Sławomir Murawiec

Zjawiska psychologiczne w początkowym okresie leczenia psychoz schizofrenicznych w kontekście teorii powstawania i leczenia psychoz S. Kapura — doniesienie wstępne             35

Psychological phenomena in the first two weeks of pharmacotherapy of schizophrenic patients in the context of S. Kapur's psychosis as aberrant salience theory — preliminary report   35

Streszczenie

W artykule przedstawiono podstawowe założenia teorii powstawania i leczenia psychoz S. Kapura, profesora na uniwersytecie w Toronto w Kanadzie. Zgodnie z prezentowaną teorią oraz badaniami, w leczeniu psychoz psychoterapia okazuje się elementem niezbędnym. Autor stara się odpowiedzieć na istotne pytania dotyczące

wzajemnych zależności między różnymi czynnikami obecnymi w postępowaniu terapeutycznym wobec tych pacjentów.

Summary

Introduction. According to the theory proposed by S. Kapur, psychosis is a state of aberrant salience. Dopamine and mesolimbic system play the key role in the occurrence of psychosis. According to Kapur dopamine mediates the conversion of neural representations of an external stimulus from a neutral into attractive or aversive. In the psychotic state this

physiological role of dopamine is changed. Dopamine starts to create a process of salience acquisition, instead of mediating it, as it is in normal circumstances. According to Kapur, delusions are cognitive explanations that the individual imposes on the experience of aberrant salience. Pharmacological agents share the psychological effect - dampening salience. But antipsychotics only provide the state of attenuated salience and symptomatic improvement need further psychological and cognitive resolution.

Subjects and method. Four cases of patients hospitalized because of first or second episode of schizophrenia were observed and the resolution of symptoms was carefully recorded. In addition the PANSS scale and Drug Appraisal Inventory were administered to the patients.

Results. Several psychological phenomena were noted like: patients cognitive efforts to deal with psychosis and recovery process, the verbal way of describing symptoms resolution, attribution of symptomatic change to understandable for patients factors, rationalization and defence of content of psychosis, personal assessment of psychosis and the subjective worsening of symptoms in the presence of symptomatic improvement.

Conclusions. The theory of psychosis as a state of aberrant salience may provide us with a useful framework to analyse the subjective experience of patients in the early stages of symptoms resolution at the first week of pharmacotherapy of psychotic patients.