Week 7 Psychosis PDF

Psychosis and Personality Disorders SWSP3027-NURS7128 Week 7 SWSP3027-NURS7128_20240904 How’s it work? Contains diagnostic criteria (symptom- Mental health & illness exist on a based) for all curr...

Psychosis and Personality Disorders SWSP3027-NURS7128 Week 7 SWSP3027-NURS7128_20240904 How’s it work? Contains diagnostic criteria (symptom- Mental health & illness exist on a based) for all currently recognised mental continuum illnesses & disorders DSM-5 definition of mental disorder: Diagnosis combines the objective Cautions: (indicators (symptoms) which are to Clinically significant: assessment DSM-5 is not a checklist. Diagnosis is some extent present in all of us) continuum not simply a matter of counting the symptoms and the subjective Behavioural or psychological syndrome or pattern: avoids Need to note combination of (assessments of impact on functioning, aetiology predisposing, precipitating, frequency, person’s experience, cultural perpetuating, & protective factors context etc.) Associated with distress, disability, Scales of severity & abnormality Diagnosis identifies & classifies increased risk of death, pain or can’t be captured in a text – involves thoughts & behaviours significant loss of freedom experience, training & engagement Diagnosis follows assessment Distinct from culturally “The specific diagnostic criteria expected/endorsed responses to included in DSM-5 are meant to serve as guidelines to be informed by clinical specific events judgment and are not meant to be used in a rigid cookbook fashion.” SWSP3027-NURS7128_20240904 PBS NewsHour. (2013, May 21). What DSM-5 means for diagnosing mental health patients [Video]. Youtube. https://www.youtube.com/watch?v=j67-uC8icNE&t=2s SWSP3027-NURS7128_20240904 What’s in it? SWSP3027-NURS7128_20240904 Psychosis A symptom – NOT a condition or illness Basic definition: inability / loss of ability to distinguish between reality & unreality 5 key domains: delusions hallucinations disorganized thinking grossly disorganized or abnormal motor behaviour (including catatonia) negative symptoms Bella Reed Marley Wilkie SWSP3027-NURS7128_20240904 General notes Often single episode, triggered by stress or substance use Can be organic: head injury or brain infection Common onset: late adolescence “Prodromal phase” symptoms begin to emerge, Izzie Nielson often subtle Peter Chan  SWSP3027-NURS7128_20240904 PBS NewsHour. (2011, February 10). Young man on being diagnosed with psychosis [Video]. Youtube. https://www.youtube.com/watch?v=Rws1niDxqK8&t=160s What symptoms does Andrew describe? What prevented Andrew asking for help? Why did Andrew have an issue with his diagnosis? Describe Andrew’s affect SWSP3027-NURS7128_20240904 Common prodromal indicators Why not “risks”? Social withdrawal Hostility or suspicion Decline in personal hygiene Lack of facial expression Lack of appropriate emotional expression Sleep & memory disturbance Nannan Irrational statements; strange use Wang of language SWSP3027-NURS7128_20240904 Schizophrenia SWSP3027-NURS7128_20240904 Schizophrenia SWSP3027-NURS7128_20240904 Delusions Fixed beliefs that conflicting evidence won’t change. Major types Persecutory: belief that one is going to be harmed, harassed, Can be termed bizarre if they are clearly etc. by an individual, organization, or other group. Most implausible, not understandable to same- common culture peers & do not derive from ordinary Referential: belief that certain gestures, comments, life experiences environmental cues, etc. are directed at oneself Can be termed non-bizarre if not impossible, Grandiose: belief that one has exceptional abilities, wealth, or fame but unlikely & unsupported by ervidence Erotomanic: false belief that another person is in love with them Nihilistic: belief a major catastrophe will occur Somatic: preoccupations regarding health and organ function SWSP3027-NURS7128_20240904 Hallucinations Perception-like experiences that occur without an external stimulus Vivid & clear as normal perceptions Not under voluntary control Occur in any sensory modality, but auditory hallucinations are the most common. Auditory hallucinations are usually experienced as voices, whether familiar or unfamiliar, that are perceived as distinct from the individual’s own thoughts. Must occur in the context of a clear conscious state; those that occur while falling asleep (hypnagogic) or waking up (hypnopompic) are not symptoms SWSP3027-NURS7128_20240904 Disorganised speech Indicates disorganised thought disorder. Derailment or loose associations: person may switch from one Because mildly disorganized speech is topic to another without prompting or apparent linkage common, the symptom must be severe enough to substantially impair effective Tangentiality: answers to questions may be obliquely related or communication completely unrelated (). Incoherence or “word salad”: speech may be so severely disorganized that it is nearly incomprehensible. Rare The severity of the impairment may be difficult to evaluate if the person is from a Distinct from glossolalia & shamanistic speech CaLD background SWSP3027-NURS7128_20240904 Psychedelics. (2021, August 20). Disorganized hebephrenic schizophrenia interview from 1980s psychiatric teaching film [Video]. Youtube. https://www.youtube.com/watch?v=T9U5UcgOfzo&t=74s SWSP3027-NURS7128_20240904 Grossly disorganized or abnormal motor behaviour Wide-range of manifestations Catatonia can also include: Most notable in goal-directed behaviour – tasks of daily living purposeless & excessive motor activity incomplete or not correctly attempted without obvious cause (catatonic Can include childish, infantile “silliness” as well as excitement) unpredictable agitation repeated stereotyped movements Catatonia staring – Marked decrease in reactivity to the environment. Can involve: grimacing resistance to instructions (negativism) echoing of speech maintaining a rigid, inappropriate or bizarre posture complete lack of verbal and motor responses (mutism & stupor) SWSP3027-NURS7128_20240904 Negative symptoms Negative in the sense that something is taken away or missing from typical behaviour. Diminished emotional expression: reductions in the expression of emotions in the face, eye contact, intonation of speech (prosody), and body language - gestures that normally give an emotional emphasis to speech Avolition: decrease in motivated self-initiated purposeful activities. The individual may sit for long periods of time and show little interest in participating in work or social activities. Other negative symptoms: Alogia: diminished speech output Anhedonia: decreased ability to experience pleasure Asociality: apparent lack of interest in social interactions and may be associated with avolition SWSP3027-NURS7128_20240904 Schizophrenia SWSP3027-NURS7128_20240904 Schizophreniform Disorder Related conditions – Symptoms as per schizophrenia – Episode lasts less than 6 Linked to schizophrenia, but distinct months Schizotypal Personality Schizoaffective Disorder Disorder – Crit. A smptoms concurrent with – Person experiences delusions & major mood disorder possibly hallucinations linked to (depression or mania) the delusion (but not overly disruptive) Substance-Induced Psychotic Disorder – Behaviour is not bizarre – Person experiences delusions &/or – No other crit. A symptoms hallucinations around the time they were exposed to or withdrawing from a drug – No pre-drug evidence of illness – age factor – Name of the substance included in the diagnosis – Symptoms don’t continue after use ceases SWSP3027-NURS7128_20240904 Bipolar Disorder 1 and 2 Peter Chan  SWSP3027-NURS7128_20240904 University of Nottingham. (2012, January 31). Psychiatric interviews for teaching: Mania [Video]. Youtube. https://www.youtube.com/watch?v=zA- fqvC02oM Describe John’s appearance, speech and affect What symptoms of psychosis do you note? Views on the interviewer’s approach? SWSP3027-NURS7128_20240904 Bipolar disorders “Bipolar” People with bipolar disorders have mood swings Mood goes between: – Unusually happy or excited “Mania” – Unusually sad and hopeless “Depression” The key word is “Unusually”! – The happiness and sadness are not linked to very happy or sad events in their lives – The amount of happiness or sadness is more than you would normally see SWSP3027-NURS7128_20240904 More about bipolar disorders 1 in 50 adults in Australia have a bipolar disorder Used to be called “Manic-Depression Bipolar disorders are mental illnesses – which means we can only see the signs in peoples’: – Behaviour – what they say and do – Thoughts – when they tell us what they are thinking – Feelings – when they show or tell us about their emotions The most common list of symptoms of mental illnesses used in Australia is known as DSM-5. This is what most doctors use On the next slide, we’ll look at what DSM-5 says about bipolar disorders SWSP3027-NURS7128_20240904 Bipolar 1 disorder The most common forms of bipolar disorder are bipolar 1 disorder and bipolar 2 disorder To be diagnosed with BP1, a person must be unusually happy for at least a week This is known as a “manic – They are extra talkative and friendly (sometimes to episode” strangers) – easily distracted There’s no point in telling the person to calm down: they can’t control what is – They take on a lot of new jobs or plans which seem happening to them unrealistic Manic episodes are very serious. People can run- – They don’t seem to be sleeping much (if at all), debts, get into fights, not go to work, neglect their sometimes for days family. It is impossible for them to function normally – They are talking more loudly and more quickly People should not be blamed for how – They over-spend, are too generous and take risks they behave in a manic episode: it’s not their fault! SWSP3027-NURS7128_20240904 Bipolar 1 disorder (cont.) Before and after the manic episode, people with BP1 ALSO experience: A “major depression” A less severe period of unusual happiness and energy – like manic episode, but they can function better Feeling sad, empty or hopeless most of the time – This is known as a “Hypomanic episode” No longer enjoying activities Withdrawing from loved ones OR At least 2 weeks of major depression Not sleeping OR sleeping too much Tired constantly Can’t concentrate Thoughts of dying or suicide SWSP3027-NURS7128_20240904 Bipolar 1 and Bipolar 2 What’s the difference?? Bipolar 1 Manic episode + hypomania OR major depression Bipolar 2 Major depression + hypomania No manic episode Diagnosing is difficult: takes time and attention Diagnoses can change as the doctor gets to know the person better SWSP3027-NURS7128_20240904 Patterns Sometimes we use the term “presentation” for these points BP1 and BP2 Remember: people with bipolar disorders go through swings of mood between the two poles – A person’s first mood episode (mania, hypomania or depression) tends to be the one they will experience most going forward Stress, disappointments or very happy events can lead to episodes of depression or mania Use of some drugs can lead to manic episodes (e.g., cannabis) Frequency of episodes increases with age Childbirth a recognised trigger SWSP3027-NURS7128_20240904 Treating bipolar disorders People with bipolar disorders are at greater risk of suicide than the general population 5-6% complete suicide Bipolar disorders can be treated! People in a manic episode often need to be in hospital for a few weeks until their mood settles Medication is very important in preventing episodes – people with bipolar disorders need to be in close contact with their doctors SWSP3027-NURS7128_20240904 Recovery-oriented engagement principles – Recognise complexity of the person: more than illness – Avoid diagnostic overshadowing – Active listening – Empathy – Balance validation & non-reinforcement of delusions Working with people experiencing florid symptoms – Low-stimulus environment – Slow, calm speech - regular checks for comprehension – Consistent boundaries  SWSP3027-NURS7128_20240904 Interventions (Hungerford et al, p. 379) SWSP3027-NURS7128_20240904 Biff Reed Personality Consistent patterns of thinking, feeling & acting which characterise individuals Stable over time Our “subjectivity” Product of experience, genetics, physiology, social processes Mr. Fluffymittens Wilkie SWSP3027-NURS7128_20240904 Disordered personalities Inflexible & pervasive → clinically significant distress or impairment in important areas of functioning Enduring pattern of inner experience & Stable, long duration behaviour that deviates markedly from the expectations of the individual’s culture Onset can be traced back at least to adolescence or early adulthood Manifested in two (or more) of the Not better explained as a manifestation or following areas consequence of another mental disorder Cognition Not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) Affectivity or another medical condition (e.g., head Interpersonal functioning trauma) Impulse control  SWSP3027-NURS7128_20240904 Luna Jones Critical questions What does an “ordered” personality look like? Where does the person end and the disorder begin? How can we be objective about the state of another person’s self? Ace, Koko & Ryder Hamer SWSP3027-NURS7128_20240904 Cluster B – Dramatic/erratic Structure behaviour Antisocial PD Borderline PD DSM-5 Histrionic PD Narcissistic PD Cluster A – Cluster C – Odd/eccentric Anxious/fearful behaviour Paranoid PD behaviour Avoidant PD Schizoid PD Dependant PD Schiztotypal PD Obsessive-compulsive PD Therapeutic support SWSP3027-NURS7128_20240904 Edward et al, pp. 260-261 Active, careful focus on Validate the person’s emotional state – competence & expertise empathetic respect & Support the person to – collaborative risk validation understand negative management emotional experiences – Engage w/.- What happened? Impact Develop routine, understanding problems on well-being? How can predictability in facing the person – the situation be treatment – establish avoid constant repaired? yourself as reliable suggestions or unrealistic solutions Present-focus on Encourage reflection on movement of emotions thoughts rather than Focus on helping person in the here-and-now. behaviours - enables understand & cope w/- Validation of emotional development of emotions & beliefs states as they occur meaning-making which are associated with relationships SWSP3027-NURS7128_20240904 Odd/eccentric: Paranoid Personality Disorder Suspects others are exploiting, harming, or deceiving without real evidence Preoccupied with unjustified doubts about loyalty or trustworthiness of others Reluctant to confide in others - fear the information will be used maliciously Interprets benign comments or events as hidden threats or insults Bears grudges Reacts with anger to perceived attacks are not apparent to others Recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner SWSP3027-NURS7128_20240904 Dramatic/emotional: Antisocial Personality Disorder Ignores social norms with respect to lawful behaviour Deceitfulness - repeated lying, use of aliases, or conning others Impulsive Physically aggressive / violent Recklessness Disregards obligations Lack of remorse & empathy SWSP3027-NURS7128_20240904 Dramatic/emotional: Narcissistic Personality Disorder Grandiosity (in fantasy or behavior), need for admiration, & lack of empathy Inflated sense of self-importance Arrogant, haughty behaviours or attitudes Believe they can only be understood by, or should associate with, other special or high- status people Requires excessive admiration. Sense of entitlement - interpersonally exploitative Lacks empathy Envious of others or believes that others are envious of them SWSP3027-NURS7128_20240904 Dramatic/emotional: Borderline Personality Disorder Frantic efforts to avoid real or imagined abandonment A pattern of unstable & intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation Identity disturbance: markedly & persistently unstable self- image or sense of self Impulsivity in at least two areas that are potentially self- damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating) Recurrent suicidal behaviour, gestures, or threats, or self- mutilating behaviour Affective instability due to a marked reactivity of mood Chronic feelings of emptiness Inappropriate, intense anger or difficulty controlling anger SWSP3027-NURS7128_20240904 Project Air Strategy. (2017, November 13). Stephanie Leary shares her daily recovery journey from BPD with Project Air Strategy. https://www.youtube.com/watch?v=dqiz2TEUMjQ SWSP3027-NURS7128_20240904 Anxious/fearful: Obsessive-Compulsive Personality Disorder Preoccupied with orderliness, perfectionism, & control Excessively devoted to work and productivity to the exclusion of leisure activities and friendship Miserly spending style toward both self and others Scrupulous, & inflexible about matters of morality, ethics, or values Perfectionism that interferes with task completion Difference to OCD – no ritual behaviour