How psychosis occurs in Schizophrenia (as simple as I can make it)

[@S1lentBob]

I love how you went from funny video man to this honestly. i still love the sketch stuff, but as a med student who sometimes really isn't happy with the personalities i encounter in this field on a daily basis, i'm really grateful for your insights on issues like this and healthcare in general, it just seems to come from a very genuine place

[@itspresro]

Thanks dude, I am opening up my platform to really talk about whatever I think is relevant, funny or interesting. I think it’s more genuine that way, like you said. Thanks for being here!

[@micah8101]

i was just thinking the same thing. Im only a pre med working in the ED as a scribe and to see the behavior and attitudes of some of the doctors/nurses has been a real slap in the face. Its nice to know that there a doctors out there that have the mindset i hope to have.

[@avgstudent4.0]

As a freshman in college, I can confirm this makes sense.

[@itspresro]

Target audience reached!

[@im1385]

I have mental illness, so was fully prepared to feel queasy about this explanation - but it was honestly amazing. I've dated more than one person with schizophrenia and it's a life sentence of horror. I think the way you humanized the propensity toward salience attribution errors was stunning. 10/10. We need doctors like you running the show once the old guard dies out. It’s sorely needed.

[@mick2317]

Thank you so much. I am an IM resident and honestly, this really will help me contextualize my interactions with many of my patients. You explained it so well-any chance you want to do academic medicine? Because you would be great at it.

[@itspresro]

Yeah I’m almost certainly gonna end up in academics

[@misteratoz]

Hospitalist here....I learned a lot.. thank you again

[@steviereads4267]

Thank you for this. I am a final year medical student at an international program studying in Hungary. My main study language is English, but I'm competent enough in Hungarian to be able to understand and interact with psychiatric patients here. I've seen schizophrenia before, heard patients speaking to angels, believing they work for Elon Musk, and know the elites are freezing their clones for future takeover of the world after the AI age. This was all in Hungarian. Recently an American citizen ended up in our psychiatric ward. Hearing all of these delusions in "my own" accents and words made this all too real. I felt, for the first time, an immense sadness for the condition. I've been wanting to follow psychiatry since beginning medicine, but this experience really solidified the horror and pain that psychiatric patients can go through, and my want and belief that they need help. I hope to be able to provide that for them.

[@Vade_mecum_]

Wow. This is such a powerful experience that it deserves a blog post! Good luck on your journey to help patients suffering from mental health problems.

[@Jackie.B.]

One of my siblings is schizophrenic and I had a psychotic episode in my 20s. It was really cool to hear more about the neuro/bio aspect of what we experience/d

[@spazcrunch]

AMAZING video!! Please do more for other common conditions - BPAD, anxiety, depression etc

[@Mothwasher]

Incredibly well thought out and gracious. Thank you for making this Anecdotally (and hopefully just adding some thoughts to the kind contributions so far), the degree to which causality or relation is being applied to an experience varies pretty significantly. There are combinatorial states of existence across overactive and underactive limbic and cortical processes, meaning there can be rational thought and/or emotional regulation happening some days and other days are much harder. Then, there are attempts to piece together the memories and feelings in a way that constitutes reality. It gets very fuzzy very quickly. An event one day with longstanding consequences could introduce challenges to easier days.

[@orlandonavarroalarcon1992]

I’m a RN. My eldest brother suffered schizophrenia for more than a decade. It is the most painful thing. We went through everything with him but couldn’t help him beyond what was available. He left home around 2 years ago and he now lives in NYC and is probably homeless at best. He thinks we are monsters and hates us. There’s not a day where we don’t think if maybe we had done this and that … I definitely don’t wish this to anyone and I hope that someday we can find a better treatment one day 😔

[@BecomingAMan]

Thank you, Professor Preston

[@barryjudge3065]

Excellent, excellent. Not only does this give a really nice overview, but actually let's us imagine what we would be experiencing if we were experiencing psychosis. Which is a really hard thing to do.

[@henne8890]

Last year I experienced psychosis during med school. I was in clinic for almost two months. Luckily, it was just one episode not linked to bipolar (it was a maniac episode with paranoid delusions) or schizophrenia. Nevertheless it was a life-changing experience and I am considering going into neuro or psych.

[@JAYZ999]

amazing how I knew most of this for my step 1 but I feel like it only JUST clicked.

[@castellijm]

Very interesting and well explained. I'd love to see this become a series. The way you break everything down is excellent!

[@sldenn5303]

I agree!!

[@turtguyakadanz]

I wish I had this back in med school man, awesome stuff!

[@V4NSCLAN]

Please do a whole series (as often as possible) breaking down and explaining certain diseases and concepts just the way you did this!!! I loved the explanation alongside the presentations of these diseases/ailments alongside the analogies / examples !

[@pantsofbattle]

This is a really intuitive and satisfying way of understanding cause and effect in schizophrenia. Thank you!

[@hunter1029016]

Dude. This was great. I'd love to see more videos from you talking about different disease processes

[@francischic7854]

Thank you so much Preston, it's amazing to have access to free material online for general information this in depth. It's exposure to content like this that truly motivates pre meds (myself included) to pursue their own careers in medicine!

[@bell10877]

This is fascinating. I'm amazed I can follow this because you are talking very fast and usually I find that a challe ge to follow in other people. My late mother had schizophrenia and the treatments back then were bad and also probably she didn't get treated early enough to have that healing you describe. I lived alone with her since birth so you can imagine that was quite a ride for me. Meanwhile one of my dearest friends ( we are in our forties) was diagnosed with schizophrenia about 15 years ago and he has been well treated and it was got early and he seems to have had the healing impact you describe in early treatment. He is so well you would hardly know..he works a good job that he reasonably enjoys and has a lovely girlfriend now etc... My mum couldn't work etc. Thank you and best wishes with your work.

[@iansnyder9031]

Preston, not sure if you remember me - I rotated with you on consult psych this past July for my audition rotation. Just discovered that you have this awesome channel! I remember seeing schizophrenic patients with you and thinking how much professional insight you had as a resident that gave me something to look up to! Just been watching some of these videos for motivation as I finalize my match application. Hope to have the chance to work with you again sometime in the future!

[@robertmotr]

im an undergrad CS student who has a huge interest in neuroscience. thank you for this it was such an interesting watch!!!

[@jeremiahbaker6396]

❤ I'm about to do my 1st Psych rotation. So this is literally so well timed

[@YoungTatertot]

This was such an eye opening video for me, I really like this format

[@Chris-ze7el]

Presssssttttooooon i would love to see your take on the video featuring Dr. Mike and Dr. Kanojia.

[@itspresro]

What video is this?

[@Chris-ze7el]

@@itspresro kzbin.info/www/bejne/sKWZmmmsi8ychZY Its an interesting take on how some aspects of eastern medicine are focused on the individual and how that could potentially be used in western medicine. It sort of critiques how we look as things from a population perspective and the biases errors we encounter but also shortcomings of the eastern perspective. Hope you're doing well dude.

[@Chris-ze7el]

@@itspresro kzbin.info/www/bejne/sKWZmmmsi8ychZY Its a good video looking at the debate between the population based approach that western med takes versus and more individualistic seen in eastern medicine. Dr. K is also a psychiatrist and i thought you might find his perspective interesting. Hope you're doing well.

[@enacte]

Great video, can you explain more about why it tends to manifest in the 20s and the genetic influences. I'd also live to hear about the specific phenotypes that are being identified now that make it a spectrum disorder. Also love to hear you do ASD too! Amazing content tbh

[@hiimpercy]

A great review. I'm going to keep it in mind for my students. I once saw a piece of art done by a person under treatment for schizophrenia. They illustrated how once things seemed limned in significance for them - a pencil, a syringe would be almost glowing blue with importance. They stated things were better now, but they missed when things had meaning. That stuck with me. When your brain is freely interpreting importance without applying rules, the world seems more magical. Frightening - but magical.

[@sable428]

Preston, please keep doing educational videos, especially if it allows you to be more active on your socials. I enjoyed this video a lot and gleaned good insight from it. - love, nursing student

[@patrickl1371]

Med Surg nurse at a community hospital, this video is a fantastic resource. Thank you, Preston!

[@happytobehere-o4j]

Preston you’re a phenomenal teacher! I’m a M2, this is such a great simplified explanation but still so accurate.

[@levone8958]

Thanks for showing this and explaining all the neurology behind it. I work with people with this illness a lot and everything you describe is spot on. It makes me feel very sorry for them. The way we deal with people in psychosis usually involves 4 point restraints and a ton or involuntary medication. I can’t imagine what the person experiencing that is feeling.

[@AngeNoua]

I just had my exam on that about 30 mins ago! great timing mate!

[@anilkalyoncu1]

I really liked this explanation for schizophrenia and you literally described the malfunctioning salience network and prediction/prediction error system.

[@kahlandar21]

This is amazing. Already showin it to a couple of my Peers (canadian paramedics) and my wife plans to show it to the paramedic class she teaches, as they are doing mental health this week

[@naturallynadine5897]

I’m in nursing school and taking mental health in next month. This is useful. Make more!

[@BethanySchwarz5678]

When I worked at a homeless shelter there was a good amount of people who had some sort of delusional-related disorder. It was always sad because they were so scared and it ended up making them more likely to get assault charges because they were incapable of trusting others. And then court fines and charges on your record and everything else that comes with, they were set up for failure just because they were lost.

[@SemperCuriosus_]

As just a simple FM resident this was fantastic, thank you.

[@aacc8466]

Thank You!!! This makes so much sense. I am currently in my Psych rotation, and this is clarified butter to me!

[@keepgoing.b]

Hey!!! Just took the MCAT today and wanted to say how inspiring/insightful your videos have been for me - thank you!!!!!!! Sending the best vibes from Iowa 🤠🤠🤠

[@savannah4439]

When you asked us what 3-letter entity a reasonable person would conclude had an omniscient presence, I was like “…god?” Then you said “the CIA or the FBI” 😂😂

[@Batman881-w1t]

This video is awesome and helped me grasp schizophrenia so much better, thank you. I referenced it in my psychology class too and my teacher loved it😂. Keep it up Doc.

[@airraidband]

I love this new direction of content you are moving in. Would you be interested in doing a similar breakdown of generalized anxiety disorder? As a med student who suffers from GAD that would be amazing

[@UUwUU80]

Is it just me or is Preston’s hair getting more and more wild as time progresses?

[@jaitron1]

I'm on my psych rotation right now. Thank you very much

[@matt6768]

I’d love more videos like this. This was great

[@mjackstewart]

Even with flat affect, you’re still adorable! Oh, and wicked smaht. 😂

[@pedropabloleteliercamus4533]

Great video man! Never seen that triangle explanation/theory, but it seems pretty intuitive. You got a source for that? I'd love to read more on it

[@NerfNZ]

Good timing bro, got my 3rd year neuro exam tomorrow. Nice summary, its held solidify knowledge. Also solidified that lecturer's sometimes take a bit long to teach a concept

[@itspresro]

A lot of lecturers just need to get to the point, granted this video is really fast and dense haha

[@yeehawtomahawk]

Excellent video

[@shahdmaki761]

I'm just a 12 th grader and omg this is amazing like I fully understood so plz plz start making explanation vids on medical topics like u're so good with explanation 😭😭

[@meganmattu]

Great work 👏🏽 you did an excellent job at explaining this

[@eunjaelee8027]

Hi Preston, could you share your thoughts on the Bondi stabbing that happened last weekend? I'm a 4th year student in Australia and I just finished my psych rotation. I got to see so many psychiatrists and clinicians working so hard to care for those in need, and it's heartbreaking that such incident can still happen. Is there even a more effective way to do risk assessment? Are we missing something in our current approach?

[@aydenr5467]

Care to give your two cents to Matt Ball's term named Dissociachotic and his explanation of it? I'd love to get your perspective. It appears to be a way to understand psychosis through the frame of dissociation and survival responses.

[@danaandiris]

sooo crazy interesting i love this explanation im so ready to work in psych !

[@melissaeberling1333]

I have tried simplifying this to explain to many people for years... I am blown away. Do you do workshops? Or if we did a zoom for 20-100 please let us know we are just outside DC part of a movement and 4 US by US CommUNITY This is imperitive to social injustice we have too many undiagnosed as well. But this explains for anyone, I spent years of self study but I struggled with bullet pointing. We are absolutely in awe. Please we need to get you to national organizations This ties into some other stuff theres a large study. Warrior Within US Project - awareness empowerment- advocacy. We will be in DC 5.11.25 with M.O.M.S. movement Having events all over the country. Let's make one with you! Or even that Natl event weekend How do we reach you or your management team

[@shymron]

Great explanation

[@J_MHequi]

Beautifully done

[@pablop.7635]

I wish I liked psych more. It's a growing field, has a very high potential in research and it provides benefit for a big chunk of the population. And the pay is very attractive.

[@sarahmihuc3993]

I have some follow up questions if you're interested... (But I can also just google this myself) What do we know about what causes it? How prevalent is it in the population? Is it purely genetic or also involves some environmental triggers like trauma, neglect and ACEs etc? Based on my personal experience with friends who have it, I'd guess it's a combo of both? I wonder if there's maybe a slightly higher rate of it where I grew up, due to environment and/or genetics - it's at least 1 in 150 among people I grew up with, which is higher than what Google said for the general population. We are a pretty isolated rural area, almost all people from the same ethnic background, and the area has some problems economically and with high rates of trauma/abuse, substance use, etc.

[@Arun118Official]

amazing explanation

[@jableshoward6572]

If there’s an overactive NMDA issue, when not use like memantine for schizophrenia treatment?

[@amberwyman3176]

This explanation was so helpful!!

[@myboatforacar]

What is your opinion on dopamine's role in reinforcement learning? Is it at all related to this? It's been a hot minute since I took psych classes and I've always wondered if there was a connection.

[@kdawgman21]

Preston, please make more videos like this. That is all

[@meee2014]

so how would you explain the auditory/visual hallucinations? like is that stuff self generated in the respective cortical lobes? or does it come from somewhere deeper in the middle brain?

[@elijahsmith5683]

Thank you for this explanation

[@samroberts7815]

"Freshman at college level" "The frontal lobe is where you do the thinky think"

[@DeltaVxx]

can you do one on anxiety and panic disorder???!!! Also derealization and depersonalization as a result of panic!!!! So under addressed!!

[@ayyyy_lmao]

I am said to have treatment resistant scz, I don't exactly agree but hope to be an MD someday. more doctors need lived experience.

[@nathanzaroban156]

Thank you for this.

[@enacte]

What do you think of the interaction between schizophrenia and karl fristons free energy principle which describes the disorder as a failure of prediction error identification and salience?

[@Widda68]

Where does the reuptake of serotonin occur? In what area of the brain are panic attacks born? Have you ever researched and studied the brain of a stickleback? They produce really curious behaviors.

[@LeonieLawliet]

Presro! Explain bipolar to us please!

[@LoneWolf343]

Any commentary on the idea that schizophrenia has an autoimmune origin?

[@DennisBolanos]

Is the nucleus accumbens involved in the symptoms of schizophrenia?

[@AngeNoua]

i'd say yes becasue the N.A deals with reward system and Shizophrenia is loss of memory from increase d2 receptors. so yes, it is a contributing structure :)

[@JAYZ999]

yes its part of the mesolimbic pathway

[@PhilippMehr]

Hey! Schizophrenia can be triggered or enhanced be life events. What is the function of those ndma neurons that go haywire? Is there a reason in the prozessing of those life events that those neurons get overloded?

[@itspresro]

A lot of glutamate neurons and NMDA receptors are implicated in stress responses

[@PhilippMehr]

@@itspresro thank you so much for your kind response! KZbin realy is a wonderful invention. One aquaintances of mine developed a depression and another a psychosis after a life event and they asked me, why the Depression stayed although the life event was long over. I tried to explain, that organs have their job in handling different kinds of stressors. The liver is for detox, bones help us against forces and the brain helps us recognize and prozess things to act on. And as the bones can break when overloaded, the neurons in the brain can become overloaded, too. Healing of those Traumas takes a lot langer than the impact itself and sometimes it needs medical care to not get irreversibel damaged. That sounded logical to me, but Im only a therapist and not a psychiatrist. And I had no idea, if my metaphor had any base in reality

[@itspresro]

@@PhilippMehr your metaphor works well for helping your clients! I think one further distinction I would make is between the brain and the mind and the person. You (the person) live inside your mind, your mind can dysfunction and tell you things that aren’t right. Your mind, is seated inside your brain which is also susceptible to misfiring. When you have attacks on the person (trauma) it’s gonna affect the mind and the brain causing neuronal damage, and when you have primary damage to the brain (like a TBI) it’s gonna effect the mind and the person

[@kamdiy2]

Studying brain and behaviour right now. Do you see patients where the connection to the object is disrupted? Would it be more of a paranoia that something somewhere is following me but I don't know what?

[@ocnus1.61]

To me it's as though your "mental immune system" becoming autoimmune.

[@raaaaney]

Thanks so much Preston

[@waineph]

Depression next!

[@nibirugami]

maybe it had a survival advantage a whiiiiile ago, and with time we lost knowledge on how to deal with it, like from when the world wasn’t societies and humanity and such like when it was still survival and all

[@jmanzo2009]

What causes the verbal diarrhea? Or is that a separate symptom of psychosis?

[@jmanzo2009]

From what I gathered from the video it could be overstimulation of inhibitory neurons or the deactivation of the miso-cortical pathway?

[@aidancurran4399]

GOAT

[@moosemoose5003]

Man my step 1 is on november!!! Pray everybody!! I dont think praying helps but what if it does? i dont wanna leave any stones unturned!!! By the way great explanation!!you are a great teacher preston!!love your work in this space!

[@NarutoUzumaki-vc4wy]

Bro thinks he’s slick using us as for his Feynman Technique.. Kidding keep doing it…

[@szxnv]

:)