Introduction to and early intervention in Psychosis Flashcards
How is Psychosis defined?
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.
What are the two most well known symptoms that are characteristic of psychosis?
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.
What are the main delusional themes that occur in Psychosis?
*Persecutory
*Grandiose
*Ideas of reference
What are some of the negative symptoms of psychosis?
*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
What are some of the cognitive difficulties of psychosis?
*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
What are some examples of psychotic disorders?
Schizophrenia
Schizoaffective disorder
Schizophreniform disorder
Delusional disorder
Bipolar Affective disorder with psychotic features
Major depressive disorder with psychotic features
What are some of the diagnostic criteria of schizophrenia?
Delusions
Hallucinations
Disorganised speech
Grossly disorganised or catatonic behaviour
Negative symptoms such as diminished emotional expression.
What key factors are present in schizophrenia in the pentagon diagram?
Psychosis
Negative symptoms
Cognitive impairment
What key factors are present in bipolar disorder in the pentagon diagram?
Psychosis and mania
What key factors are present in schizoaffective disorder in the pentagon diagram?
Psychosis and negative symptoms
What’s the definition of ethnicity?
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.
What are some of the demographics of psychosis?
Male
Ethnic minority
Family history of sever mental health problems
Parental poverty
Perinatal risk factors
What are some of the risk factors to the onset of psychosis?
Stress
Unemployment/educational difficulties
Ethnic discrimination
Isolated
Substance use
Physical health factors
Childhood trauma
Problems with parental communication
What did the Kapur and Van Os (2009) study show
Twin studies show that psychosis has a heritability rate of around 80%
What are some of the factors in fetal life that are linked with Psychosis?
Hypoxia
Maternal infection
Maternal stress
Maternal malnutrition
What proportion of people diagnosed with Schizophrenia have experienced past trauma?
74%
What did Hardy et al (2005) find with regards to trauma and psychosis?
53% of their psychosis sample reported a traumatic event still impacting on them negatively.
What did the Varese 2012 study show?
Significant association between childhood adversity and psychosis.
May be mediated by emotion and negative appraisals of self.
What are the environmental/social links with psychosis?
Migrant status, minority status, drug use.
What are the normal contexts that can elicit psychotic experiences?
Sleep Deprivation
Bereavement
Sensory Deprivation
Military combat
Trauma – e.g. abuse & torture.
In the Van O’s et al (2009) study what percentage of the population report experiencing delusion/hallucational experiences?
40%
What are some of the questions for assessment within the power threat meaning framework?
- 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?)
What are the main impact areas of psychosis?
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%
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?
8%
15 to 20 years
earlier than others
(Wahlbeck et al., 2011)
avoidable physical illnesses, including heart disease and cancer, many caused by smoking.
What’s the mean delay in untreated psychosis?
52 - 156 weeks
What does longer DUP often lead to?
Severe symptoms
Harder to engage
Impaired cognitive function
Poor physical health
What are the costs on healthcare related to psychosis
11.8bn per year.
What’s the rationale for EIP?
High rates of relapse
High rate of inpatient admissions
Suicide
National costs
What are the NICE recommended treatments for EIP?
CBT
Family intervention
Clozapine
Employment support
What is an EIP team?
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
How should we conceptualise psychosis?
An umbrella term which incorporates a range of experiences.
In EIP service delivery, what aspects of psychoeducation should be given?
Likely course of the illness, the treatments available and the importance of compliance?
What did the 2011 cochrane review show with regards to psychoeducation in EIPs?
Decreased relapse readmission rates at 9 - 18 months.
-Positive influence on a persons wellbeing and social functioning.
- Possibly improve compliance with medication.
What percentage of clients within EIP services will relapse within 5 years?
80%
