Lecture 4 - Psychosis Flashcards
What is the definition of psychosis?
Loss of contact with reality.
What are positive symptoms of psychosis?
- Hallucinations
- Delusions
What are negative symptoms of psychosis?
- Avolition (reduction or loss of motivation, initiative, and goal-directed behaviour)
- Social isolation
What are hallucinations?
Sensory experiences that are not based on external stimuli. The most common hallucinations in psychosis are auditory, involving hearing voices or sounds that others do not perceive. Visual, tactile, olfactory, or gustatory hallucinations can also occur.
What are delusions?
False beliefs - paranoid
What does CBT assume about psychosis?
Event (internal or external) -> trigger thoughts <-> emotions <-> behaviours
Cognitive responses to events determine our reactions to these events.
What is covert behaviour in terms of psychosis?
Not body actions
How our mind reacts - suppressing thoughts or ruminating on negative events
How does CBT work for psychosis? NICE, 2014
- Establish links between thoughts, beliefs, perceptions and feelings in relation to current or past symptoms
- Re-evaluate the beliefs
- Develop alternative ways of coping with the target symptoms, reducing stress and improving functioning
What is an internal triggering event?
Memories, images, bodily perceptions
How does a therapist formulate psychotic experiences?
After appropriate goals for therapy are identified (which problem / symptom to target):
- Therapist identifies thoughts, feelings and behaviours linked to the problem
- Helps the client see how these interact to maintain the problem
- Create shared understanding of how the problem developed and what can be done to resolve it
Example of cognitive model of hallucinations - Morrison, 1998
Triggers (stress, sleep deprivation, isolation) -> auditory hallucinations -> safety behaviours -> misinterpretation of hallucinatory experience -> mood
LOOP!
How can normalisation improve psychosis?
The stigma in the media regarding psychosis is damaging, normalising this can challenge the stigma and correct misconceptions
How can more accurate information be promoted regarding psychosis?
- Making the experience understandable (behaviours, thoughts and feelings are reactions to extreme adverse traumatic events)
- Experiences exist within the range of human functioning and can be in the absence of distress or MH problem
- Psychoeducation - learning and understanding
‘People with psychosis are dangerous’ - how is this a myth?
- There’s no evidence of this
- Violence may be due to substance abuse, pre-existing violent history
- People with psychosis more likely to be victims of violence - vulnerable situations
‘Psychosis is a diagnosis for life and there is no recovery’ - how is this a myth?
- Some people only have a single episode (30%)
- Some people experience more than one episode but with long periods without any symptoms (30%)
‘People with psychosis are unable to work’ - how is this a myth?
- Psychosis doesn’t always impact functioning
‘Psychosis always causes distress and people always need treatment’ - how is this a myth?
- Some cultures perceive psychotic symptoms as positive
- Many people make sense of their experiences and find it helpful - telepathy, psychics, reincarnation beliefs
‘Psychosis is always a consequence of brain disease’ - how is this a myth?
- Can occur due to lack of sleep, sensory deprivation, substance abuse (altered states), stressful events, bereavement and trauma
How can coping be improved for people with psychosis?
- Review the strategies client already uses and how effective they are, encourage new ones
- Increase coping strategies when facing distress, provide respite and encourage control
- Understanding (humming, reading, singing to distract from inner speech and auditory hallucinations)
- Responding differently to symptoms - acting assertively and dismissing the voices
- Reduce arousal and distress - soothing music, mindfulness
How does CBT change unhelpful beliefs and appraisals of psychotic experiences?
- Ask client to keep a log of recent voice hearing experiences
- Can alleviate psychotic symptoms
- NICE state that CBT should be offered as a first one of treatment for psychosis (can be effective without meds too)
What is CBT for psychosis based on?
Based on appraisals of events- determining behaviours thoughts, feelings and distress
Can childhood adversities increase the risk of psychosis?
Yes
What do the NICE guidelines suggest for prevention and management of psychosis?
- More research required to evaluate the efficacy of trauma reprocessing interventions
- All people with first episode psychosis should be screened for trauma and PTSD
- Service users with psychosis and PTSD should be offered treatment options by NICE for PTSD
How is Schizophrenia diagnosed?
- Individual must experience at least 2 or more symptoms, present for at least 6 months, including 1 month of active-phase symptoms
- The symptoms must cause social and occupational dysfunction
- They must not be explained by other mental health disorders or substance abuse
What are the main symptoms of Schizophrenia?
- Delusions
- Hallucinations
- Disorganised speech
- Disorganised or catatonic behaviour (unpredictable or unusual behaviours)
- Negative symptoms
What are the negative symptoms of Schizophrenia?
- Flat affect (affective flattening) - reduced emotional expression (facial expression, voice tone, body language) - appear emotionally unresponsive
- Alogia = speech poverty
- Avolition = decreased motivation, initiative and goal-directed behaviour
- Anhedonia = diminished pleasure
- Social withdrawal
