WEBVTT

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[MUSIC PLAYING]

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So psychosis is relatively
easy to understand.

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It simply refers to people
who have hallucinations,

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that say they hear things,
or they see things.

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Predominantly, they
hear things, voices,

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or they have strange ideas,
which are false ideas.

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And they hold on to
these with great fervour.

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And we call these delusions.

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There's a range from really
quite acute onset to insidious,

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little by little, over a period
of maybe a year or maybe even

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two or more years.

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We know a lot about the
causes of psychosis.

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We know, for example, there
is family predisposition.

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You don't inherit a gene
that says definitely you're

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going to develop psychosis or
the severe type schizophrenia,

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but you may inherit
a vulnerability.

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But you don't go psychotic
just for genetic reasons.

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You have to have some
environmental problems.

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And the environmental
problems can be developmental.

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We know, for example, that
babies who are born prematurely

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or babies who were born whose
mothers have a particularly

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difficult labour, we know that
these can impact on the cortex,

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the grey matter of the
brain as it's developing,

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and that maybe messes up some
of the connections in the brain.

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Surprisingly, that can
remained mostly silent

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throughout childhood.

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And then after puberty,
after adolescence,

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it can come to the surface.

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Then we know also that adversity
or a range of difficult times,

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for example, a parent dying, or
being separated from a parent,

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or having a range of
difficulties in childhood.

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If you have a nice
happy childhood,

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that diminishes your risk of
all psychiatric disorders.

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If you have an
unhappy childhood,

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that increases your risk.

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And it increases your
risk of psychosis a bit.

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It's not the biggest
factor, but it

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does contribute in some people.

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Then we also have drug use.

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And a range of
drugs can increased

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risk of psychosis, not heroin,
not alcohol, not barbiturates,

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but say amphetamines, cocaine,
and cannabis, in particularly.

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You may have taken drugs or
you may have a family history,

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but you're getting
on OK, but the thing

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that might tip you
over the edge would

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be if you had some adverse
life event, particularly

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a threatening one.

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If you're bullied at
work, if you're assaulted,

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then that may be more likely to
provoke a psychosis, as well.

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So there's all these different
risk factors, we call them.

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We really have learned a lot
about psychosis in the last 10

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years.

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Actually, much more in
the last 10 years then

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all the other years that
I've worked in psychiatry.

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And one of the
things we've learned

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is that when people
are psychotic,

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they have too much
dopamine being

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released in the their midbrain.

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Now what does dopamine do?

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Dopamine grabs your attention.

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For example, if you play the
lottery and each week you look

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to see whether your numbers
come up, you're sort of looking,

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not really bothered, but when
you realise it's your number,

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you release dopamine.

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So it's something that
grabs your attention.

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Actually, a good thing or a
bad thing releases dopamine.

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But if you're running on too
much dopamine all the time,

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then all sorts of things
are grabbing your attention.

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You think, why did I
see all these red cars?

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Why are people wearing jumpers?

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Does this mean there's danger?

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Why are these people whispering?

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Are they whispering about me?

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So the excess dopamine makes you
think insignificant things are

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significant.

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The antipsychotics,
they block this dopamine

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and diminish all these
experience that people have.

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We've also learned that
although dopamine is involved,

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you need to just use the
minimum dose of antipsychotics

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that is necessary and
not knock-out people

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with an antipsychotic.

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When somebody comes
for help, first of all,

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you've got to find which
particular problems have

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provoked their illness.

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Psychosis is not all biological
or not all psychological,

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but there's an interaction.

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And therefore, it's important
in treating somebody

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with psychosis, that you deal
with all the different aspects

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of the problem, that you deal
with the imbalance of dopamine

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in the brain, which is
being caused by the stress.

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You deal with that
with medication,

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but we also need
to find out what's

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the underlying stress, what
is it that is really worrying

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the patient, and therefore
a more psychosocial approach

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is useful.

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So a multi-disciplinary
approach would be the ideal.

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There is the professional
team who can help the patient.

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But, of course,
the important thing

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is for the patient to have help
and support in the community.

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And this is where the
family is most important.

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People who have the
best outlook are those

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who have supportive family.

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And, of course, it's
important for psychiatrists

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and psychologists to involve
the patient and the patient's

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relatives in decisions.

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I would say to families,
you should keep pushing

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and ensure that your
relative does have access

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to the best pharmacological
treatment, the best

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psychological treatment, that
they get some social help,

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and that they keep busy.

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The worst thing is to be staring
at the wall, hallucinating.

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Even going down shopping,
or going out and doing

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a little part-time voluntary
job, or going to the gym,

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going to a football
match, anything

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to stop one just thinking
about one's paranoid delusions,

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activity is important.

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And, of course, also
for physical health.

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But, I think, with the correct
treatment and encouragement

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from the mental health
services, most people

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can recover to a
considerable extent

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and some people can go back
to a pretty normal life.

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And, of course, what do
people with psychosis want?

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The same as the rest
of us, somewhere

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decent to live, a job, and a
family, and a relationship.

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So these are the things that
we should be trying and pushing

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people towards.

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