Sleep problems are a common complaint in clinical samples. Specifically, the high level of co-occurring sleep disturbances, such as insomnia and hypersomnia, amongst patients with schizophrenia and bipolar disorder suggests a relationship between poor sleep and psychopathology. Furthermore, recent evidence consistently indicates that sleep disturbance may be related to symptoms of psychosis such as hallucinations and delusions. The research described in this thesis attempts to explore the relationship between sleep in psychosis. Paper 1 presents a systematic review entitled: Evaluating the Effectiveness of Sleep Treatments in Severe Mental Illness. The review identified fifteen controlled trials of pharmacological and non-pharmacological interventions for the treatment of sleep disturbance in patients with severe mental illness. The outcomes of the review indicated that sleep could be reliably improved in persons with schizophrenia and bipolar disorder. Significant improvements to sleep were observed for some pharmacological interventions as well as for non-pharmacological interventions. Paper 2 describes an empirical study aimed at exploring the effects of poor sleep on the cognitive mechanisms underlying psychotic experiences. Using an independent groups design, two, well-defined, non-clinical groups comprising good sleepers and poor sleepers (those meeting criteria for insomnia disorder) were recruited to the study. The two groups were compared on a series of questionnaires and computer tasks designed to assess mechanisms underlying hallucinations and delusions, with a view to determine whether there was a difference in performance between groups that could be attributed to sleep. No significant differences were found between groups, although the study was underpowered. The findings are discussed in the context of sample characteristics and tests used to compare groups. The final paper offers a critical reflection on the systematic review and empirical study, drawing together conclusions about the role and treatment of sleep in relation to psychotic experiences.

This thesis explored how psychosis stigma affects the psychological wellbeing of young people at risk of psychosis and people with psychosis. The efficacy of psychosocial methods to reduce stigma in young people were explored. Multiple methods were used including qualitative, cross sectional, longitudinal and a randomsied controlled trial. Chapter 1 included a comprehensive review of the literature on stigma. Chapter 2 provided a review of the methodology used throughout the thesis. Study 1 (Chapter 3) examined the subjective experience of psychosis using Interpretative Phenomenological Analysis. Three super ordinate themes of judgment, disclosure and psychological distress were identified. Analysis of the data suggested a directional relationship between the themes with societal judgments, affecting issues of disclosure and judgment and disclosure issues increasing psychological distress. Possible exits from distress were suggested. Study 2 (Chapter 4) explored relationships between internalised stereotypes (IS) of psychosis and emotional dysfunction in people at risk of developing psychosis. Correlational analyses indicated significant relationships between IS, depression, social anxiety, and distress. Multiple regression analyses indicated that baseline IS predicted depression at follow up. Results suggested that IS may increase psychological distress and in particular depression in young people at risk of psychosis. Study 3 (Chapter 5) explored relationships between IS and emotional dysfunction in people with psychosis not taking antipsychotic medication. The findings revealed significant positive relationships between IS, depression and social anxiety. Multiple regression analysis suggested that baseline IS predicted depression at follow-up but this did not remain significant when controlling for baseline depression. These results replicate the findings of previous research carried out in other psychosis populations. Study 4 (Chapter 6) explored differences in the level of IS and the strength of relationship between IS and emotional dysfunction, between those at risk of psychosis and those with psychosis. Results of the cross sectional analysis indicated no significant differences between the groups on level of IS or on the strength of correlation between IS and emotional dysfunction. This interesting find suggests that young people at risk of psychosis may be internalising stereotypes early and before official diagnostic labels are applied. Study 5 (Chapter 7) examined the efficacy of internet based anti-stigma interventions for young people. Results indicated a non-significant trend towards reduction in stigma, immediately post intervention for the contact and psychosocial educational conditions, however superiority over control was not demonstrated. Findings indicated that internet based interventions for this group should be brief and ensure maximum engagement. This thesis has demonstrated that stigma affects the wellbeing of people whose experiences exist along the psychosis continuum. Research is required to better understand the feasibility and efficacy of clinical and mass media interventions to reduce the negative effects of stigma in people with psychosis and the public.

This thesis explored conceptualisations of recovery, associated psychological factors and predictors, measurement of subjective recovery, and attitudes towards recovery. A multi-method approach was utilised, including reviewing evidence from the existing literature, cross-sectional, survey and longitudinal designs, and a computer based implicit association task. Chapter 1 provided a review of the literature, followed by an overview of the methodology employed throughout this thesis in chapter 2. Chapter 3 (study 1) included a user informed review of existing recovery measures. The Recovery Assessment Scale appeared to be the most valid and acceptable measure currently in use, although the Questionnaire about the Process of Recovery (QPR) received particularly positive feedback from service users, but lacked further psychometric validation. Consequently, chapter 4 (study 2, N=335) went on to explore the psychometric properties of the QPR. Exploratory factor analysis suggested a one factor model with high internal consistency, test re-test reliability and convergent validity. Recommendations for the use of the QPR in routine clinical practice was discussed. Chapter 5 (study 3, N=381) utilised the Delphi method to consult a large sample of service users about their views on recovery. A high level of consensus (>80%) was reached for a number of items on defining recovery, factors which help and hinder recovery and factors which show recovery. Implications for clinical practice and future research are discussed. Chapter 6 (study 4, N=110) examined longitudinal predictors of recovery. Negative emotion, positive self-esteem, hopelessness, and to a lesser extent symptoms and functioning predicted subjective recovery. Psychosocial factors and negative emotion appear to be the strongest longitudinal predictors of subjective recovery. Chapter 7 (study 5, N=146) used an online survey and computer task to explore attitudes towards recovery in health professionals and the general public. Explicit attitudes towards recovery were generally positive, with health professionals having significantly more positive attitudes than the general public group. Positive attitudes towards recovery were predicted by greater knowledge of recovery and a preference for psychosocial causal models of psychosis. Implications for focussing on psychosocial causal explanations in recovery training and awareness programmes for health professionals and the general public are discussed. This thesis has advanced our understanding of recovery by reaching consensus about what recovery means to individuals with experiences of psychosis, evaluating tools for measuring recovery and determining some of the key psychological processes and predictors of recovery, including causal beliefs, locus of control and negative emotion. These findings appear to fall into four main themes: conceptualising and defining recovery, measurement of recovery, relationships between psychological processes and recovery, and facilitating recovery. Further research is needed to explore recovery across the continuum of psychosis and investigate recovery focussed interventions which target the key psychological processes identified throughout this thesis.

Cette thèse se propose de remettre en question la signification historique de l’un des évènements les plus emblématiques de l’histoire du Brésil, la Guerre de Canudos (1867), ou coïncident le symptôme d’un homme, le Pèlerin Antonio Vicente Mendes Maciel, et le symptôme de la foule dans le Culture. La signification historique fut pérennisée par la lecture idéologique des évènements à partir d’un diagnostic inspiré par la théorie de la dégénérescence, qui fixa l’idée que la guerre avait résulté de l’interaction entre un meneur psychotique et une foule ignorante et soumise, enlevant aux acteurs du drame de Canudos toute implication en tant que sujets de l’Histoire. Notre travail se propose de rediscuter le diagnostic à partir de la méthodologie propre à l’anthropologie psychanalytique et d’une lecture inédite des manuscrits du Pèlerin, permettant une compréhension plus large du meneur et de la foule en tant que sujets de l’Histoire. / This thesis brings to the forefront of historical significance, one of the most iconic events in Brazilian history, the Canudos war in 1897, when pilgrim Antonio Vicnte Mendes Maciel’s symptom, that is, one man’s symptom and the mass symptom coincide in Culture. The standing historical significance was founded on an ideological reading of thos events according to the theory of degeneracy and diagnoses that war as the result os the interaction between a psychotic leader and the ignorant, submissive mass. All implication of the actors in the Canudos drama as subjects of History was erased. An unprecedented reading of the pilgrim manuscripts using psychoanalytic anthropological methodology allowed us challenge the established diagnosis and led to broader understanding of Pilgrim as a leadr and of the mass as subjects of History

The concepts of urban psychosis and urban trauma rarely appear in scholarly literature. This study explores what urban psychosis is from a health perspective and how it affects African Americans who have lived in urban environments. The study also explores in what ways the experiences of people from inner-city neighborhoods illustrate the tenets of urban trauma and urban psychosis. Through an exploratory qualitative study, the researcher seeks to discover how urban dwellers experience urban psychosis and/or urban trauma.

Although genetic factors appear to contribute substantially to the onset of psychotic disorders, environmental factors also influence the development and course of psychosis. One environmental risk factor that has been robustly associated with multiple psychosis outcomes is exposure to traumatic life events (TLEs). Specifically, TLEs have been associated with increased risk of psychotic disorders, with the prodrome of psychosis, and with dimensional measures of psychotic symptoms, such as attenuated positive psychotic symptoms. Nevertheless, TLEs have been linked to various mental disorders; therefore, the specificity of TLEs to psychosis remains unclear. Similarly, the mechanisms underlying the TLE-psychosis relation have not been fully delineated. The current project addressed these gaps by exploring three areas within the field of TLEs and psychosis. The first is by reviewing the literature on two understudied areas of the trauma and psychosis literature: 1) the specificity between trauma and psychosis in relation to other disorders that often result post-trauma, and 2) proposed mechanisms that uniquely link trauma to psychosis. Second, this project tested whether attentional biases, present in samples with trauma histories and experiencing attenuated forms of psychosis, were similar within both populations. Third, this project examined multiple putative mechanisms influencing the association between TLEs and attenuated psychosis that have been proposed, but not fully tested, in psychosis research, including dissociation, negative self-schemas, negative other-schemas, external locus of control, and stress sensitivity. Analysis of variance suggested that individuals with TLE histories demonstrate attentional biases for physical abuse words and overall TLE-related words, but that experiencing attenuated positive psychotic symptoms does not increase attentional biases in conjunction with a TLE history. Additionally, a bootstrapping method for examining multiple mediation indicated that increases in dissociation, negative self- and other-schemas, external locus of control, and perceived stress mediate the relationship between TLEs and attenuated psychosis. Collectively, this project underscores the importance of targeting multiple cognitive-based mechanisms that may emerge post-trauma in order to reduce psychotic-like experiences or disorders. / Psychology

Essa tese tem como questão central o estatuto teórico e clínico da Psicose Ordinária, hipótese clínica proposta desde 1998, no âmbito da Associação Mundial de Psicanálise (AMP), como tentativa de abordagem e de teorização sobre os casos atípicos da clínica psicanalítica: sintomas que não preenchem claramente os critérios de formação substitutiva e de mensagem simbólica da neurose, mas também não configuram os clássicos fenômenos elementares da psicose. Apresentada inicialmente como um programa de investigação e de refinamento da diferenciação entre neurose e psicose, a hipótese de Psicose Ordinária, no entanto, passou a ser cada vez mais utilizada como um diagnóstico, mobilizando intenso debate no campo da psicanálise de orientação lacaniana. Considerando a importância do diagnóstico diferencial para a condução de um tratamento, a pesquisa tem o objetivo de delimitar a especificidade, o alcance conceitual, bem como os limites da noção de Psicose Ordinária. Para isso, inicialmente, discutese o que é um conceito em psicanálise e são apresentadas as principais perspectivas com que a questão do diagnóstico vem sendo abordada na psicanálise lacaniana. A noção de Psicose Ordinária é interrogada a partir da análise crítica da extensa bibliografia produzida a respeito, visando identificar os fatos clínicos, as matrizes conceituais e as linhas argumentativas que sustentam sua proposição, sua utilização, bem como as críticas que lhe são endereçadas. Conclui-se que a Psicose Ordinária é um conceito forjado a partir das premissas e dos avanços teóricos do último ensino de Lacan e configura uma nova categoria clínica dentro do campo das psicoses: uma psicose não desencadeada, onde a singularidade de um sinthoma assegura, ainda que de forma frágil, o enlaçamento de Real, Simbólico e Imaginário e a inserção no laço social. Propõe-se que a Psicose Ordinária configura, também, uma ferramenta epistêmica com potencial de circunscrever e fazer avançar a tarefa de precisar as especificidades e as implicações teóricas e clínicas da evolução do ensino de Lacan / This thesis has the theoretical and clinical statute of Ordinary Psychosis as its core question, a clinical hypothesis proposed in 1998 within the scope of the World Association of Psychoanalysis (AMP), as an attempt to approach and theorize about the atypical cases in the psychoanalytic clinic: symptoms that do not clearly meet the criteria of substitutive formation and of neurosis symbolic message, but neither configure the classic elementary phenomena of psychosis. Initially presented as a program of investigation and refinement of the differentiation between neurosis and psychosis, the hypothesis of Ordinary Psychosis, however, has become increasingly used as a diagnosis, mobilizing intense debate in the field of Lacanian-oriented psychoanalysis. Considering the importance of the differential diagnosis for conducting a treatment, the research aimed at delimiting the specificity, the conceptual scope, as well as the limits of the hypothesis of ordinary psychosis. To do so, initially, it is discussed what a concept is in psychoanalysis, then, the main perspectives, with which the diagnosis matters are being approached in Lacanian psychoanalysis, are presented. Ordinary Psychosis is interrogated from the critical analysis in the extensive bibliography produced concerning the subject, whose aim is to identify the clinical facts, its conceptual matrices and the argumentative lines that support its proposition, its utilization, as well as the critiques addressed to it. A conclusion is reached: Ordinary Psychosis is a concept which was forged based on premises and theoretical advances of Lacan´s last teaching. It configures a new clinical category within the field of psychoses an unchained psychosis, in which the singularity of a sinthoma ensures, although in a fragile way, the entanglement of Real, Symbolic and Imaginary and the insertion in the social bond. It is proposed that Ordinary Psychosis also constitutes an epistemic tool with potential to circumscribe and advance the task of specifying the peculiarities and the theoretical and clinical implications of Lacan\'s teaching evolution

Essa tese tem como questão central o estatuto teórico e clínico da Psicose Ordinária, hipótese clínica proposta desde 1998, no âmbito da Associação Mundial de Psicanálise (AMP), como tentativa de abordagem e de teorização sobre os casos atípicos da clínica psicanalítica: sintomas que não preenchem claramente os critérios de formação substitutiva e de mensagem simbólica da neurose, mas também não configuram os clássicos fenômenos elementares da psicose. Apresentada inicialmente como um programa de investigação e de refinamento da diferenciação entre neurose e psicose, a hipótese de Psicose Ordinária, no entanto, passou a ser cada vez mais utilizada como um diagnóstico, mobilizando intenso debate no campo da psicanálise de orientação lacaniana. Considerando a importância do diagnóstico diferencial para a condução de um tratamento, a pesquisa tem o objetivo de delimitar a especificidade, o alcance conceitual, bem como os limites da noção de Psicose Ordinária. Para isso, inicialmente, discutese o que é um conceito em psicanálise e são apresentadas as principais perspectivas com que a questão do diagnóstico vem sendo abordada na psicanálise lacaniana. A noção de Psicose Ordinária é interrogada a partir da análise crítica da extensa bibliografia produzida a respeito, visando identificar os fatos clínicos, as matrizes conceituais e as linhas argumentativas que sustentam sua proposição, sua utilização, bem como as críticas que lhe são endereçadas. Conclui-se que a Psicose Ordinária é um conceito forjado a partir das premissas e dos avanços teóricos do último ensino de Lacan e configura uma nova categoria clínica dentro do campo das psicoses: uma psicose não desencadeada, onde a singularidade de um sinthoma assegura, ainda que de forma frágil, o enlaçamento de Real, Simbólico e Imaginário e a inserção no laço social. Propõe-se que a Psicose Ordinária configura, também, uma ferramenta epistêmica com potencial de circunscrever e fazer avançar a tarefa de precisar as especificidades e as implicações teóricas e clínicas da evolução do ensino de Lacan / This thesis has the theoretical and clinical statute of Ordinary Psychosis as its core question, a clinical hypothesis proposed in 1998 within the scope of the World Association of Psychoanalysis (AMP), as an attempt to approach and theorize about the atypical cases in the psychoanalytic clinic: symptoms that do not clearly meet the criteria of substitutive formation and of neurosis symbolic message, but neither configure the classic elementary phenomena of psychosis. Initially presented as a program of investigation and refinement of the differentiation between neurosis and psychosis, the hypothesis of Ordinary Psychosis, however, has become increasingly used as a diagnosis, mobilizing intense debate in the field of Lacanian-oriented psychoanalysis. Considering the importance of the differential diagnosis for conducting a treatment, the research aimed at delimiting the specificity, the conceptual scope, as well as the limits of the hypothesis of ordinary psychosis. To do so, initially, it is discussed what a concept is in psychoanalysis, then, the main perspectives, with which the diagnosis matters are being approached in Lacanian psychoanalysis, are presented. Ordinary Psychosis is interrogated from the critical analysis in the extensive bibliography produced concerning the subject, whose aim is to identify the clinical facts, its conceptual matrices and the argumentative lines that support its proposition, its utilization, as well as the critiques addressed to it. A conclusion is reached: Ordinary Psychosis is a concept which was forged based on premises and theoretical advances of Lacan´s last teaching. It configures a new clinical category within the field of psychoses an unchained psychosis, in which the singularity of a sinthoma ensures, although in a fragile way, the entanglement of Real, Symbolic and Imaginary and the insertion in the social bond. It is proposed that Ordinary Psychosis also constitutes an epistemic tool with potential to circumscribe and advance the task of specifying the peculiarities and the theoretical and clinical implications of Lacan\'s teaching evolution

Heritable and environmental factors contribute to an individual’s risk of substance abuse and psychosis. Individuals diagnosed with a mental disorder have greater vulnerability for substance abuse. Our laboratory established that neonatal treatment of rats with quinpirole (NQ), a dopamine (DA) D2-like agonist, results in a significant increase of DAD2 receptor sensitivity throughout the animal’s lifetime. An increase of DAD2 receptor sensitivity is relevant to a model of schizophrenia (SZ), although increases of DAD2 receptor activity also occur in a number of clinical disorders, including bipolar disorder, obsessive-compulsive disorder, panic disorder, and major depression. Common amongst these clinical conditions is a dramatic increase in cigarette smoking compared to the general population. We bred NQ-treated male and female rats with their NQ-treated or neonatal saline (NS)-treated counterparts once they reached adulthood to determine whether increases in DAD2 sensitivity were passed to the next generation. Offspring of these animals, regardless of whether one or both founders received NQ-treatment, also demonstrated increases of DAD2 receptor sensitivity both behaviorally and neurobiologically. RNASeq preliminary data revealed an increase in cortisol synthesis and release in F1 generation animals, demonstrating an enhanced response to stress, consistent with a model of drug abuse vulnerability. Consistent with this finding, F1 generation rats demonstrated enhanced nicotine conditioned place preference (CPP) and had an enhanced brain derived neurotrophic factor (BDNF) response to nicotine in the nucleus accumbens (NAcc), a brain area critical to drug reward. The DAD2 receptor forms a triple heteromer with the adenosine A(2A) and metabotropic glutamate type 5 (mGlu5) receptor, such that stimulation of either receptor results in a decrease of DAD2 activity. Therefore, we analyzed whether use of a positive allosteric modulator (PAM) of mGlu5 in the F1 generation would block nicotine CPP and improve sensorimotor gating deficits, which is a hallmark of psychosis. In both experiments, the mGlu5 PAM effectively blocked the enhanced rewarding effects of nicotine and also alleviated sensorimotor gating deficits in this model. In essence, we demonstrate in results reported here that there may be a common therapeutic target for the dual treatment of substance abuse and psychosis.

<p>Cognitive impairments in schizophrenia (SZ) include abnormalities in executive function, attention, and semantic processing. Event-related potentials (ERPs) are used as neurophysiological measures of cognitive impairment that have been shown to map onto symptom dimensions of psychotic disorders, such as schizophrenia. While much research exists on schizophrenia, less is understood about the longitudinal relationships between ERPs and symptom dimensions among individuals at risk for psychosis. Of published work in risk samples, most have been cross-sectional, leaving clinical inferences regarding longitudinal patterns non-specific. The current study aimed to bridge this gap by recording ERPs (P300, ERN, N400) across a battery of tasks within a single risk sample, and measured positive, negative, and disorganized symptom severity via the Multidimensional Schizotypy Scale (MSS). Participants exhibiting psychosis-risk were recruited from the community (N=60), and completed a baseline and 6-month follow-up assessment (n=29). The primary goal of the baseline assessment aimed to replicate ERP-symptom dimension relationships observed in the SZ literature. Effect sizes for P300-positive and ERN-negative relationships were observed to be in the same directionality as noted in the clinical SZ literature. While not statistically significant, the small effects suggest that P300 and ERN may be similarly effected by presence of positive and negative symptoms, respectively. By contrast, N400, however, was found to have an effect size directionality opposite to that reported in the literature. This finding is consistent with mixed presentation of disorganized symptoms in clinical SZ populations. The follow-up assessment aimed to examine the relationship of symptom dimensions over time in a single at-risk sample, and leveraged ERPs as potential prospective predictors of worsening of symptoms. As expected, baseline symptoms prospectively predicted corresponding symptoms at follow-up. However, only N400 amplitude at baseline correlated with disorganized symptoms at follow-up, and no ERP prospectively predicted corresponding symptom dimensions at follow-up. Overall, examining the relationship between multiple ERPs and symptom dimensions in a single sample and via a longitudinal design is a novel addition to the literature. Future research will be necessary to clarify the use of ERPs as neural biomarkers to identify and predict symptom severity over time, ultimately reducing subjectivity in clinical diagnosis and treatment. </p>