, mechanism and meaning.
Location: China
Open access status: An open access version is available from UCL Discovery
DOI: 10.11919/j.issn.1002-0829.215027
Publisher version: http://dx.doi.org/10.11919/j.issn.1002-0829.215027
Additional information: This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License
Keywords: Epidemiology; social factors; psychosis; cognitive behavior therapy
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > IoN RLW Inst of Neurological Sci
URI: https://discovery.ucl.ac.uk/id/eprint/1467276
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