Preface

The awareness that psychotic suffering can no longer be considered a disorder that can't be treated is very important for this book. This is why it's very important to deepen the research on its genesis and treatment in the most complete and updated way possible. As Oya Mortan Sevi recalls, compared to the past, now we are also aware of the existence of a continuity among normal beliefs, anomalous experiences and psychotic symptoms: it is a more wide‐ spread phenomenon than what was thought decades ago. In fact, recent research points out that even people considered healthy may manifest mild psychotic symptoms. This creates a growing social interest in this issue, being aware of the fact that psychosis involves a greater part of the population than was previously believed. As Lui Unterrassner emphasizes in his contribution, the interest for the study of subclinical psychosis has now increased, as it could provide critical information on the mechanisms that are involved in the exacerbation of subclin‐ ical symptoms and in maintaining mental health.

In this book, Starlin Mythri rightly points out that psychotic manifestation can be a devastating personal experience because of its ability to rob a person of his/her self-determination and control over his/her behavior. In the interpersonal context, it can damage confidence in the relationship and can decrease the familiarity between the healthy person and the person affected, giving rise to negative interpersonal criticism, and this can even lead to a complete loss of the relationship.

In the wake of these awarenesses, the relational aspects of psychosis have been investigated in various research, and this is important, because, there is a deep intertwining between the cog‐ nitive and relational aspects, and the research on it must therefore be deepened. There is there‐ fore a greater awareness of the fact that psychosis does not only concern individuals, but also their families, as well as the society in which they live: it was therefore essential to take into consideration the psycho-social implications of this disease. Eduardo García-Laredo emphasiz‐ es that research on psychosis highlights the importance of psychosocial factors and family fac‐ tors. Just as we must not neglect the biological aspects, as Abdulwakeel Ayokun-nun Ajao points out: there are indeed interesting perspectives on the new approaches to cure the disease.

From what has been mentioned, it is evident how this book adopts a perspective that respects the complexity of the human person and his/her relationships; it has been highlighted that the central themes in psychotic manifestations and in patient care are the existential anxieties (such as the preoccupation of maintaining one's own identity), find meaning in one's life experience, maintain hope, and for this reason, the assistance to the psychotic person and the care path‐ ways that support the family must be articulated while taking into consideration, in a global manner, all the dimensions of human existence, to be effective and to truly meet the needs of those who suffer. This perspective today finds its roots when George Engel introduced the term "Biopsychosocial Approach" as a privileged way to understand the processes of health and dis‐ ease along the entire existential path and to articulate forms of care. The biopsychosocial model is inspired by the paradigm of complexity, in clear contrast to biomedical reductionism, as well as to the hierarchization of the sciences. It adopts the perspective of the general systems theory developed by Von Bertalanffy [5], which considers a set of interrelated events as a system, which manifests specific functions and properties depending on the level to which it belongs

compared to a more broad level that includes it. The theory of systems maintains that all levels of the organization are connected to one another, so that the change of one affects the change of the other, overcoming the dichotomy between holism and reductionism. Overall, the model re‐ fers to three basic principles: dialogue-connection, relationship, and humility. In other words, it aspires to look at the person in his "whole" as genetic heir (bio), subject of reflection and deci‐ sion (psycho), as well as historical-cultural and family (social) subject. The axioms of the model are focused on understanding diversity, and not setting aside what is considered not to be within its competence. The answers that look for this kind of perspective are global regardless of the point of entry into the system (biological, psychological, social). The usefulness of this model has been confirmed and validated by a now limitless literature, which marks the transi‐ tion from a traditional medical model centered on the biological aspects of the disease to a per‐ son-centered medicine, and it is now widespread knowledge that a biopsychosocial screening, more than a compartmentalised approach to medical and psychosocial models, can help plan a more effective treatment. As a matter of fact, the human being tends to be constituted through the development of complex group systems that affect the three main areas explored by the biopsychosocial model, and any alteration of the patient's health will be characterized by a var‐ iation both in an area and throughout the system overall. Consistently, this book devotes a space both to the deepening of the more strictly biological aspects, the psychological aspects, and the social aspects. Each section of the book (biological, psychological, social) reveals a deep connection with the themes of the other sections, showing the strength of this interweaving. The relationship and the intertwining between different fields are certainly a foundation of our existence and constitute a law that we cannot escape from, so it is necessary that the biopsycho‐ social model is always considered in the interventions for the psychotic patient. Focusing only on one aspect or another can be misleading: to interpret the mental illness exclusively from a neurobiological perspective leads to losing sight of the life experiences of the specific subject, but also, for example, a single sociological reading of the disease can be confusing and partial. Fortunately we can argue that during the last two decades, the psychological interventions that respect this complex optics have become central in psychosocial interventions for patients and their families as they have proved useful in improving various dimensions of Quality of Life. In the light of what emerged we cannot therefore recognize the appropriateness of the proposal of a book that is based on the complex biopsychosocial and relational dimensions, adopting a per‐ spective that integrates the issues related to biology, with the psychological aspects and inter‐ subjective-social topics.

> **Floriana Irtelli** Catholic University of the Sacred Heart Milan, Italy Italian Society of Psychoanalysis of the relationship (SIPRe) Milan, Italy

> Italian Society of Psychoanalysis of the relationship (SIPRe)

**Enrico Vincenti**

**Section 1**

**Psychological Point of View**

Fatebenefratelli Hospital Cernusco sul Naviglio, Italy

Cinisello Balsamo, Italy

**Psychological Point of View**

compared to a more broad level that includes it. The theory of systems maintains that all levels of the organization are connected to one another, so that the change of one affects the change of the other, overcoming the dichotomy between holism and reductionism. Overall, the model re‐ fers to three basic principles: dialogue-connection, relationship, and humility. In other words, it aspires to look at the person in his "whole" as genetic heir (bio), subject of reflection and deci‐ sion (psycho), as well as historical-cultural and family (social) subject. The axioms of the model are focused on understanding diversity, and not setting aside what is considered not to be within its competence. The answers that look for this kind of perspective are global regardless of the point of entry into the system (biological, psychological, social). The usefulness of this model has been confirmed and validated by a now limitless literature, which marks the transi‐ tion from a traditional medical model centered on the biological aspects of the disease to a per‐ son-centered medicine, and it is now widespread knowledge that a biopsychosocial screening, more than a compartmentalised approach to medical and psychosocial models, can help plan a more effective treatment. As a matter of fact, the human being tends to be constituted through the development of complex group systems that affect the three main areas explored by the biopsychosocial model, and any alteration of the patient's health will be characterized by a var‐ iation both in an area and throughout the system overall. Consistently, this book devotes a space both to the deepening of the more strictly biological aspects, the psychological aspects, and the social aspects. Each section of the book (biological, psychological, social) reveals a deep connection with the themes of the other sections, showing the strength of this interweaving. The relationship and the intertwining between different fields are certainly a foundation of our existence and constitute a law that we cannot escape from, so it is necessary that the biopsycho‐ social model is always considered in the interventions for the psychotic patient. Focusing only on one aspect or another can be misleading: to interpret the mental illness exclusively from a neurobiological perspective leads to losing sight of the life experiences of the specific subject, but also, for example, a single sociological reading of the disease can be confusing and partial. Fortunately we can argue that during the last two decades, the psychological interventions that respect this complex optics have become central in psychosocial interventions for patients and their families as they have proved useful in improving various dimensions of Quality of Life. In the light of what emerged we cannot therefore recognize the appropriateness of the proposal of a book that is based on the complex biopsychosocial and relational dimensions, adopting a per‐ spective that integrates the issues related to biology, with the psychological aspects and inter‐

**Floriana Irtelli**

Milan, Italy

Milan, Italy

**Enrico Vincenti**

Fatebenefratelli Hospital Cernusco sul Naviglio, Italy

Cinisello Balsamo, Italy

Catholic University of the Sacred Heart

Italian Society of Psychoanalysis of the relationship (SIPRe)

Italian Society of Psychoanalysis of the relationship (SIPRe)

subjective-social topics.

VIII Preface

**Chapter 1**

**Provisional chapter**

**Subtypes of Psychotic-Like Experiences and Their**

**Subtypes of Psychotic-Like Experiences and Their** 

DOI: 10.5772/intechopen.78691

More recently, the interest in studying subclinical psychosis has increased, as it might provide critical information regarding mechanisms that are implicated in the exacerbation of subclinical symptoms and the maintenance of mental health. However, psychosis research has tended to focus on clinical outcomes and not to differentiate between subtypes of psychotic-like experiences (PLE) that might differ regarding their psychopathological significance. Importantly, this might have obscured a more accurate picture of the complex structure of psychosis and the significance of particular risk and protective factors. Notably, while studies point toward a continuity of psychotic experiences and accompanying factors across the general population, there is evidence indicating that some PLE in healthy individuals might also be associated with a weaker expression of other subclinical symptoms, increased well-being and even resilience to some degree. Importantly, such findings might have implications on strategies in psychosis prevention and therapy, early detection, as well as the construction of continuum models of psychosis. The present chapter aims at drawing together findings that necessitate a more differentiated view and assessment of PLE. It intends to provoke new questions that might offer starting points for future investigations, such as longitudinal studies investigating

**Keywords:** psychotic-like experiences, psychosis continuum, psychosis phenotype, subclinical psychosis, positive symptoms, disorganized symptoms, negative symptoms,

Psychotic disorders such as schizophrenia may feature frightening hallucinations as well as bizarre beliefs and behaviors that not only arouse anxiety in the general public and the media

affective symptoms, well-being, mental health, resilience, risk, specificity

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

**Significance for Mental Health**

**Significance for Mental Health**

Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.78691

the interplay of subclinical symptoms.

Lui Unterrassner

Lui Unterrassner

**Abstract**

**1. Introduction**

#### **Subtypes of Psychotic-Like Experiences and Their Significance for Mental Health Subtypes of Psychotic-Like Experiences and Their Significance for Mental Health**

DOI: 10.5772/intechopen.78691

#### Lui Unterrassner Lui Unterrassner

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.78691

#### **Abstract**

More recently, the interest in studying subclinical psychosis has increased, as it might provide critical information regarding mechanisms that are implicated in the exacerbation of subclinical symptoms and the maintenance of mental health. However, psychosis research has tended to focus on clinical outcomes and not to differentiate between subtypes of psychotic-like experiences (PLE) that might differ regarding their psychopathological significance. Importantly, this might have obscured a more accurate picture of the complex structure of psychosis and the significance of particular risk and protective factors. Notably, while studies point toward a continuity of psychotic experiences and accompanying factors across the general population, there is evidence indicating that some PLE in healthy individuals might also be associated with a weaker expression of other subclinical symptoms, increased well-being and even resilience to some degree. Importantly, such findings might have implications on strategies in psychosis prevention and therapy, early detection, as well as the construction of continuum models of psychosis. The present chapter aims at drawing together findings that necessitate a more differentiated view and assessment of PLE. It intends to provoke new questions that might offer starting points for future investigations, such as longitudinal studies investigating the interplay of subclinical symptoms.

**Keywords:** psychotic-like experiences, psychosis continuum, psychosis phenotype, subclinical psychosis, positive symptoms, disorganized symptoms, negative symptoms, affective symptoms, well-being, mental health, resilience, risk, specificity
