L4 psychotic symptoms

Question 1

define psychosis

Answer 1

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.

Question 2

types of psychosis

Answer 2

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

• drug induced psychosis
• brief reactive psychosis
• schizophrenia
• bipolar disorder
• depression

Question 3

stat about context of psychosis

Answer 3

– 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

Question 4

characteristic of psychosis and psychotic episode

Answer 4

– 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

Question 5

what is definition of psycosis,andits primary symptoms

Answer 5

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

Question 6

Symptoms of Psychosis:
Perceptual Disturbance (Hallucination)

Answer 6

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

Question 7

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

Answer 7

Question 8

symptoms of psychosis: delusion

Answer 8

Question 9

types of delusion:

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

Question 10

Symptoms of Psychosis: Thought Disorder

Answer 10

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.

Question 11

thought disorder (form)

• flight of ideas
• pressured speech
• circumstantiality
• perserveration
• poverty of thought

Answer 11

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

Question 12

Thought Disorder

Disturbance in language:

• echolalia
• neologism
• word salad

Answer 12

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

Question 13

thought disorder: beliefs about thoughts

• thought broadcasting
• thought withdrawal
• thought insertion

Answer 13

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

Question 14

Symptoms of Psychosis:
Disorganised (Bizarre or usual) Behaviour

• appearance
• repetitive/stereotyped behaciour
• apraxia
• echopraxia
• aggression/agitation

Answer 14

Question 15

Symptoms of Psychosis: Emotions and Affect

Answer 15

Changed Feelings

– Feel strange

– Cut off from the world

– Mood swings

– Dampened emotions

Changed Affect

– Emotional blunting

– Incongruent affect

Question 16

Schizophrenia and other Psychotic Disorders

Answer 16

– 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

Question 17

Schizophrenia

• prevalence
• age onset
• gender distribution
• life expectation

Answer 17

Question 18

Causes of Schizophrenia / Psychotic Disorders: stress- diathesis theory

Answer 18

Question 19

Causes of Schizophrenia / Psychotic Disorders Biological Theories

Answer 19

Question 20

Causes of Schizophrenia / Psychotic Disorders Social and Environmental Theories

Answer 20

Question 21

Two Major Categories of Symptoms: positive symptoms

Answer 21

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

Question 22

Two Major Categories of Symptoms Negative Symptoms

Answer 22

– 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

Question 23

Clinical Course of psychosis

Question 24

Nursing Management for People Experiencing Psychotic Symptoms

Answer 24

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.

Question 25

Answer 25

Question 26

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

Question 27

Comorbidity =

Answer 27

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

Question 28

Antecedent model*

Consequence model

Answer 28

Antecedent model*
prospective relationship between mental disorder and physical disorder

Consequence model
mental disorder consequent to medical condition

Question 29

The scandal of premature mortality

Answer 29

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.

Question 30

cuses of increased mortality and morbidity

Answer 30

Question 31

MI ad physical health

Answer 31

Question 32

Risk factors and psychotropic medications

Answer 32

Question 33

Poor access and unnatural deaths

Answer 33

Question 34

metabolic syndrome

Answer 34

Question 35

Metabolic Syndrome (MetS)

Answer 35

Question 36

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

Question 37

Comorbid conditions in first episode psychosis (FEP) and emerging adults

Answer 37

Question 38

Comorbid conditions in first episode psychosis (FEP) and emerging adults

Answer 38

Question 39

Physical health of young people with MI and taking psychotropics (Sydney inpatient study)

Answer 39

Question 40

Physical health of young people with MI and taking psychotropics (Sydney inpatient study)

Answer 40

Question 41

Physical health of young people with MI and taking psychotropics (Sydney inpatient study)

Answer 41

Question 42

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.

Question 43

Nursing Interventions for Physical Health in Mental Health

Answer 43

Question 44

Target Areas for Attention

Answer 44

Question 45

Interventions

Answer 45

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

Question 46

Interventions

Answer 46

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.

Question 47

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.

Answer 47

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