Week 3- psychosis/crisis intervention Flashcards
psychosis
definition
disruptions to a persons thoughts and perceptions that make it difficult to recognize what is real and what isnt
psychosis DSM-5 definition
abnormalities in 5 different symptomatic domains
- delusions
- hallucinations
- disorganized thoughts/speech
- disorganized behavior
- negative symptoms
psychosis physiology
no one cause but thought to deal with lack of dopamine which leads to positive symptoms
- can be due to environment, toxins, genetics
- usually develops early to late 20’s due to amount of stress during this time
schizophreniform disorder
duration
1- 6 months
schizophrenia
duration
symptoms last longer than 6 months
schizoaffective disorder
psychosis with a mood disorder
- there will be psychosis at all times
disorders that may manifest psychosis
bipolar disorder I, major depressive disorder, alcohol use disorder, substance use disorder
secondary psychosis
product of underlying medical problems
schizophrenia diagnostic criteria
2 or more of the following;
- delusions
- hallucinations
- disorganized speech
- disorganized behavior
- negative symptoms
delusions
false, fixed beliefs that are unlikely to change despite contradictory evidence
hallucinations
perceptions that occur without an external stimulus
- auditory is most common
positive symptoms
- hallucinations
- delusions
- disorganized speech
- thought disorder
- disorganized behavior
negative symptoms
- alogia (no speech)
- flat affect
- poor attention
- avolition (no motivation)
- anhedonia (no pleasure)
- loss of social interest
- attention defecits
1st phase of psychosis
- subtle early signs
- vague changes in thoughts/feelings/perceptions
- able to maintain some level of functioning
2nd phase of psychosis
- clear psychotic signs
- functioning deteriorates
- substance abuse for coping is common
- high risk of suicide due to lots of frustration
3rd phase of psychosis
- treatment/recovery
- medication
- social supports and resources
- relapse is common
consequences of psychosis
- problems with functional ability
- dementia
- long term problems related to pharmacological treatment
grandiose delusions
belief of special powers or of being greatly significant
paranoid delusions
reflect profound fear and anxiety
control delusions
do not feel in control of their movement
somatic delusions
deals with feelings in body
- eg. parasites
nihilistic delusions
believes they are dead
magical thinking
believes that specific thoughts/words have special influence on world around them
command halluciantions
voice telling you to do something
circumstantial thought
gives excessive and non-essential detail but returns to point or answers question
tangential thought
never returns to topic
loose associations
lack of logical relationship betwen thoughts
flight of ideas
rapid change from one topic to another
thought blocking
sudden pause in train of thought and then cannot recall
preservation
persisting on topic even when stimulus has changed
clang association
similar sounds but incoherent meaning
echolalia
repetition of things said by others
neologisms
making up words
word salad
incoherent mixture of words
waxy flexibility
body showing resistance to being moved
- specific symptom of catatonia
stereotypy
repetitive or ritualistic movement or posture
echopraxia
involuntary repetition or imitation of another persons actions
alogia
poverty of speech
avolition
decreased motivation
anhedonia
inability to feel pleasure
ambivalence
strong opposing feelings
acute phase interventions
psychosis
safety, establish trust, do not confirm delusions or hallucinations
recovery phase interventions
psychosis
show positive regard for experience, focus on goal oriented activity, model appropriate skills
first generation antipsychotics
most common is haldol; least expensive
- treats positive symptoms
- not for long term
- side effects are parkonsinism, NMS, dystonia, akathisia
neuroleptic malignant syndrome
mental status change with muscle rigidity and fever
dystonia
involuntary muscle contraction
akathisia
inability to remain still
2nd generation antipsychotics
clozapine, olanzapine, risperidone, palperidone
- treats positive and negative symptoms but much more expensive
- very potent
- can cause side effects but lesser degree than 1st gen
* can cause agranulocytosis
3rd generation antipsychotics
aripiprazole (abilify)
- treat mood disorders and schizophrenia
- can cause side effects but lesser degree than 1st or 2nd gen
- expensive
meds to manage side effects for antipsychotics
benztropine and clonazepam
purpose of crisis intervention
goal is rapid resolution to prevent further deterioration
stages of a crisis
precipitant –> early escalation –> meet needs –> cope
initial threat
stage of crisis
problem where patient has to cope
escalation
stage of crisis
problem persists and usual defensive coping skills fails
crisis
stage of crisis
fight or flight response and may attempt to find helpful resources
personal disorganization
stage of crisis
if problem is unresolved from 2nd or 3rd stage then there will be serious disorganization
situational crisis
things related to immediate life circumstances
maturational crisis
related to stages of life
adventitious crisis
related to natural disasters, acts of terrorism, interpersonal disaster
key to crisis intervention
3
empowerment, empathy, interdisciplinary
stage 1 crisis intervention
crisis assessment
- level of functioning and current safety
- suicide risk assessment
stage 2 crisis intervention
establish rapport
- may need to use de-escelation techniques
- active listening
- empathy
- role clarity
- boundaries
stage 3 crisis intervention
identify major problems
- identify major problems
- client perspective on the situation
stage 4 crisis intervention
feelings and emotions
- education
- empower
- positive reframing
stage 5 crisis intervention
explore alternatives
- avoid probing in depth
- ask what strategies work for them
- offer choice
stage 6 crisis intervention
develop plan
- collaborative agreement on a plan
- focus on basic needs
- implement the plan
illusion
misperception of a real experience or stimulus
