Psychosis & Bipolar Care Principles

Psychosis & Bipolar

• Psychosis Risks: Self-harm, neglect, harm to others. 50-60% admitted within the first episode, often under the Mental Health Act.
• Feasible Home Management: Possible for acute psychosis depending on the risks.
• Immediate Needs Assessment: Assessing and managing risks, history, physical health, personality, coping, support system for acute and severe mental health problems.
• Further Assessment: Diagnosis and further treatment planning.
• Services Available: Acute inpatient wards, crisis houses, day hospitals, early intervention, rehabilitation, primary care, and community mental health teams.
• Psychosis Care Principles: Assessment and reassessment, multidisciplinary approach, and collaboration.
• Holistic Approach: Incorporating consideration of physical health, social care, and recovery.
• Early Intervention for Psychosis: Mandatory in UK since 2001. Specialist services involved from the start, even during inpatient and crisis treatments.
• Antipsychotic Medication: Used to treat positive symptoms. 81% experience improvement with antipsychotics, with 52% improvement without. Most improvements occur in 6 weeks to 6 months. Side effects include: weight gain, metabolic syndromes, motor side effects, sedation, and cardiac arrhythmias.

Bipolar

• Risks in Mania: Severe recklessness, physical illnesses, injury, overspending.
• Interventions: Medication (mood stabilizers such as valproate, carbamazepine, lamotrigine, and lithium), antipsychotics (first in UK for acute states), antidepressants, psychoeducation, social support, CBT.
• General Management: Self-care, calming activities, sleep routines, stress management, coping strategies, relapse identification, collaborative plans with family/support systems, risk management.
• Bipolar Depression: Difficulties distinguishing it from regular depression, less attention to it amidst mania.
• Culture & Diversity: Culture is not static and influenced by factors like social class, geographic location, and generational status. Ethics are individual.

Dementia

• Delayed Diagnosis: Delayed or missed diagnoses in dementia are largely due to individuals not believing they have memory issues (1/3 of people with dementia fail to receive diagnosis)
• Loss of Hippocampus: The hippocampus typically experiences atrophy in Alzheimer's disease.
• Dopamine Deficiency: Dementia with Lewy bodies (DLB) results in lower dopamine levels.
• Mental Health Care: Primary care workers such as GPs, practice nurses, counselors etc. and mental health workers play a crucial role in providing mental health care

Depression

• DSM-5 Criteria: Five or more of nine symptoms present for two weeks; at least one is depressed mood or loss of interest/pleasure
• Common Symptoms: Depressed mood, decreased interest/pleasure, significant appetite/weight changes, insomnia/hypersomnia, fatigue/loss of energy, psychomotor agitation/retardation, feelings of worthlessness/guilt, decreased ability to concentrate, and recurrent thoughts of death.
• Overlap of Symptoms: Symptoms overlap typically between depression and anxiety. Some symptoms may be normal, but are a concern if affecting daily life.

Anxiety Disorders

• Common Features: Increased heart rate, muscle tension, shallow breathing, sweating, appetite suppression, nausea, and preparation for threats.
• Activation of Autonomic Nervous System: The "fight or flight" response (autonomic nervous system activation) is a core aspect of anxiety disorders.
• Panic Attacks: Characterized by often-difficult-to-treat panic attacks, worries, and fears of heart attack, stroke, or collapse, often coupled with physical symptoms.

Intellectual Disability

• Normalisation Movement: (Denmark 1959) - Individuals with ID should be able to live a normal life.
• Policy & Theory: 2001 Valuing People(UK); 2015 Transforming Care (UK); Person-Centred Planning (International); Positive Behaviour Support (applied science).
• Criteria (DSM-5): Intellectual functioning less than 70 on standardized IQ tests, adaptive functioning challenges, and symptoms that have been present since the developmental period before 18 years of age
• Limitations: Communication difficulties, difficulties with everyday tasks, often misunderstood, and/or stigmatized.

Physical Health Conditions and Mental Health

• Long-Term Health Conditions: Significant chronic conditions that require ongoing management and frequently accompanied by psychological distress, which account for a considerable proportion of NHS budgets.
• Increased costs: Costs increase when psychological support is lacking as well, ranging from 45% - 75% in some cases.
• Mind-Body Dualism: The 17th-century concept of mind and the body as separate entities, underpins the medical model and continues to impact healthcare.

Biopsychosocial Model

• Model Components: Biological factors include genetics, tissue damage, and nervous system characteristics. Psychological factors involve emotions, behaviors, coping mechanisms, beliefs, and attitudes. Social factors encompass environmental factors, cultural norms, relationships, socioeconomic factors, and access to healthcare resources
• Role of Clinical Psychologists: Clinical work, individual work, family & couple therapy, group work, joint work with other professionals, inpatient and outpatient consultation, training, supervision, research, development.
• Relevant Models: Cognitive behavioural therapy(CBT), third-wave approaches (like compassion focused therapy), and solution-focused therapy.

Language & Assumptions

• Language: It is crucial to use clear and simple language, avoiding medical jargon or misinterpretations. Cultural factors also influence language understanding.
• Assumptions: Subtle and often unconscious assumptions influence perceptions and impact service delivery, but the use of simple and everyday language aids in understanding, even in the face of potential assumptions based on cultural factors.

This quiz evaluates your understanding of psychosis and bipolar disorder care, including risk assessment, available services, and management approaches. It focuses on effective strategies for acute care, diagnosis, and the importance of a holistic treatment plan. Test your knowledge on the various assessments and community support available for individuals experiencing these mental health issues.