W5: Psychosis

Question 1

Define psychotic disorders, give some examples of common disorders and what can they co-occur with?

Answer 1

= characterised by experience of delusions, hallucinations and speech and behavioural disorganisation.

e.g. Schizophrenia, Delusional disorder, Schizoaffective disorder, or a Depressive or Bipolar disorder, with psychotic features.

Psychotic disorders can also occur due to other conditions eg; Substance/medication-induced psychotic disorders.

Question 2

What are brief psychotic disorders?

Answer 2

Characterised by experience of delusions,
hallucinations and speech and behavioural disorganisation with a
- duration of at least one day but less than a month
- with eventual full return to premorbid level of functioning (completely cured).

Question 3

Define puerperal psychosis

Answer 3

= Is a rare psychotic condition commences immediately following childbirth and affects about one in every 1000 women who have given birth.

Question 4

What is psychosis?

Answer 4

• state of experiencing a break from reality

Question 5

What are some general symptoms of psychosis?

Answer 5

• Delusions
• Perceptual Disturbances
• Disorganised thinking

Question 6

Define delusions

Answer 6

= Fixed false beliefs that cannot be altered by rational arguments and cannot be accounted for by the cultural background of the individual.
-A belief or altered reality that is persistently held despite evidence or agreement to the contrary, generally in reference to a mental disorder.

Question 7

Define the type of delusion: paranoid delusions

Answer 7

= An irrational belief that a person being followed, tracked or targeted.
e.g. camers in their roof

Question 8

Define the type of delusion: persecutory delusions

Answer 8

A false belief that one is being followed or harassed by other people or gangs.
e.g. people at school are ganging up on them

Question 9

Define the type of delusion: grandiose delusions

Answer 9

= A false belief that a person possesses special powers, talents and abilities.
e.g. is a millionaire, the government

Question 10

Define the type of delusion: somatic delusions

Answer 10

= A false belief that a person has an illness which is not supported by medical evidence.
e.g.
- remember people with mental illnesses can co-occur with physical issues so we must rule these out

Question 11

Define the type of delusion: religious delusions

Answer 11

=A false belief with religious or spiritual content.
e.g. a person believe that they are a special prophet to save the world.

Question 12

Define the type of delusion: erotomatic delusions

Answer 12

= Believing that a famous person is in love with them.

Question 13

Define the type of delusion: thought broadcasting

Answer 13

= Belief that ones thoughts can be heard by others.

Question 14

Define the type of delusion: delusions of guilt

Answer 14

= False belief that one is guilty or responsible for something. Example: ‘I am solely responsible for my child’s sickness.’

Question 15

Define the type of delusion: ideas of reference

Answer 15

= A false belief that insignificant events have personal significance.
e.g. a person believes that the television or radio has special messages for them.

Question 16

What are hallucination?

Answer 16

= False sensory perceptions without existing sensory stimuli.
- hallucinations of every sense
- the hallucinations may command the person to behave in a certain way

Question 17

Define illusion

Answer 17

= Misinterpretation of an existing sensory stimuli.

Question 18

What are some types of auditory hallucinations?

Answer 18

Command voice= tell the person to do certain things. may not be able to disobey them

Running commentary= voices telling the person what they are doing

Several voices= many voices talking to the person

Question 19

What are sensory hallucination

Answer 19

Visual: seeing things, animals or objects that arent there. Common in dementia and drug intoxication

Tactile= feeling things hat arent there. Common in drug use or alcohol withdrawal

Gustatory= tastes

Olfactory= smells. Common in people whoo have seziures

Question 20

What are some ways to describe thought form?

Answer 20

= how the person’s thoughts are expressed in their speech

Loosening of associations
Tangentiality
Derailment
Circumstantiality
Neologism
Word salad
Echolalia

Question 21

What is thought stream/process?

Answer 21

Flight of ideas
Clanging
Thought broadcasting
Poverty of thoughts
Thought blocking
Perseveration

Question 22

How should we respond to people having hallucinations?

Answer 22

• acknowledge what the person has said
• acknowledge your understanding
• try and imagine how the other person might feel
• tell the person what you see/taste
• explore the feelings and methods of coping

Question 23

What are some nursing considerations and interventions for people having delusions or hallucinations?

Answer 23

• Nursing considerations and interventions are similar to clients experiencing psychosis and Schizophrenia.
• Actively listen and acknowledge the client
• Identify the unique needs to your clients and plan interventions accordingly

Question 24

What are the 5 essential steps of shared decision/suppored making?

Answer 24

Step 1: Seek the client’s participation. Communicate that a choice exists and invite the client to be involved in decisions
- Summarise the health problem, provide options, encourage participation, involve family and carers

Step 2: Help your client explore and compare treatment options, including no treatment. Discuss the benefits and harms of each option, using evidence
- Assess consumer knowledge, list options in plain language. Communicate risks, benefits and unknowns.
- Use visual aids and information to show evidence
- Use teach-back technique- Ask the client to explain the available options in their own words

Step 3: Assess your client’s values and preferences. E.g. What matters most to your client?
- Ask open ended questions and listen with empathy

Step 4: Reach a decision with your client. Decide together on the best option and arrange for follow-up appointment
- Assist in decision-making- Is the client ready?
- Confirm the decision and organise treatment

Step 5: Evaluate your client’s decisions. Support your client so the treatment decisions has a positive effect on health outcomes
- Monitor treatment experience, assist to manage
barriers
- Revisit the decisions with the client

Question 25

What are some pharmacological interventions for the management of psychosis?

Answer 25

Antipsychotic medications
- Typical/Atypical
Mood stabilisers

Question 26

What are some non-pharmacological interventions for the management of psychosis?

Answer 26

• Cognitive behavioural therapy
• Acceptance and commitment therapy
• Assertive community treatment
• Case management
• Vocational therapy
• Motivational Interviewing
• Psycho education

Question 27

Describe schizophrenia

Answer 27

= a group of abnormalities around thinking, perception and behaviours.
- state being between a dream state and reality.

Question 28

What are some causes of schizophrenia and the populations it effects?

Answer 28

• Develops in late adolescence/early adulthood
• Affects both genders

Causes
- Not well established
- Genetic
- Biochemical
- Environmental

Question 29

What is the DSM V criteria for schizophrenia?

Answer 29

A. Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3):
1. delusions
2. hallucinations
3. disorganized speech (e.g., frequent derailment or incoherence)
4. grossly disorganized or catatonic behaviour
5. Negative symptoms (i.e., diminished emotional expression or abolition).

B. For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning).

C. Duration: Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either (1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or (2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

F. If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1 month (or less if successfully treated).

Question 30

What are the three phases of schizophrenia? explain each

Answer 30

Prodromal: decline in functioning that proceded fist psychotic episode. Socially withdrawn and irritable

Psychotic: all/many symptoms such as perceptual disturbances, delusions, and thought disorders manifest.

Residual: between episodes of psychosis marked by flat affect, social withdrawal odd thinking and behaviour.

Question 31

What are some signs and symptoms of schizophrenia?

Answer 31

Hallucinations
Delusions
Disordered thinking
Abnormal motor behaviour

Question 32

Define positive symptoms of schizophrenia and what are some examples?

Answer 32

= symptoms that seem to be in excess or distortions of common or ordinary experiences; e.g. hallucinations, delusions, bizarre behaviours, disorganised thinking

Question 33

Define negative symptoms of schizophrenia

Answer 33

Symptoms that seem to take away from
or suggest a deficit in relation to common or ordinary experiences, i.e. an absence or lack in the person’s ordinary experiences’ e.g. lack of motivation
e.g. Anhedonia, blunted emotions, cognitive deficits, apathy

Question 34

Define anhedonia

Answer 34

= person no longer interested in activities they previously enjoyed

Question 35

Define blunted emotions

Answer 35

= restricted emotional responses and person appeared to be withdrawn and disinterested.

Question 36

Define cognitive deficits

Answer 36

= difficulty to concentrate and alow to react to sensory input and have impact on communication.

Question 37

Define apathy

Answer 37

= difficulty in understanding straightforward tasks and may appear slow and unmotivated

Question 38

What are some nursing considerations and interventions for someone with schizophrenia or psychosis who is distracted?

Answer 38

• provide a low-stimulus environment
• encourage to retreat to their room or quiet space
• give short and simple instructions
• choose a quiet low-stim environment to conduct an MSE to prevent distractions from external environment.

Question 39

What are some nursing considerations and interventions for someone with schizophrenia or psychosis who is actively responding to their internal stimuli?

Answer 39

Validate the experiences of hallucinations and try to distract the client by suggesting;
- listening to music though headphones
- use low stimulus room
- exercise or go for a walk if safe to do so
- have a warm drink
- play a board game
- consider PRN meds

Question 40

What are some nursing considerations and interventions for someone with schizophrenia or psychosis who is actively having an altercation with a co-client?

Answer 40

• ensure your safety
• establish the issue and rectify it
• get help from other staff but stay in the vicinity
• separate people who are arguing by asking them to go to a low-time room e.g. their bedroom
• ensure privacy
• ask others in the area to leave and reassure them

Question 41

What are some nursing considerations and interventions for someone with schizophrenia or psychosis who is refusing medication?

Answer 41

• identify reason
  e.g. concern for paranoia, mistrust, past trauma, side effects, poor insite
• negotiate by giving them options
• validate their distress
• use a clinician who has rappout with the client
• avoid authoritarian language
• use appropriate non-verbal communication

Question 42

What are some nursing considerations and interventions for someone with schizophrenia or psychosis who is having sleeping issues?

Answer 42

Suggest and facilitate the following techniques;
- avoiding caffeine/nicotine especially in evening
- develop sleep routine
- exercise
- complete sleep diary
- wake up the same time in the morning
- healthy eating
- warm shower before bed
- relaxation techniques

Question 43

For someone with schizophrenia, what might be included in the nursing intervention psychoeducational?

Answer 43

• how they are at risk of other physical health issues so educate on the important of a healthy lifestyle and diet to prevent these.

Question 44

What are some pharmacological management strategies for a client with schizophrenia?

Answer 44

• Typical antipsychotics
• Atypical antipsychotics

Question 45

What are some non-pharmacological management strategies for a client with schizophrenia?

Answer 45

• Music therapy
• Behavioural therapy treatment
  - aims to ensure the client can function well in society. The main feature of schizophrenia is functional and occupational decline so this aims to improve that. Social skills, work and other activities are what it aims to improve.
• Cognitive behavioural therapy
  - not effective in acute stage of illness only in recovery phase what they have good cognitive level
• Psychoeducation
  - education of health habits, their condition, their medication

Group therapy= not recommended n schizophrenia sue to the over stimulation it leads to.