L4 psychotic symptoms Flashcards
define psychosis
A state of being, experienced by a person who has lost touch with reality
– A cluster of symptoms found within a number of mental illnesses.
types of psychosis
psychosis can occur for lots of reasons, some possibilities include:
- drug induced psychosis
- brief reactive psychosis
- schizophrenia
- bipolar disorder
- depression
stat about context of psychosis
– About 1 in every 200 Australians will experience psychosis in a 12- month period
– Affects more males than females but women tend to develop psychosis later than men
– Usually occurs in late adolescence/early adulthood
– Incidencei s higher among immigrants than the population of origin
– Can be treated successfully if people get help early
characteristic of psychosis and psychotic episode
– Psychosis
A state of being in which a person loses touch with reality and experiences delusions, hallucinations or thought disorder.
– Psychotic episode
A temporary event in which a person experiences symptoms of psychosis.
– Characteristics:
Regressive behaviour
Personality disintegration
A significant reduction in level of awareness Great difficulty in functioning adequately Gross impairment in reality testing
what is definition of psycosis,andits primary symptoms
Psychosis results in a person experiencing a distortion or loss of contact with reality, without clouding of consciousness due to:
– Perceptual disturbance (Hallucinations) and/or
– Thought disturbance (Delusions) and also
– Disordered/disorganised thought processes
and
– Bizarre or unusual behaviours
Symptoms of Psychosis: Perceptual Disturbance (Hallucination)
A false sensory perception that occurs in the absence of external or objective stimuli.
Occurs in any of the five major sensory modalities.
Auditory
Visual
Olfactory
Tactile
Gustatory
hallucination: auditory, command hallucination, visual, olfactory, tactile, gustatory
symptoms of psychosis: delusion
types of delusion:
- grandiose
- paranoid/persecutory
- religious
- somatic
- idea of reference
- ideas of control
Symptoms of Psychosis: Thought Disorder
Thought processes become disordered, continuity of thoughts and information processing is disrupted. This results in illogical and confused thinking and speech.
Thought processes are assessed by making inferences from what the person says.
thought disorder (form)
- flight of ideas
- pressured speech
- circumstantiality
- perserveration
- poverty of thought
Form (amount + rate of thinking/flow and continuity of ideas):
Thought Disorder
Disturbance in language:
- echolalia
- neologism
- word salad
Echolalia: repeating words/phrases used by other person in conversation
Neologisms: use of words that don’t exist
Word salad: jumble of unconnected or incoherent words
thought disorder: beliefs about thoughts
- thought broadcasting
- thought withdrawal
- thought insertion
Thought broadcasting: thoughts are broadcast to/heard by others
Thought withdrawal: others are taking their thoughts
Thought insertion: thoughts are being placed in their mind against their will
Symptoms of Psychosis:
Disorganised (Bizarre or usual) Behaviour
- appearance
- repetitive/stereotyped behaciour
- apraxia
- echopraxia
- aggression/agitation
Symptoms of Psychosis: Emotions and Affect
Changed Feelings
– Feel strange
– Cut off from the world
– Mood swings
– Dampened emotions
Changed Affect
– Emotional blunting
– Incongruent affect
Schizophrenia and other Psychotic Disorders
– Schizophrenia spectrum and other psychotic disorders include schizophrenia, other psychotic disorders, and schizotypal (personality) disorder.
– They are defined by abnormalities in one or more of the following five domains: delusions, hallucinations, disorganised thinking (speech), grossly disorganised or abnormal motor behaviour (including catatonia), and negative symptoms.
– Schizophrenia is associated with distorted and bizarre thoughts, perceptions, emotions, movements and behaviour.
– Schizophrenia spectrum - Not a single illness (syndrome/disease process with different varieties and symptoms)
– Poorly understood
Schizophrenia
- prevalence
- age onset
- gender distribution
- life expectation
Causes of Schizophrenia / Psychotic Disorders: stress- diathesis theory
Causes of Schizophrenia / Psychotic Disorders Biological Theories
Causes of Schizophrenia / Psychotic Disorders Social and Environmental Theories
Two Major Categories of Symptoms: positive symptoms
Positive Symptoms
– Psychotic symptoms
– Most individuals do not normally experience these, but they are present in people with schizophrenia
– Symptoms that seem to be excesses or distortions Where phenomena are added to the person’s experience
Two Major Categories of Symptoms Negative Symptoms
– A loss or diminution of normal functioning
– Symptoms that take away from or indicate a deficit
– Where there is an absence or lack in the person’s experiences
Blunted Affect: Restricted range of emotional expression
Avolition:Lack of will, ambition or drive to take action/ accomplish tasks
Anhedonia: Feeling no joy/pleasure from life
Asocialisation: Social withdrawal
Alogia: Poverty of ideas and speech – minimal speech and substance
Clinical Course of psychosis
Nursing Management for People Experiencing Psychotic Symptoms
Promote Safety
Use non-threatening manner; give the patient space; observe for signs of building agitation; institute interventions to protect patient, staff, and others; remember right to privacy and dignity
Use therapeutic communication and core communication skills
Maintain non-verbal communication when verbal is not effective; spend time with patient; being present indicates interest and caring; orientate to reality; use environmental cues; clarify feelings
– Self awareness: feelings and behaviours
– Use active listening and clear non threatening non-verbal communication
– Be patient and demonstrate acceptance
– Speak slowly, calmly, clearly
– Seek clarification and listen for themes
– Assist patient with vocabulary as needed
Working with Perceptual Disturbance
Help present and maintain reality – frequent contact and communication; Engage in reality based activities (distractions); Elicit description of hallucination (helps nurse identify how to calm/reassure the patient); Assess for intensity, frequency and duration (and content); Intensity of hallucinations often related to anxiety level – monitor and intervene to lower anxiety, assist patient to identify and manage triggers to anxiety.
Working with Thought Disturbance
Do not openly confront or argue about the delusion (when acutely unwell); establish and maintain reality; Elicit content of delusion and attend to how patient feels; Use distraction techniques; When treatment has a therapeutic effect teach the patient direct action strategies - positive self talk, positive thinking, and ignoring the delusional thought.
Environmental Management
Modify environmental influences (triggers for hallucinations or delusions) – people
– television
– radio/music
Distraction
– promote the use of activities that require attention/focus
– physical skills/activity
– talking
– listening to music
Don’t leave patient alone for extended periods when hallucinating
– can be frightening / lonely
– reinforcing (escalate)
– Establish routine
Socially inappropriate behaviours
Redirect patient away from problem situation; Be non-judgmental and matter of fact; Reassure others; Reintegrate patient into treatment milieu as soon as possible; Do not punish or shun for inappropriate behaviours; Role model.
Summary
Psychosis is a group of symptoms experienced as loss of contact with reality
Symptoms include perceptual and thought disturbance, thought disorder and unusual behaviour
Cause: Possibly a complex interaction between multiple combinations of genetic, environmental and social factors
Psychosis can be experienced across the life span and is associated with a number of mental illnesses (e.g. schizophrenia)
Nursing management comprises:
– clear communication
– developing trust
– attending to emotions
– assisting the person to gain some mastery
– symptom management
– education
– relapse prevention strategies
Comorbidity =
Comorbidity =
Concurrent presence of one or more other disorders/conditions, in addition to
a primary disorder/condition
Also referred to as: Co-associated illness/conditions Co-occurring conditions
Physical co-morbidity common in mental illness Increased mortality rate for people with MI Poorer quality of life
Antecedent model*
Consequence model
Antecedent model*
prospective relationship between mental disorder and physical disorder
Consequence model
mental disorder consequent to medical condition
The scandal of premature mortality
A 20-year mortality gap for men, and 15 years for women, is still experienced by people with mental illness in high-income countries. The combination of lifestyle risk factors, higher rates of unnatural deaths and poorer physical health care contribute to this scandal of premature mortality that contravenes international conventions for the ‘right to health.’
If such a disparity in mortality rates were to affect a large segment of the population with a less stigmatised characteristic, then we would witness an outcry against a socially unacceptable decimation of this group. The fact that significant gaps in life expectancy remain denotes a cynical disregard for these lost lives, and shows, in stark terms, by just how much people with mental illness are categorically valued less than others in our society.
cuses of increased mortality and morbidity
MI ad physical health
Risk factors and psychotropic medications
Poor access and unnatural deaths
metabolic syndrome
Metabolic Syndrome (MetS)
Comorbid physical health conditions and/or poor physical health are common for people experiencing mental illness regardless of age or diagnosis
Poor physical health is readily apparent in relatively young adults with MI, from around the mid–late 20s
Health risk factors and poor health behaviours commence prior to adulthood, and are evident in adolescents and young people
Poor physical health and health risk factors can track through to adulthood
Comorbid conditions in first episode psychosis (FEP) and emerging adults
Comorbid conditions in first episode psychosis (FEP) and emerging adults
Physical health of young people with MI and taking psychotropics (Sydney inpatient study)
Physical health of young people with MI and taking psychotropics (Sydney inpatient study)
Physical health of young people with MI and taking psychotropics (Sydney inpatient study)
Apart from a clear cut neglect of human rights for people with severe mental illness (e.g. lower access to care) and the observation that overlooked physical morbidity exacerbates the impact of mental illness, at a clinical level there is evidence that physical care can be an intervention point for mental health.
Overall nurses are well situated to play a key role in focused prevention and early intervention in the physical well-being of consumers with severe mental illness.
Nursing Interventions for Physical Health in Mental Health
Target Areas for Attention
Interventions
Comprehensive health assessment on admission / intake
– Physical examination
– Blood chemistries and BSL
– Cardiac investigation
– Weight, height, waist circumference, BP
– Body mass index (BMI)
– Family history
– Personal history, incl. diet, exercise, substance use
Interventions
Nurses have a role beyond assessment/screening:
Education
– Liaising with family/carers; family education and support on risks, nutrition/ diet and exercise, smoking
– Psycho-education and lifestyle programs e.g. physical activity groups Health promotion and illness prevention
Opportunities for health promotion and primary and secondary prevention in inpatient & community settings e.g. Community case management provides ongoing context in which to manage risk, including physical health risk
Monitoring and referral
– Clinics for physical health, including Clozapine clinics; cardiometabolic clinics
– Re-assessment, repeat investigations etc.
– GP, Dentist, Podiatrist, Dietician, Psychiatrist etc.
Comorbid physical health conditions, commonly associated with mental illness, contribute to increased morbidity and reduced life expectancy.
The trajectory to poorer health begins with onset of mental illness. For young people with mental illness, health risk behaviours and poor physical health can progress to adulthood with long-term detrimental impacts.
Smoking, alcohol use, minimal physical activity, side effects of psychotropic medication, and lack of primary healthcare are some of the evident risk factors. While these behaviours are typical of many people, those with mental illness have substantially increased vulnerability to poor health and reduced life expectancy.
Priority needs to be given to targeted health promotion and illness prevention strategies for people with mental illness to modify their risky long-term health behaviours, and improve morbidity and mortality outcomes.
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