Prevention of psychosis Flashcards
What is a psychosis?
you lose touch with common reality
Common symptoms:
- voice hearing
- delusions (paranoid delusions)
- disorganized
- low energy levels
- problems motivating oneself
It is very heterogeneous
Give the definition of schizophrenia. And why is schizophrenia is kind of a subtype of phychosis?
Definition: Someone’s had psychotic symptoms for over a months and is burdened by these symptoms for over 6 months. It’s most stigmatized psychiatric disorder, 1/12 of the psychoses.
Psychotic experiences are key in schizophrenia, but not everyone with psychosis meets criteria for schizophrenia
There is massive heterogeneity in mental health problems, give examples on how this shows.
- Symptoms of different disorders overlap.
- Within disorders, there are a lot of different ways to meet the criteria for a disorder
- It’s the norm
- patients can have the same label but not share any symptoms.
(Heterogeneity means there are many causes)
What are the causes of psychosis?
problems pregnancy and delivery discrimination genes being bullied growing up in dense urban area cannabis use (thc especially) childhood trauma
Why is prevention of psychoses needed?
- There is no clear cause of psychoses
- Moderate results of evidence based interventions (physical therapy, medicine)
- psychoses develop gradually
- Reduce duration untreated psychosis (DUP)
What are the consequences of preventing or delaying psychoses?
- Maintain social functioning
- Improve QoL
- Reduction of stigmatization and traumatization
- Improve access to mental health care
Early detection is based on clinical staging model. What are the four steps?
Premorbid phase
Prodromal phase
Psychotic phase
Reovery phase
Psychosis duration years, now early intervention aimed at secondary prevention to prevent DUP
What is the prognostic profile of psychosis. Or: what is included in the At Risk Mental State (ARMS)?-16
- Young age 14-35
- Decline in social functioning
- Seeking help in mental health care
- Psychosis like experiences (with distress)
It is measured with the PQ-16
It is not a diagnosis
Explain the paranoia hierarchy.
It’s a pyramid with, from bottom to top:
- social evaluative concerns (100%)
- Ideas of reference (93%)
- mild threat (70%)
- Moderate threat (30%)
- Severe threat (4%)
.
.
What are the four clinical stages in a psychosis (based on the clinical staging model)?
- Premorbid phase
- Prodromal phase (early detection and primary prevention, start of the symptoms. If intervening here, the prognosis is better and a less hard intervention is needed).
- Psychotic phase (early intervention in psychoses aimed at secondary prevention).
- Recovery phase
Explain the causality trap.
The developed concept becomes the causal explanation for someone’s psychiatric health.
For instance, diagnosis because she is suspicious, to: suspicious because of disorder she is diagnosed with.
Why are there a lot of moments to start an intervention for people with psychosis?
Because a psychosis develops gradually.
Name predictors for the long term outcome of a psychosis, voice hearing, and paranoia.
- long term outcome: duration of untreated psychosis
- Voice hearing: sexual abuse
- Paranoia: physical abuse.
Explain the CAARMS an in which three groups a person can be categorized in if the their cut-off score is 6.
CAARMS is the clinical interview that comes after the ARMS profile.
The groups
- Subclinical mild –> They have real symptoms, but only around 1 hour a week. They can still function. There symptoms, f.e. voice hearing, are not severe enough to call it actually voice hearing because they are aware enough of it. 85%
- BLIPS –> Brief Limited Intermittent Psychotic Symptoms group. Someone has had a psychosis that lasted last than 7 days that got into remission without professional help. They’re at high risk of developing psychosis later in life. 10%
- Primary family diagnosis. Lowest risk. –> can also be schizotypical disorder in their own person. 5%
Why is it important to lower the duration of untreated psychosis?
Because people who have already had an intervention in the early stage, do better in their prognosis than people who came into medical care with a psychosis.
What are experiences/coping mechanisms of people who meet the ARMS profile?
- They often have survival strategies and cognitive biases that might trigger and maintain symptoms of psychoses.
- They’re afraid they’re going mad right before psychosis (when they’re in psychosis, everything feels normal)
- They are often distressed and help seeking’
- They are in a decline of social functioning.
With what therapies can people with a psychosis learn how to cope?
- Psycho education
- Meta- cognitive training
- CBT
- Consolidation and blue print
What are important part of psycho-education?
- Normalising the psychosis.
- Helping people understand how it works, the science behind it as well.
- Explain that the extraordinary experiences are normal, but that you can get stuck in them.
- Influencing the outcome of the patient’s appraisal of their situation (how they think /give meaning to the experiences)
What is practical advice for people with a psychosis?
- Talk to people about experiences
- maintain socially active
- Maintain a good sleep pattern + healthy lifestyle
- don’t worry too
- watch out for drugs
- don’t get too involved in things that scare you.
What are important parts of CBT for people meeting the ARMS profile.
- It’s based in equality
- Extraordinary experiences are considered normal and understandable
- Collaboratively develop shared understanding of what is happening
- Identify most important problem that sustains the dysfunctional contextual factors, beliefs, and behaviours
- Change contexts where possible and desirable.
- To test and challenge negative dysfunctional problem-sustaining beliefs
- Break the problem-sustaining behavioural interaction patterns and test new behaviours.
