PSYCHOTIC SYMPTOM DE-ESCALATIONRhonda Nelson, M.S. Ed, LCPC

Aimee Anderson, MS

What is psychosis?

A serious mental disorder characterized by thinking and emotions that are so impaired that they indicate that a person experiencing them has lost contact with reality

Early Stage Symptoms

Difficulties concentration Depressed mood Sleep changes – sleeping too much or not

enough Anxiety Suspiciousness Withdrawal from family and friends Ongoing unusual thoughts and beliefs

Late stage symptoms

Delusions Hallucinations Disorganized speech – switching topics

erratically Depression Anxiety Suicidal thoughts or actions Difficulty functioning

What Are Delusions?

Delusions - Definition

A firmly held false belief or impression even when contrived by reality and what is commonly known as true. Delusions of Paranoia Grandiose delusions Somatic delusions

What Are Hallucinations?

A sensory perception in the absence of outside stimulus. Seeing Hearing Smelling Feeling

Positive and Negative Symptoms

Delusions and Hallucinations are the positive symptoms of psychotic disorders. They seem real to the person experiencing them

Negative symptoms include: Loss of motivation Social withdrawal Blunted emotions Thinking difficulties

DSM-V Diagnoses

Schizophrenia Delusional Disorder Brief Psychotic Disorder Schizophreniform Disorder Schizoaffective Disorder

Psychosis can also occur

Bi-polar disorder During periods of mania

Major Depressive Disorder During periods of severe depression

Other possible causes

Illnesses

Brain diseases: Parkinson’s, Huntington’s, and some chromosomal

Brain tumors or cysts Dementia (including Alzheimer's disease) HIV, syphilis, and other infections that attack

the brain Some types of epilepsy Stroke

Possible environmental causes

Alcohol Illegal drugs:

Simulants Methamphetamine Cocaine

Hallucinogenic Drugs (LSD) Bath salts; synthetic drugs (K2)

Long periods without sleep Prescription drugs: steroids and

stimulants

Risk Factors for Psychotic Disorders

Possibly genetic 50% chance of developing a psychotic

disorder if identical twin has been diagnosed Higher risk if immediate family (parent/sibling)

member has been diagnosed Brief reactive psychosis

Response to an extreme situation, death of family member, short-lived response (days)

Treatment Considerations

Rapid tranquilization Medications Therapy Psycho-education Case Management

Tools for Your Toolkit: How?

Approach the person in a caring and non-judgmental way to discuss your concerns

Allow the person to talk about their experiences and beliefs if they want to, but do not force them

Where?

Choose a private time and place, free from distractions

What?

Let the person know you are concerned and want to help- state the specific behaviors that concern you

Let the person know you are available to talk in the future

Why?

Be sensitive to the way the person is behaving

Respect the person’s privacy and confidentiality

Who?

Let the person set the pace and style of interaction

Do not touch the person without permission

“Tips” to assist with the “Tools”

Assist the person by remaining calm Talk in a clear, concise way Use short, simple sentences

More Tips…….

Speak quietly in a non-threatening tone at a moderate pace

Answer questions calmly Comply with reasonable requests

More tips…….

Maintain your safety and access to an exit

Do not do anything to further agitate the person

Key “Tip” - Listening

Understand the symptoms for what they are

Empathize with how the person is feeling about his/her beliefs and experiences

Communication

Be patient and allow plenty of time for responses

Be aware that just because the person may be showing a limited range of emotions this does not mean they are not feeling anything

Do not assume the person cannot understand you, even if the response is limited

Information

Give the person hope for recovery

Provide practical help

Do not make any promises that you cannot keep

Treatment Options - Professionals

Doctors – Primary Care Physicians Psychiatrists Social workers, counsellors & other mental

health professionals Certified Peer Specialists

Treatment Options – Non Professionals

+ Peer support groups

+ Family, friends, faith and other social networks

+ Family support groups

+ Discontinuation of alcohol and other drugs

If the person does not want help

Encourage the person to talk with someone he/she trusts

Never threaten the person with hospitalization

Remain patient

Remain friendly and open

The person may want your help in the future

Questions ?