Schizophrenia and Psychosis (Lecture)

Question 1

What is psychosis?

Answer 1

When someone 
experiences an ‘altered reality’…
lost touch with everyone else’s
interpretation of what is going on 
around them

Question 2

What are the types of psychosis?

Answer 2

Drug-induced psychosis
Brief reactive psychosis
Schizophrenia
Bipolar disorder
Severe depression

Question 3

What marks a diagnosis of schizophrenia?

Answer 3

1. Delusions
2. Hallucinations
3. Disorganised speech (frequent derailment or incoherence)
4. Grossly disorganized or catatonic behaviour.
5. Negative symptoms, (diminished emotional expression, avolition)

Question 4

How does schizophrenia impact occupational and social functioning when diagnosed?

Answer 4

For a significant portion of the time since onset, level of functioning in one or more major areas (e.g. work, self-care, social relations) is markedly below the level achieved prior to onset.

Question 5

What are associated features of schizophrenia?

Answer 5

• Lack of interest in eating/refusing food
• Abnormalities of psychomotor activity
• Concentration, attention, memory difficulties
• Treatment non-adherence
• Poor psychosocial functioning
• Anxieties and phobias
• Depersonalisation, derealization, somatic concerns

Question 6

What are impacts of schizophrenia?

Answer 6

• Physical health issues, e.g. cardiovascular disease, obesity, diabetes, substance misuse, metabolic syndrome.
• Activities of Daily Living.
• Range of losses may be experienced (e.g. credibility, capacity to communicate, rationality, reputation, relationships, education, work, home, possessions, physical health, sense of hope/future).
• Sensory processing.

Question 7

What is the aetiology of schizophrenia?

Answer 7

• Stress Vulnerability Model (as response to stress).
• Neuroanatomical differences and neurotransmitters (i.e. dopamine).
• Prenatal factors (i.e. flu and 2nd trimester of pregnancy).

Question 8

What is treatment of schizophrenia?

Answer 8

• Medication
• Oral and injection: side effects can be serious
• Hospitalisation
• Social skills training
• Psychoeducation
• Family Psychoeducation (FPE)
• Group therapy
• Case management
• Cognitive Behavioural Therapy

Question 9

How should person re-engage in activities and socially after first episode of psychosis?

Answer 9

• Making new plans
• Developing a balance of activity and social routines
• Participating despite disturbances in emotional connection to activities and socialising
• Matching participation to the recovery of performance abilities
• Managing new self-care and social skills
• Managing changed conditions and contexts for activity and social participation

Question 10

What should occupational therapy for people with psychosis or schizophrenia focus on?

Answer 10

• Person centred and collaborative
• Considers person’s strengths as well as limitations
• Balanced programme (not just focused on one area)
• Engages family, supports where appropriate
• Cognitive remediation; cognitive adaptation
• Sensory processing (Dunn’s model); sensory rooms
• Psycho-educational groups
• Social skills training
• Peer support
• ADL & IADL
• Individual sessions where appropriate (e.g. budgeting)
• Supported education & supported employment
• Vocational assessment and rehabilitation
• Community arts and other creative activity groups