Lecture 4 - Psychosis

Question 1

What is the definition of psychosis?

Answer 1

Loss of contact with reality.

Question 2

What are positive symptoms of psychosis?

Answer 2

• Hallucinations
• Delusions

Question 3

What are negative symptoms of psychosis?

Answer 3

• Avolition (reduction or loss of motivation, initiative, and goal-directed behaviour)
• Social isolation

Question 4

What are hallucinations?

Answer 4

Sensory experiences that are not based on external stimuli. The most common hallucinations in psychosis are auditory, involving hearing voices or sounds that others do not perceive. Visual, tactile, olfactory, or gustatory hallucinations can also occur.

Question 5

What are delusions?

Answer 5

False beliefs - paranoid

Question 6

What does CBT assume about psychosis?

Answer 6

Event (internal or external) -> trigger thoughts <-> emotions <-> behaviours
Cognitive responses to events determine our reactions to these events.

Question 7

What is covert behaviour in terms of psychosis?

Answer 7

Not body actions
How our mind reacts - suppressing thoughts or ruminating on negative events

Question 8

How does CBT work for psychosis? NICE, 2014

Answer 8

• Establish links between thoughts, beliefs, perceptions and feelings in relation to current or past symptoms
• Re-evaluate the beliefs
• Develop alternative ways of coping with the target symptoms, reducing stress and improving functioning

Question 9

What is an internal triggering event?

Answer 9

Memories, images, bodily perceptions

Question 10

How does a therapist formulate psychotic experiences?

Answer 10

After appropriate goals for therapy are identified (which problem / symptom to target):
- Therapist identifies thoughts, feelings and behaviours linked to the problem
- Helps the client see how these interact to maintain the problem
- Create shared understanding of how the problem developed and what can be done to resolve it

Question 11

Example of cognitive model of hallucinations - Morrison, 1998

Answer 11

Triggers (stress, sleep deprivation, isolation) -> auditory hallucinations -> safety behaviours -> misinterpretation of hallucinatory experience -> mood
LOOP!

Question 12

How can normalisation improve psychosis?

Answer 12

The stigma in the media regarding psychosis is damaging, normalising this can challenge the stigma and correct misconceptions

Question 13

How can more accurate information be promoted regarding psychosis?

Answer 13

• Making the experience understandable (behaviours, thoughts and feelings are reactions to extreme adverse traumatic events)
• Experiences exist within the range of human functioning and can be in the absence of distress or MH problem
• Psychoeducation - learning and understanding

Question 14

‘People with psychosis are dangerous’ - how is this a myth?

Answer 14

• There’s no evidence of this
• Violence may be due to substance abuse, pre-existing violent history
• People with psychosis more likely to be victims of violence - vulnerable situations

Question 15

‘Psychosis is a diagnosis for life and there is no recovery’ - how is this a myth?

Answer 15

• Some people only have a single episode (30%)
• Some people experience more than one episode but with long periods without any symptoms (30%)

Question 16

‘People with psychosis are unable to work’ - how is this a myth?

Answer 16

• Psychosis doesn’t always impact functioning

Question 17

‘Psychosis always causes distress and people always need treatment’ - how is this a myth?

Answer 17

• Some cultures perceive psychotic symptoms as positive
• Many people make sense of their experiences and find it helpful - telepathy, psychics, reincarnation beliefs

Question 18

‘Psychosis is always a consequence of brain disease’ - how is this a myth?

Answer 18

• Can occur due to lack of sleep, sensory deprivation, substance abuse (altered states), stressful events, bereavement and trauma

Question 19

How can coping be improved for people with psychosis?

Answer 19

• Review the strategies client already uses and how effective they are, encourage new ones
• Increase coping strategies when facing distress, provide respite and encourage control
• Understanding (humming, reading, singing to distract from inner speech and auditory hallucinations)
• Responding differently to symptoms - acting assertively and dismissing the voices
• Reduce arousal and distress - soothing music, mindfulness

Question 20

How does CBT change unhelpful beliefs and appraisals of psychotic experiences?

Answer 20

• Ask client to keep a log of recent voice hearing experiences
• Can alleviate psychotic symptoms
• NICE state that CBT should be offered as a first one of treatment for psychosis (can be effective without meds too)

Question 21

What is CBT for psychosis based on?

Answer 21

Based on appraisals of events- determining behaviours thoughts, feelings and distress

Question 22

Can childhood adversities increase the risk of psychosis?

Answer 22

Yes

Question 23

What do the NICE guidelines suggest for prevention and management of psychosis?

Answer 23

• More research required to evaluate the efficacy of trauma reprocessing interventions
• All people with first episode psychosis should be screened for trauma and PTSD
• Service users with psychosis and PTSD should be offered treatment options by NICE for PTSD

Question 24

How is Schizophrenia diagnosed?

Answer 24

• Individual must experience at least 2 or more symptoms, present for at least 6 months, including 1 month of active-phase symptoms
• The symptoms must cause social and occupational dysfunction
• They must not be explained by other mental health disorders or substance abuse

Question 25

What are the main symptoms of Schizophrenia?

Answer 25

• Delusions
• Hallucinations
• Disorganised speech
• Disorganised or catatonic behaviour (unpredictable or unusual behaviours)
• Negative symptoms

Question 26

What are the negative symptoms of Schizophrenia?

Answer 26

• Flat affect (affective flattening) - reduced emotional expression (facial expression, voice tone, body language) - appear emotionally unresponsive
• Alogia = speech poverty
• Avolition = decreased motivation, initiative and goal-directed behaviour
• Anhedonia = diminished pleasure
• Social withdrawal