3 - Psychosis

Question 1

What are the 5 key symptoms of psychosis?

Answer 1

• delusions
• hallucinations
• negative sx (avolition, alogia, anhedonia, amotivation)
• thought disorder
• grossly disorganised behaviour

EITHER:

• subset of these sx (schizophrenia, schizophreniform, brief psychotic dx, delusional dx)
• or these sx and a mood component (schizoaffective, bipolar, depression with psychotic features)

Question 2

Explain the course of psychosis

Answer 2

• experiences and sx are different at different stages
• single episode only: 5-25%
• multiple episodes: 50-80%
• when this happens: sx appraisals become a key factor (it’s happening again; this will happen forever etc.)
• may function well b/w (or even during) episodes > focus on sx management
• incomplete response: 10%+
• least likely outcome

Question 3

How might psychosis assessment differ from other mental disorders?

Answer 3

• client may not have insight

- many sx are assessed by observation/reports of others

Question 4

What is the issue with anti-psychotic drugs?

Answer 4

• do not address the vulnerability or environmental insults > merely block the effects of the abnormal DA system

Question 5

What are the risk factors for psychosis?

Answer 5

DISTAL:

• country of birth
• gender
• genetics (variety of genes)
• viral infection, early developmental anomaly
• SES disadvtange
• urban birth, migration
• developmental abuse/trauma

PROXIMAL

• substance use/abuse (cannabis)
• neurodevelopmental changes
• life events
• critical/intrusive interpersonal rships (high EE)

IMPORTANTLY it is a combo of a number of different biological, social and environmental factors

Question 6

What do you think it might be like to have psychosis?

Answer 6

• reduced self-esteem
• burdensome
• isolated
• vulnerable
• scared (content frightening)
• anxious + fearful (appraisals about future, can’t trust people, I’m going crazy)
• treatment (distressing, lose autonomy, fear)
• after: dealing with what you did whilst psychotic

Question 7

What might you see as a clinician working with someone with psychosis?

Answer 7

POSITIVE SX:

• suspiciousness
• guardedness
• paranoid
• slow to respond, distractible
• client may try to hide sx from you
• may attend to stimuli you can’t see/hear
• can be SUBTLE

NEGATIVE SX:

• reduced range of emotional expression: face, eye contact, speech intonation, hand/head/face movements
• reduced eye contact
• reduced fluency and productivity of speech
• poor functioning

THOUGHT AND BEHAVIOUR

• disorganised/unusual speech
• poor/disorganised functioning (eg. unusual behaviour > wearing warm clothes on hot day; shout/swear with no trigger)

Question 8

What things are important to assess in psychosis?

Answer 8

• frequency intensity + consequences of sx
• appraisal of sx
• observations (self-care, language/speech, -ve sx etc.)
• recent changes in functioning?
• why have they come to tx: what are they/family/friends most worried about?
• has anyone ever told you that you’re paranoid of that you can see/hear things that other people cannot?