Introduction to and early intervention in Psychosis

Question 1

How is Psychosis defined?

Answer 1

A medical word used to describe mental health problems that stop a person thinking clearly, telling the difference between reality and their imagination and acting in a normal way.

Question 2

What are the two most well known symptoms that are characteristic of psychosis?

Answer 2

Hallucinations – where a person hears, sees (and in some cases
smells) things that are not really there; an example would be a
person hearing voices speaking to them when there is no-one there

Delusions – where a person holds strong beliefs that others around
them do not share. An example would be a belief that there is a
conspiracy against them by the CIA, or that someone else is
controlling their thoughts.

Question 3

What are the main delusional themes that occur in Psychosis?

Answer 3

*Persecutory
*Grandiose
*Ideas of reference

Question 4

What are some of the negative symptoms of psychosis?

Answer 4

*Anhedonia – inability to feel pleasure
*Amotivation/avolition – lack of energy to engage in goal directed activities
*Apathy – flat affect
*Alogia – poverty of speech and poverty of content of speech
*Asociality – impairments in social relationships, withdrawal from others

Question 5

What are some of the cognitive difficulties of psychosis?

Answer 5

*Executive functions
*Attention
*Memory
*Thought disorder
*Flight of ideas – leaping from one topic to another
*Perseveration – persistent repetition of words
*Pressure of speech – Rapid speech with no pauses

Question 6

What are some examples of psychotic disorders?

Answer 6

Schizophrenia
Schizoaffective disorder
Schizophreniform disorder
Delusional disorder
Bipolar Affective disorder with psychotic features
Major depressive disorder with psychotic features

Question 7

What are some of the diagnostic criteria of schizophrenia?

Answer 7

Delusions
Hallucinations
Disorganised speech
Grossly disorganised or catatonic behaviour
Negative symptoms such as diminished emotional expression.

Question 8

What key factors are present in schizophrenia in the pentagon diagram?

Answer 8

Psychosis
Negative symptoms
Cognitive impairment

Question 9

What key factors are present in bipolar disorder in the pentagon diagram?

Answer 9

Psychosis and mania

Question 10

What key factors are present in schizoaffective disorder in the pentagon diagram?

Answer 10

Psychosis and negative symptoms

Question 11

What’s the definition of ethnicity?

Answer 11

Ethnicity refers to an individuals sense of belonging to a group of people sharing a common origin and history, along with similar social and cultural beliefs. It also refers to an individuals shared decent, aspirations and behavioural norms. It may also imply national or geographical origin.

Question 12

What are some of the demographics of psychosis?

Answer 12

Male
Ethnic minority
Family history of sever mental health problems
Parental poverty
Perinatal risk factors

Question 13

What are some of the risk factors to the onset of psychosis?

Answer 13

Stress
Unemployment/educational difficulties
Ethnic discrimination
Isolated
Substance use
Physical health factors
Childhood trauma
Problems with parental communication

Question 14

What did the Kapur and Van Os (2009) study show

Answer 14

Twin studies show that psychosis has a heritability rate of around 80%

Question 15

What are some of the factors in fetal life that are linked with Psychosis?

Answer 15

Hypoxia
Maternal infection
Maternal stress
Maternal malnutrition

Question 16

What proportion of people diagnosed with Schizophrenia have experienced past trauma?

Answer 16

74%

Question 17

What did Hardy et al (2005) find with regards to trauma and psychosis?

Answer 17

53% of their psychosis sample reported a traumatic event still impacting on them negatively.

Question 18

What did the Varese 2012 study show?

Answer 18

Significant association between childhood adversity and psychosis.

May be mediated by emotion and negative appraisals of self.

Question 19

What are the environmental/social links with psychosis?

Answer 19

Migrant status, minority status, drug use.

Question 20

What are the normal contexts that can elicit psychotic experiences?

Answer 20

Sleep Deprivation
Bereavement
Sensory Deprivation
Military combat
Trauma – e.g. abuse & torture.

Question 21

In the Van O’s et al (2009) study what percentage of the population report experiencing delusion/hallucational experiences?

Answer 21

40%

Question 22

What are some of the questions for assessment within the power threat meaning framework?

Answer 22

• What has happened to you? (How is power operating in
  your life?)
• How did it affect you? (What kind of threats does this
  pose?)
• What sense did you make of it? (What is the meaning of
  these situations and experiences to you?)
• What did you have to do to survive? (What kinds of threat
  response are you using?)
• What are your strengths? (What access to Power
  resources do you have?)
• What is your story? (How does all this fit together?)

Question 23

What are the main impact areas of psychosis?

Answer 23

Sleep disturbance 100 %
Anxiety / Depression 86 %
Deterioration in role functioning 76%
Social Withdrawal 71 %
Suspiciousness 71 %
Change in sense of self / world 61 %
Perceptual changes 62%
Thought blocking 24%

Question 24

What percentage of people with Psychosis are in work?
How many years earlier are those with severe mental illness at risk of dying?

Two thirds of these premature deaths are from what?

Answer 24

8%

15 to 20 years
earlier than others
(Wahlbeck et al., 2011)

avoidable physical illnesses, including heart disease and cancer, many caused by smoking.

Question 25

What’s the mean delay in untreated psychosis?

Answer 25

52 - 156 weeks

Question 26

What does longer DUP often lead to?

Answer 26

Severe symptoms
Harder to engage
Impaired cognitive function
Poor physical health

Question 27

What are the costs on healthcare related to psychosis

Answer 27

11.8bn per year.

Question 28

What’s the rationale for EIP?

Answer 28

High rates of relapse
High rate of inpatient admissions
Suicide
National costs

Question 29

What are the NICE recommended treatments for EIP?

Answer 29

CBT
Family intervention
Clozapine
Employment support

Question 30

What is an EIP team?

Answer 30

A MDT which works with people experiencing
their first episode of psychosis
The team is made up of psychologists, care
coordinators, psychiatrists and employment
specialists, dieticians
Care coordinator caseloads are supposed to
be 15-18
People are able to stay within the team for up
to 3 years (2 years in some Trusts) and are
supported through crisis and into recovery

Question 31

How should we conceptualise psychosis?

Answer 31

An umbrella term which incorporates a range of experiences.

Question 32

In EIP service delivery, what aspects of psychoeducation should be given?

Answer 32

Likely course of the illness, the treatments available and the importance of compliance?

Question 33

What did the 2011 cochrane review show with regards to psychoeducation in EIPs?

Answer 33

Decreased relapse readmission rates at 9 - 18 months.
-Positive influence on a persons wellbeing and social functioning.
- Possibly improve compliance with medication.

Question 34

What percentage of clients within EIP services will relapse within 5 years?

Answer 34

80%