Kaleidoscope Yorkshire

Understanding Psychosis

Introductions

Objectives• Identify what we mean by psychosis• Identify what it is ‘isn’t’• Discuss the difference between

symptoms and illness• Identify other medical conditions• Describe the main presenting symptoms• Identify what causes psychosis• Have a brief look at first episode

psychosis• Discuss and Identify ‘First Aid’ for

psychosis• Briefly identify treatment options

What is Psychosis...

?

What it is….

• A psychiatric term• Greek: Psyche: Abnormal

Mind / Condition• Experiences: Hallucinations,

Delusions, Unusual Beliefs• Loss of contact with reality• A marked change in behaviour

Cultural Aspects

R.D. Laing‘Madness need not be all

breakdown. It may also be break-through. It is potential liberation

and renewal as well as enslavement and existential death’

What is isn't?

Diagnosis

• Severe Depression• Schizophrenia• Bi Polar (Affective) Disorder• Schizoaffective Disorder

What other mental health issues witness psychosis as a symptom?

• Some Personality Disorders• PTSD• OCD• Brief Hallucinatory experiences

Medical Conditions

• Secondary PsychosisDementia

Parkinson’s

PsychosisBrain Tumour

Cancer Treatment

Thyroid problems

ChildbirthB12

Liver and Kidney problems

Lupus

Recreational Drugs**

Therapeutic Drugs

Plants

FluAnimal Toxins

Is it common?

• UK Health Authorities suggest 1 in every ? People in Britain has had psychosis.

• 100• 200• 500

Other Facts

• 80% of all cases of Psychosis are experienced by people aged 16 – 30

• There are more incidences in urban than rural communities

• In the UK there is a slightly higher prevalence in people from black and ethnic minority groups

• Men and women are affected with equal frequency

Main presenting symptoms

• Hallucinations• Delusions• Thought disturbances• Lack of insight

4 Main Symptoms

• Hallucinations – Sight, Sounds, Touch, Smell

• Delusions – Paranoid, Grandeur

• Thought Disturbances – Speech, content, train of thought

• Lack of insight – Unaware, lack self awareness

What causes it?

• Physical (Organic)• Substance Induced (e.g.: Drugs

and Alcohol)• Medication• Brain Chemistry**• Inherited Vulnerability • Traumatic experiences

Brain Chemistry• What Happens Normally?• Information is moved around the brain,

from nerve cell to nerve cell, by means of chemical substances, called???

• A message travels along the nerve and when it approaches the nerve ending a neurotransmitter is released (1)

• The neurotransmitter is received by the next cell (2)

• some of the neurotransmitter gets reabsorbed (3)

• When enough neurotransmitter is received by the next nerve cell the message moves forward (4)

NEUROTRANSMITTERS.......

However.....• Dopamine and Serotonin are two neurotransmitters that

are important in psychosis

• In people with psychosis, the balance between these chemicals is disturbed

• One theory, is that in psychosis there may be too much Dopamine

• Symptoms of psychosis, like Hallucinations and odd beliefs ( Delusions ) are thought to be related to this overstimulation

• Nerve cells shut down

• Symptoms

• Medication

• Treatment

First Episode Psychosis

• 3 phases• Prodrome• Acute• Recovery

First Aid – For Psychosis

• Not a sticking plaster for the mind, some real practical guidance.

• Caring and non judgmental, share your concerns

• Privately, away from distractions• Tailor your approach• Be specific about your concerns• Allow the person to articulate

themselves• Offer reassurance

How should you approach someone who may be experiencing psychotic symptoms

How can you be supportive?

• Treat the person with respect• Avoid any confrontation• Bee honest

How would deal with ‘delusions’ and ‘hallucinations’?

• Validate their ‘realness’• Don’t argue, dismiss, or

minimise• Don’t act alarmed, horrified

or embarrassed

How would you deal with communication difficulties?

• Uncomplicated responses, succinct

• Be patient, allow time• Don’t assume someone

doesn’t understand

How should you encourage someone to get professional help?

• What did the person do previously?

• Support the person emotionally and practically

What if the person refuses help?

• Encourage to talk to someone the person trusts

• A person can’t be forced to accept help

• Above all, remain friendly, and open to the possibility of future help

What about a crisis?

• Remain calm, assess risks• Is there an advance directive?• Who can help?• Can the person be left alone?• Use appropriate

communication• What if things escalate?

What if the person becomes aggressive?

• De-escalation• Don’t be hostile, disciplinary or

challenging• Don’t threaten or prompt aggression• Avoid raising your voice or talking too

fast• Stay calm, avoid abrupt movements• Don’t restrict the person’s movement• Be aware of increasing fear and

possible aggression

Dolly’s experiences, CBT

• F:\Videos\Dolly's experience with psychosis and CBT.flv

Treatment Options

• Talking Treatments• Medication• Community Care and CPA• Hospital admission• Crisis Teams / Support lines• Early Intervention in Psychosis• Advocacy• Advance Decisions