Psychosis + Schizophrenia

Question 1

What percentage of people with a diagnosis of schizophrenia experience recovery?

Answer 1

70%

Question 2

When is the onset of schizophrenia most common?

Answer 2

In the early to mid-20s

Question 3

What is the a clear biological etiology for psychosis and schizophrenia?

Answer 3

There is none, there are guesses and assumptions

Question 4

What are delusions?

Answer 4

are fixed beliefs that are not amenable to change in light of conflicting evidence. Their content may include a variety of themes (e.g. persecutory, referential, somatic, religious, grandiose).

Question 5

What are paranoid delusions?

Answer 5

a belief that the person is being followed or monitored (e.g. ‘My neighbour is plotting to kill me’)

Question 6

What are grandiose delusions?

Answer 6

where a person may believe they have special abilities or ‘powers’ (e.g. ‘I can fly’ or ‘I’m on a mission from God’)

Question 7

What is thought broadcasting?

Answer 7

the belief that the person’s thoughts are being broadcast to or heard by others.

Question 8

What is thought withdrawal?

Answer 8

the belief that others are taking their thoughts

Question 9

What is thought insertion?

Answer 9

the belief that thoughts are being placed in their mind against their will.

Question 10

What are hallucinations?

Answer 10

distortions in perception. People with psychosis may experience hallucinations in any of the five senses, hearing, seeing, feeling, smelling or tasting sensations that do not appear to be real. Common hallucinations include:

Question 11

What are auditory hallucinations?

Answer 11

auditory hallucinations, which commonly include hearing voices talking to them or about them, or hearing music and other noises when there is no sound (e.g. hearing someone call their name when they are at home alone)

Question 12

What are visual hallucinations?

Answer 12

seeing things that are not there, or seeing things in a strange way (e.g. seeing unusual shapes, colours or lights, or seeing an image of someone standing before them)

Question 13

What are somatic hallucinations?

Answer 13

involving feeling something touch or something happening in their body when there is nothing there (e.g. feeling as though ants are crawling on their skin)

Question 14

What are olfactory hallucinations?

Answer 14

smelling things when there are no smells around (e.g. smelling rotting fish in the house, even though there are no fish there)

Question 15

What are gustatory hallucinations?

Answer 15

hallucinations, which refer to tasting things in a strange way (e.g. tasting metal in their mouth)

Question 16

What is disorganized thinking?

Answer 16

Disorganised thinking is inferred from a person’s speech. It is commonly characterised as including speech that switches rapidly from one topic to another; this may be described as ‘derailment’ or ‘loose associations’. A person may reply to questions with answers that are tangential, which means they are oblique or unrelated. Sometimes speech may be incomprehensible, and it may be described as incoherent or ‘word salad’. Nurses need to remember that symptoms must be severe enough to substantially impair effective communication

Question 17

What are neologisms?

Answer 17

This involves using words that dont exist

Question 18

What are echolalia?

Answer 18

Repeating words/phrases used by other people in conversation

Question 19

What is perseveration of speech?

Answer 19

When the person uses excessive continuation/repetition of a single response or idea

Question 20

What is disorganised behavior?

Answer 20

Behaviour that can be unpredictable. For example that ranges from childlike ‘silliness’ to unpredictable agitation. Other examples include:

• resistance to instructions (negativism)
• maintaining a rigid, inappropriate or bizarre posture
• a complete lack of verbal and motor responses (mutism and stupor)
• purposeless and excessive motor activity without obvious cause (catatonic excitement).

Question 21

What are negative symptoms?

Answer 21

Absences or reductions of thought processes, emotions and behaviors that were present before the onset of the illness but have since diminished or are absent following the onset of the illness. These symptoms are substantial in schizophrenia but less common in other psychotic disorders.

an example: Diminished emotional expression includes reductions in the expression of emotions in the face, eye contact, intonation of speech and movements of the hand, head and face that normally give an emotional emphasis to speech

Question 22

Common diagnostic terms currently used to describe psychotic disorders in modern health care include:

Answer 22

• substance-induced psychotic disorder
• brief intermittent psychosis
• delusional disorder
• schizophreniform disorder
• schizophrenia
• schizoaffective disorder

Question 23

What is the requirements for a substance-induced psychotic disorder?

Answer 23

a person needs to have experienced delusions or hallucinations, physical findings need to indicate that psychosis developed during or soon after substance intoxication or withdrawal or after exposure to a medication capable of producing psychotic symptoms. and this needs to have caused substantial distress or impairment in social, occupational or other important areas of functioning.

Question 24

What is brief intermittent psychosis?

Answer 24

Brief intermittent psychosis involves the sudden onset of psychosis that is strictly time-limited, lasting for more than a day but less than a month.

with eventual full return to psychosocial functioning.

Question 25

What is the requirements for a delusional disorder?

Answer 25

a person needs to have experienced the presence of one (or more) delusions for a month or longer. On diagnosis the specific type of delusional psychosis should be described – for example, grandiose, jealous, persecutory, mixed or erotomanic

Other requirements:

• the person must not meet diagnostic criteria for schizophrenia.
• the person’s behaviour needs to be interpreted as not being obviously odd or bizarre; social and occupational functioning needs not to have been markedly impaired.
• if manic or major depressive episodes have occurred, these need to have been brief relative to the duration of the delusional periods.
• other illnesses including mental disorders such as body dysmorphic disorder or obsessive-compulsive disorder or the possibility that the person may be affected by drugs or other general medical conditions needs to be excluded.

Question 26

What are the requirements for a schizophreniform disorder?

Answer 26

For a diagnosis of schizophreniform disorder, a person needs to have exhibited at least two of the following list of symptoms including at least one from a, b or c:

a. delusions
b. hallucinations
c. disorganised speech (e.g. frequent derailment or incoherence)
d. grossly disorganised behaviour
e. catatonic behaviour
f. negative symptoms (diminished emotional expression or avolition).

Symptoms must last for at least 1 month but less than 6 months. Other disorders such as schizoaffective disorder and depressive or bipolar disorder with psychotic features need to be excluded.

Question 27

What are the requirements for schizophrenia?

Answer 27

A diagnosis of schizophrenia requires a person to have experienced at least 6 months of a mixture of negative and positive symptoms.

use 2-4-6 analogy: at least 2 symptoms 4 at least 6 months.

Question 28

What is a schizoaffective disorder?

Answer 28

Schizoaffective disorder describes a long-term condition in which a person experiences a mood episode (major depression or mania) along with symptoms fulfilling the primary criteria for schizophrenia.

Question 29

What is open dialogue therapy?

Answer 29

The primary goal of ODT is increased engagement of a person’s social network/family in therapy, with a view to creating a more open dialogue about experiences related to psychosis in the home environment.

Question 30

What are the 3 commonly posited biological theories for the case of psychotic disorders?

Answer 30

Brain anatomy, genetics, and brain biochemistry

Question 31

What is the stress-vulnerability-protective factors model (Diathesis-stress model)?

Answer 31

a framework that attempts to integrate environmental, biological and traumagenic theories, suggesting that stressful events may precipitate symptoms in some people who have a biological predisposition to mental ill health. Essential to this theory is the notion that some people are more vulnerable to mental ill health than others.

Question 32

What are 7 common interventions nurses use to deliver for those experiencing psychosis and schizophrenia

Answer 32

Assessment, therapeutic communication, psychopharmacology, physical health promotion, social advocacy, relapse prevention and recovery-oriented care planning

Question 33

What is the advice for working with a person with schizophrenia who is distracted by their symptoms and experiences difficulties with attention and concentration and/or distressed and isolated?

Answer 33

• Respect the person’s privacy and autonomy.
• Keep communication and choices clear.
• Check that the person and nurse have a shared understanding about what has been said.
• Do not dismiss them, even if what they are saying sounds unusual or doesn’t make sense to you.
• Recognise what the person says seems very real to them.
• Listen respectfully to what they are saying.
• Avoid arguing or getting into a debate unless safety is an issue.