L4 psychotic symptoms Flashcards by Sainan an

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.

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types of psychosis

psychosis can occur for lots of reasons, some possibilities include:

drug induced psychosis
brief reactive psychosis
schizophrenia
bipolar disorder
depression

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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

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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

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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

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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

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hallucination: auditory, command hallucination, visual, olfactory, tactile, gustatory

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symptoms of psychosis: delusion

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types of delusion:

grandiose
paranoid/persecutory
religious
somatic
idea of reference
ideas of control

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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.

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thought disorder (form)

flight of ideas
pressured speech
circumstantiality
perserveration
poverty of thought

Form (amount + rate of thinking/flow and continuity of ideas):

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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

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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

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Symptoms of Psychosis:
Disorganised (Bizarre or usual) Behaviour

appearance
repetitive/stereotyped behaciour
apraxia
echopraxia
aggression/agitation

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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

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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

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Schizophrenia

prevalence
age onset
gender distribution
life expectation

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Causes of Schizophrenia / Psychotic Disorders: stress- diathesis theory

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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

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.