Psychosis and PTSD

Question 1

Psychosis

Answer 1

Delusions, hallucinations, disorganised speech, abnormal motor behaviour, negative symptoms

Question 2

Risk factors

Answer 2

Foetal: family hx, pregnancy complications, certain genes

Early life: trauma, vulnerable personality, early rearing experiences

Late adolescent: Age, substance use, TBI, stressful life events

Question 3

Typical psychosis pathway

Answer 3

1. impaired social functioning + neurotic symptoms
2. exacerbation of symptoms to subthreshold psychotic symptoms
3. first episode psychosis

Question 4

Psychosis benefits of early intervention

Answer 4

1. prevention or delay of transition into psychotic stage
2. engagement with services (before too late) -> benefit tx adherence
3. reduce psychosocial disability
4. reduction in severity of psychotic episode (reduced stigma, trauma, hospitalisation)

Question 5

Family involvement

Answer 5

Help prevent family burnout and long term abandonment of pt, decrease family isolation due to stigma, supervise medication adherence w/o power struggle

Question 6

Phases of CBT for psychosis

Answer 6

1) development of therapeutic alliance
2) psychoed + normalising
3) working with delusions and hallucinations
4) relapse prevention and recovery

Question 7

Therapeutic alliance

Answer 7

predictor of outcomes, therapy/hw/medication adherence
positive regard + empathy + flexibility

Question 8

Normalisation and psychoeducation

Answer 8

Psychotic symptoms part of a continuum

Psychoeducation on: symptoms, diagnoses, formulation, impact of substance use, medications, warning signs, nature of recovery, support agencies

Question 9

Working with delusions

Answer 9

identify precipitating and perpetuating factors

modify distress appraisal of symptoms and generate alternative hypotheses
- curious stance; behavioural experiments; peripheral delusions first

Question 10

Working with hallucinations

Answer 10

exploration of origin/nature of hallucination
monitoring diaries
coping strategies
promoting self control and power
socratic questions to raise doubts

Question 11

Relapse prevention

Answer 11

early warning signs
triggers
affect regulation
tx adherence
reducing risk

Question 12

Assessment of PTSD

Answer 12

Clinical interview (pre-trauma hx, family hx of psychopathology, what happened and what happened after (i.e medical/legal) + MSE)

Psychometric assessments (trauma specific self-report)

Question 13

Psychoeducation

Answer 13

• Normalisation of stress response and anxiety
• Adaptive functions of anxiety
• Biological basis of anxiety response
• Treatment rationale

Question 14

Explanation of treatment rationale for PTSD

Answer 14

1. Physical - attribute the physical sensations to anxiety
2. Mental - recognising un-adaptive thinking
3. Behavioural - avoidance (temporary relief)

Question 15

Digestion analogy

Answer 15

Food - indigestion - bottom of stomach (weighs us down).

To get rid - expel or digest

Can’t expel trauma - need to digest

Question 16

Exposure

Answer 16

• exposure hierarchy ( lowest to highest SUDs rating)
• stays in scenario for 40-50 minutes or until habituation
• in-vivo or imaginal
• present tense
• emotional engagement
• asking anxiety level
• prompting and reinfocement
• minimum SUDS 50-70

Question 17

Common problems with exposure for PTSD

Answer 17

• Lack of trust in therapist
• Dissaociative tendencies (avoidance)
• Lack of affective involvement
• Anxiety didnt drop
• Too much anxiety

Question 18

Cognitive intervention for PTSD

Answer 18

ABC model
Activating event
Belief
Consequnce

Challenge assumptions

Question 19

Cognitive Interweave

Answer 19

Prepare client for imaginal exposure
Initiate imaginal exposure
Challenge faulty beliefs
Test beliefs with re-runs

Question 20

Coping strategies for PTSD

Answer 20

Breathing
PMR
Guided self dialogue (replacing negative self-talk with more rational, adaptive dialogue)