Psychosis and Schizophrenia Flashcards
Disorders with Psychosis as a component
- Schizophrenia
- Schizoaffective disorder (meeting criteria for schizo. but also have a depression or anxiety component)
- depression with psychotic features (clinical depression and psychotic features are only present when in a deep depression)
- catatonia
what is psychosis:
- some loss of contact with reality –> what that person is experiencing is different then reality
- it is a component not a disorder
- psychotic episode: a chunk of time that they are experiencing this state
- disturbed thoughts and perceptions –> what is real what is not
Psychosis is characterized by:
Delusions: false beliefs
Hallucinations: seeing/hearing things others do not see or hear
-“attending to internal stimuli”
DSM V: Schizophrenia
- 2 or more of the following for at least 1 mo:
Positive Sx: (additional/added to experience)
- delusions
- hallucinations
- disorganized speech
- disorganized or catatonic behavior
Negative Sx:
- flat affect
- social withdrawal
- difficulty initiating activity
- disorganization of sensorimotor, cognitive, and psychosocial
- impaired functioning: work. interpersonal, and/or ADLs
Presentation of Schizophrenia
- attending to internal stimuli (or stimuli that others can’t see)
- feels threatened or paranoid
- false beliefs or grandeur
- minimal insight
- disorganized
- absence of interest, attention, volition
- suicidal tendencies and substance abuse
- incoherent or disorganized speech
- inappropriate behavior
- withdrawal
- inappropriate affect (laughing at wrong time)
- disturbed sleep pattern
- dysphoric mood
- anxiety and phobias
- depersonalization
- derealization
- cognitive deficits (huge piece of this)
- lack of insight into disorder
- social cognition deficits
- hostility and aggression
cognitive deficits for schizophrenia
- more strongly associated with functional impairments than other symptoms
- highly variable
- destress of self can lead to cognitive deficits
- lack of structure
- impacts language, attention, processing, executive function, and/or memory
- attention: screening out distractors
- memory: good short term memory, working memory is hard i.e. grocery shopping
- executive function: idea of can you plan a dinner party?, difficulty using scripts/forming habits in familiar situations (making apts.)
- social cognition: often likened to autism, but schizophrenia, individuals know how/what to say they just struggle to real social cues
Schizophrenia: impact on occupational performance
Health and Wellness
-higher rates of morbidity and mortality than general population
-tend to have poor lifestyle habits
(unhealthy diet, decreased access to regular medical care, sedentary, side effects of medication)
-evidence shows benefit from long-term lifestyle programs using active learning strategies
Schizophrenia: impact on occupational performance
Stigma and Poverty
- most stigmatizing of all illnesses
-belief that individual will not recover
-more likely to live in poverty
(barriers to public transportation, employment barriers, basic needs for food and shelter, less likely to have cars)
-effective at combating stigma:- informal opportunities to socialize with individuals with mental illness
- anti-stigma campaigns
- informal opportunities to socialize with individuals with mental illness
Strategies for providers and caregivers
- be aware of cognitive difficulties
- break down sequences, SLOW DOWN
- use CONCRETE and SPECIFIC language
- lists and reminders (short and simple)
- reduce sensory overload and distractions in the environment
- concrete, specific activities
- encourage client to:
- identify what triggers internal stimuli
- take videos for reality testing
nonviolent communication– how to respond
Client: “There’s a helicopter outside and they’re coming to take me away!”
do not say “don’t worry there’s not a helicopter outside”
– rather: “you feel as through something is threatening you and you are scared. Would you like to go to a quiet place where it is safe?”
Interventions - Cognition
Attention
- limit distractions
- keep tasks simple and brief
- don’t multitask
- use cues
Interventions - Cognition
Memory
- use memory aids
- use repetition
- develop rhythms and routines
Interventions - Cognition
Executive function
- use a schedule
- make lists
- play games to exercise your brain –> smartphone app
Interventions - Cognition
Social Cues and Interpersonal Skills
- role play
- ask others for clarification
- keep track
- emotional regulation strategies
Group Ideas
- During Psychotic Episode
- depending on severity, assess appropriateness for group
- art activities
- basic meal prep
- board games
- limit sensory overload in environment
- 1:1 support within group
