Psychosis 101

What is psychosis?

Psychosis has many definitions, but most refer to a breakdown that occurs in the ability of a person to form a coherent sense of reality, manifesting as false perceptions (hallucinations) or false beliefs that are not shared by others (delusions). It is often referred to as 'reality distortion.' It should be pointed out that not every hallucination or delusion is a sign of psychosis, and the determination of what makes a belief or perception true or false rests upon the assumption of a shared sense of what constitutes reality. At a philosophical or political level, people will dispute the nature of reality, but we take a primarily medical/normative approach, where these disputes have little relevance. In this approach, individuals have experiences that fall outside of their regular cultural context and are associated with both an impaired ability to function and distress. These sorts of experiences with reality distortion commonly occur with other 'symptoms,' such as depression and anxiety.  The most common diagnostic labels we use for psychotic experiences include: schizophrenia, schizoaffective disorder, or sometimes, just 'unspecified psychosis,' when a person's experience does not fit neatly into the categories defined in the Diagnostic and Statistical Manual (DSM-5). For more information about psychosis and schizophrenia, you can watch the video below. Understanding what happens in the brain to cause psychosis, and finding better ways to treat it, has been one of the central themes of my research.

Psychosis 101

PREP Early Psychosis Clinic

Program for Risk Evaluation and Prevention (PREP) Early Psychosis Clinic

Founded by Dr. Stephan Taylor in 2013, PREP provides evaluations, research, and treatment for adolescents and young adults (14+) in the early stages of psychosis, or those who show signs of the Attenuated Psychosis Syndrome (APS). The clinic includes 5 faculty members, 2 post-doctoral fellows, 2 social workers, and usually 1 pre-doctoral psychology practicum student. The clinical operation is directed by Dr. Cynthia Burton. The UM PREP clinic is the only program in Michigan focusing on APS individuals, serving as a referral source for evaluations sought by primary care providers, other mental health practitioners, and school-based counselors. 

Learning Health Care System for Optimizing Care of Early Psychosis

EPINET is a national learning health care system for early psychosis. EPINET links early psychosis clinics through standard clinical measures, uniform data collection methods, data sharing agreements, and integration of client-level data across service users and clinics. Clients and their families, clinicians, health care administrators, and scientific experts partner within EPINET to improve early psychosis care and conduct large-scale, practice-based research.

Initiated in 2019 and sponsored by the National Institute of Mental Health (NIMH), the EPINET initiative includes 8 Regional Hubs, 101 early psychosis clinics across 17 states, and the EPINET National Data Coordinating Center (ENDCC).

Early Detection, Intervention and Prevention of Psychosis Program (EDIPPP)

The Early Detection and Intervention for the Prevention of Psychosis Program (EDIPPP) was designed to test the effectiveness of early detection and preventive intervention (e.g. PIER in Greater Portland, ME) across the United States in a large, ethnically, and geographically diverse population, in 6 typical mental health agencies and settings. The goal was to evaluate whether early intervention, ie, prior to onset of psychosis, with young people at clinical high risk could delay or prevent the development of frank psychosis and reduce functional impairment, in typical and diverse populations and clinical settings. It will also generate rapid referrals of youths at clinical high risk of psychosis by creating a network of professionals and community members trained to identify signs of early psychosis.

Research in Psychosis

Completed Studies

Taylor et al, Biological Psychiatry, 2012

Heightened stress sensitivity is a common characteristic of schizophrenia and may be predictive of clinical and functional outcomes.

We have developed a new scale for the assessment of psychological stress in psychosis (Psychological Stress Index; PSI). This work shows that both of the 18-item and 9-item PSI demonstrated good levels of reliability and could significantly discriminate patients from healthy controls. Both versions showed moderate convergence with self-report and clinician ratings of depression and anxiety, and superior predictive validity of 12-month follow-up clinical and functional outcomes compared to an existing measure of stress (Perceived Stress Scale).

Self-assessment of psychological stress in schizophrenia: Preliminary evidence of reliability and validity, published in Psychiatry Research
This table  shows that both of the 18-item and 9-item PSI demonstrated good levels of reliability and could significantly discriminate patients from healthy controls.