Study Notes on Psychosis

What is Psychosis?

  • Definition: Psychosis is a medical condition affecting the brain, characterized by a loss of contact with reality.

  • Psychotic Episode: The occurrence of psychosis is referred to as a psychotic episode.

  • Prevalence:

    • Psychosis is most prevalent among young adults.

    • Approximately 3 out of every 100 people will experience a psychotic episode, making it more common than diabetes.

    • Most individuals make a full recovery from psychosis.

    • People from any demographic can experience psychosis, and it is treatable.

Symptoms of Psychosis

  • Psychosis can lead to various changes in mood, thinking, and abnormal ideas, complicating emotional understanding. Symptoms characteristic of psychosis include:

    • Disorganized Thinking:

    • Thoughts become confused or fail to connect properly.

    • Sentences may be unclear or nonsensical.

    • Difficulty in concentration and following conversations; memory issues.

    • Thoughts may seem to speed up or slow down unexpectedly.

    • Hallucinations:

    • Perceptual experiences where the individual sees, hears, feels, smells, or tastes things that are not present.

    • Examples include hearing voices or sensing the presence of non-existent objects.

    • Sensory distortions may lead to perceptions of bad or poisonous tastes and smells.

    • False Beliefs (Delusions):

    • Individuals may hold strong false beliefs that are resistant to logical arguments against them.

    • Example: Belief that one is being watched by the police because cars are parked outside their house.

    • Changed Feelings:

    • Emotional states may seem abnormal; feelings change without clear reason.

    • Individuals may feel alienated or as if reality is in slow motion.

    • Common mood swings can result in unusual excitement or depression.

    • Diminished emotions; reduced ability to express feelings to others.

    • Changed Behavior:

    • Behavior manifests differently, with extremes like hyperactivity or lethargy.

    • Individuals may laugh inappropriately or show sudden anger without clear cause.

    • Changes in behavior often relate to the previous symptoms of disorganized thinking, hallucinations, or delusions (e.g., calling police in fear based on what they think they've seen or heard).

    • A belief that food is poisoned may lead someone to stop eating.

    • A person identifying as a religious figure, such as Jesus, may spend time preaching publicly.

  • Variation: Symptoms can vary widely among individuals and may change over time.

First Episode Psychosis

  • Definition: First-episode psychosis refers to the initial occurrence of psychotic symptoms in an individual.

  • Distress: Individuals may be confused and distressed, often failing to comprehend their experiences.

  • Impact of Myths: Lack of information about mental illness can amplify distress due to negative stereotypes.

Phases of a Psychotic Episode

  • A psychotic episode typically unfolds in three phases:

    • Phase 1: Prodrome

    • This phase involves early signs that are often vague and barely noticeable, possibly changing individuals' descriptions of their feelings and thoughts.

    • Phase 2: Acute

    • Clear psychotic symptoms manifest, including disorganized thinking, hallucinations, and delusions.

    • Phase 3: Recovery

    • Recovery is possible and varies by individual, with many never experiencing another episode.

Types of Psychosis

  • A specific psychotic illness diagnosis is usually determined when a person is experiencing psychosis. The diagnosis depends on the nature of the illness and the duration of symptoms.

Management of Delusions

  • Establish Trust:

    • Building a trusting relationship with the client is crucial, as delusions can be frightening.

    • Ensure the client feels safe and that no harm will come to them.

  • Understanding Delusions:

    • Identify and explore the content of the delusion by asking for their thoughts.

    • Clarify any confusion you might have regarding their beliefs.

    • Determine the central theme of the delusion alongside the principal feelings experienced by the client.

    • Assess the delusion's intensity and how it interferes with the client's Activities of Daily Living (ADLs).

    • Investigate any actions taken based on the delusion.

    • Identify stressors or triggers that may exacerbate the delusion and recent changes in routines.

  • Emotional Support:

    • Encourage discussion of feelings, such as anxiety or frustration, as these can contribute to delusions.

    • Avoid arguing or challenging the delusion; gently present reality without implying the client's perspective is wrong.

    • Suggest coping strategies to manage the delusion, prioritizing emotional tone over content.

Strategies for Reducing Anxiety and Delusional Thinking

  • Utilizing one-on-one contact and anxiety-reducing techniques can help mitigate delusional thoughts.

  • Engage the client in discussions focused on real events or people to redirect conversation from delusions.

  • Encourage participation in activities requiring physical skill and concentration to help divert attention from overwhelming thoughts.

References

  • Corrigan and Storzbach, 1993; Lowe and Chadwick, 1990; Moller and Wer, 1989, 1992; Murphy and Moller, 1993; Rosenthal and McGuinness, 1986.