Psychosis

Question 1

What is Dialectical Behavioural Therapy?

Answer 1

It is a cognitive behavioural therapy in which helps to create self-awareness, reduce impulsivity, through emotional regulation and positive coping strategies.

Question 2

Who pioneered DBT?

Answer 2

Marsha Linehan

Question 3

DBT is most commonly used for…

Answer 3

People with borderline personality disorder with self harm tenancies.

Question 4

What is DBT based on? Describe this:

Answer 4

A biosocial theory that suggests that borderline personality disorders evolve as a consequence of an emotionally vulnerable person growing up in an ‘invalidating environment’.

Question 5

What is dialectics?

Answer 5

the art of investigating or discussing the truth of opinions

Question 6

What does DBT place an emphasis on?

Answer 6

Dialectics and the fact that there is no absolute truth- the fact that all things can be changed and worked through.

Question 7

What is psychosis?

Answer 7

Comes from the Greek psyche (mind) and –osis (diseased or abnormal condition)
A SYMPTOM or FEATURE of mental illness characterized by: changes in personality, impaired functioning, and a distorted or nonexistent sense of objective reality (MHERC).
-One must find the cause of this psychosis- psychosis is not a disorder in itself; it is a symptom.

Question 8

What are the symptoms of psychosis?

Answer 8

Hallucinations and delusions

Question 9

What are the 5 types of hallucinations?

Answer 9

-Auditory
o Visual
o Tactile
o Olfactory
o Gustatory

Question 10

What are the 6 types of delusions?

Answer 10

-Bizzarre
 Jealous
 Grandise (when you think you are a big, grand delusion- ‘I am the Queen’)
 Persecution (most often with schizophrenia, also known as paranoia- ‘everyone is trying to kill me’)
 Somatic (something is wrong physically- i.e., ‘My leg is chopped off’ so acts as if it isn’t there)
 Control (thought broadcasting (being told what to do) and blocking (not allowed their own thoughts); they think someone is controlling their thoughts )

Question 11

What are delusions?

Answer 11

A false belief, firmly held despite objective and
contradictory evidence and despite the fact that other
members of the culture do not share the same beliefs.

Question 12

What are hallucinations?

Answer 12

A false sensory perception in the
absence of external stimulus (thus different from
illusions)

Question 13

What are the five stages of psychosis?

Answer 13

1. Premorbid- Developmentally appropriate experiences
   and behaviours are the norm
2. Prodrome - Early warning signs of illness
3. Acute - Illness is present
4. Recovery and late recovery - Begins with treatment
5. Relapse

Question 14

There are only TWO conditions that are MENTAL HEALTH psychosis related- what are they?

Answer 14

Schizophrenia and bipolar disorder

Question 15

What else can be associated with psychosis (related to other physical condition)?

Answer 15

Brain tumours, seizures, delirium, dementia, postpartum, alcohol and drug induced.

Question 16

Before DSM-IV diagnosis, what must be ruled out?

Answer 16

Physical conditions

Question 17

Describe the The stress Vulnerability model

Zubin and Spring (1977):

Answer 17

The individual is exposed to stressful events which may
reach a threshold & may precipitate symptoms in some
people who have a genetic predisposition to mental
illness

Question 18

As a nurse, what can we do?

Answer 18

 Establish therapeutic alliance.
 Respectful use of language.
 Maintain a positive, strengths based attitude.
 Affirmation and validation are powerful & evidence-based
 Follow the LEAP principles
 Use WRAP® planning

Question 19

What is a nursing intervention with a client experiencing hallucinations?

Answer 19

Engage the person
 Assess the extent and content fully and the risks to self
and others.
Identify with the client the nature of the stress that
tends to bring the hallucinations & devise ways of
coping. Eg sensory modulation
Identify with the client ways of reducing the impact
of hallucinations eg. Listening to music through
headphones, talking on the phone etc
Discuss the use of PRN medication if hallucinations
are very distressing

Question 20

What is sensory modulation room?

Answer 20

Providing a room with heaps of things for the senses to help calm down a pt experiencing an severe hallucination, to help them calm and cope with distressing hallucinations.

Question 21

What are nursing interventions for delusional thinking?

Answer 21

Engage the person
Convey empathy, warmth, acceptance, sincerity
and honesty
 Assess the risk the delusional thinking imposes to self or
others and manage risks accordingly.
 Attempt to understand the content conveys concerned
understanding
 Don’t agree but at the same time don’t argue
 Adopt LEAP principles
 Take a calm, confident approach

Question 22

What can make symptoms of psychosis worse?

Answer 22

Stress