1. 1 Stress Vulnerability and Psychosis Manchester Mental Health & Social Care Trust

2. 2 Aims & Objectives To gain an understanding of the possible causes of schizophrenia. To have an understanding of the relationship between vulnerability and stress. To begin to identify those young people who might be vulnerable to developing psychosis. To identify stress factors that might contribute to the onset of a mental health problem.

3. 3 Causes of Schizophrenia The relationship between the psychology of the mind and the structure of the brain is as yet unclear. The nature-nurture debate persists as the contributions of both are presented as possible causes of schizophrenia.

4. 4 Causes of Schizophrenia Over the years many different causes have been considered to explain the development of schizophrenia. These have included biological causes, including genetic factors and the structure of the brain and psychological factors – thinking patterns that might cause problems.

5. 5 Biological Sources of Vulnerability Genetically based – however, 60% of clients do not have a relative with the illness. 10% of one parent has the illness(Gottesman 1990),9% have a sibling with the illness. This compares to an overall figure of 1% of the population generally (Sartorious et al 1986) Biochemical abnormalities – Dopamine appears to be significant in the development of psychosis. For instance, drugs such as amphetamine (speed) that increases dopamine levels can induce psychotic episodes.

6. 6 Biological Sources of Vulnerability Abnormal brain structure – The lateral ventricles of the brain are often larger in those with psychosis. Other possibilities being investigated by neuro-psychiatrists include the pattern of blood flow and the electrical activity in the brain Environmental influences, such as viruses or difficulties in birth have been considered. There is no conclusive evidence of any causal link.

7. 7 Psychological Vulnerability Information processing problems refer to specific phenomena that might contribute to the development of psychotic experiences: ‘Cognitive deficits’ - impairments of such processes as perception, memory and attention.The causes of this could be as a result of trauma, abuse or social isolation. ‘Cognitive biases' – This is a normal process and occurs when more attention is given to some elements of information, memories or experiences than others.

8. 8 Stress Vulnerability Both psychological and biological factors are thought to contribute to the onset of psychosis. Those who do not have high levels of vulnerability are less likely to develop psychological problems when high stress levels are present. When stress levels increase, those individuals who are more vulnerable might be more likely to experience problems.

9. 9 Stress Vulnerability The presence of psychosis is similar to other forms of mental health problems such as anxiety and depression in that it is on a continuum. The more vulnerable someone is and the more stress they experience then the more likely they are to experience more distressing symptoms. The stress – vulnerability model explains why it is that some people might experience psychosis and others do not.

10. 10 Group Work In small groups generate a list of those issues or events that young people might experience that causes them stress. Within this exercise consider the following:  Physical stresses that young people place upon their bodies.  Environmental stresses young people might be subject to.  Emotional stresses  Are these stress factors short or long term?

11. 11 Sources of Stress  Physical Stress - Late nights, binge drinking, illicit drug use, lack of routine, poor diet, illness  Environmental Stress – Poor housing, social isolation, unemployment, new environments to adjust to such as moving house or holidays  Emotional Stress - relationship problems, peer pressure, high expressed emotion within the family home, conflicting cultural values and beliefs, leaving home, marriage.

12. 12 Sources of Stress  Acute Life Events – Bereavements, Physical illness / accidents, arrest / imprisonment, fights, pregnancy and childbirth, rape and assault.  Chronic Stress – Accommodation problems, debts, prolonged use of drugs / alcohol, social anxiety.

13. 13 Stress Vulnerability Low High ILLNESS WELLNESS Zubin& Spring (1977) Model of Stress Vulnerability

14. 14 The Stress Vulnerability ‘Bucket’ Smoking Joints Staying out late clubbing and not getting enough sleep Stress of exams Debts building up Brabben & Turkington 2002

15. 15 Group work Using the case study provided, outline those factors which you think contribute to this persons’ vulnerability. Consider stress factors which will affect the possibility of the person experiencing a mental health problem.

16. 16 Interview skills In groups of three, one person needs to take the role of a young person. This might be someone you know, Monica in the case study or you can ‘invent’ this person as you go along. Another person has the task of interviewing Monica The aim is to elicit the level of vulnerability and current chronic and acute stresses of this young person. The third person takes the role of observer/ scribe.

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18. 18 Conclusions Although there are many theories concerning the cause of schizophrenia none of these are conclusive. The concept of the relationship between vulnerability and stress seems a plausable model. The stress - vulnerability model can assist in the engagement process with clients as a method of understanding why levels of stress should be monitored.