Understanding Psychosis:

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Understanding Psychosis

• An Introduction to the Issues and the
• Early Intervention Service for Carers.

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Starting Point

• EXERCISE
• A post-it note
• On the other, write down three words you
  associate with psychosis.
• Place on the whiteboard

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Todays Session

• Session plan
• Our service - Why, What and How
• Psychosis A better understanding?

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What is GRIP?

• Gloucestershire Recovery In Psychosis
• The GRIP Team is an Early Intervention in
  Psychosis service.
• Countywide 3 patch teams.
• Stroud, Gloucester, Cheltenham
• Office base Albion Chambers, Eastgate St,
  Gloucester
• Multi-disciplinary team
• Community and hospital interventions.

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Who uses our service?

• Adults and young people aged 14-35 years.
• From any referral source including self or family
  member referral.
• Currently living in Gloucestershire
• First presentation of psychosis within 18 months
  of positive signs.

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Early Intervention Service provision

• Psychological Interventions
• Family Interventions
• Pharmacological Interventions
• Social Interventions
• Relapse Prevention
• Early Detection
• (Nice 2002)

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How is GRIP different from other mental health
services?

• Short time from referral to assessment
• Greater frequency of visits
• Holistic approach
• Specialist knowledge
• Youth friendly/ flexible approach
• Involvement of carers/family work

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Understanding Psychosis

• EXERCISE
• Confidence line

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Diagnosing a First Episode of Psychosis.

• Psychosis doesnt present in neat packages.

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PSYCHOSIS SYMPTOMS 1

• Positive symptoms are active, noticeable
  behaviours that are NOT normally present in a
  person without psychosis. Examples include
  hallucinations or hearing voices.
• Negative symptoms refer to the absence or
  lessening of behaviours that are normally present
  in a person. Examples include lack of motivation
  and social withdrawal.
• Depressive or anxiety symptoms may also be
  present e.g.
• lowering of mood, worrying and loss of interest
  or pleasure.

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PSYCHOSIS-SYMPTOMS 2

• Positive symptoms are easier to spot and more
  likely to bring someone to attention of the
  mental health services quickly.
• Negative symptoms and depressive symptoms may
• be difficult to distinguish from each other.
• Negative symptoms can be very difficult to cope
  with for the person and their carers
• they may predominate over time, interfering with
  normal social life.

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DIAGNOSTIC CRITERIA SYSTEMS

• Physicians use diagnostic criteria systems to
  categorise a users symptoms and arrive at a
  diagnosis.
• However, the assessment of the presence or
  absence of these criteria remains a process of
  subjective interpretation.
• The commonly used systems are
• those developed by the American Psychiatric
  Association and called DSM-III-R and DSM-IV.
• those developed by the World Health Organisation,
• such as ICD-10.

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ICD-10 CRITERIA FOR PSYCHOSIS 1.

• Symptom(s) are clearly present for most of the
  time during a period of 1 month or more.
• One (if the symptom is very clear) or two or
• more of the following symptoms
• delusions of control of thought (e.g. thought
  echo)
• delusions of being controlled
• hallucinatory voices
• persistent delusions of other kinds (e.g. the
  person believes they possess superhuman powers
  and abilities)

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ICD-10 CRITERIA FOR PSYCHOSIS 2.

• Or
• At least two of the following clearly present for
  most of the time during a period of 1 month or
  more
• persistent hallucinations
• breaks in chain of thought (leading to
  incoherence)
• catatonic behaviour
• negative symptoms (apathy, loss of concentration)
• significant and persistent change in personal
• behaviour, social and/or occupational functioning

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PHASES OF PSYCHOSIS

• Fortunately, around 20 of people diagnosed as
  having psychosis only experience one episode.
• Studies have shown that the course of psychosis
  is variable.
• Researchers have described three phases of
  psychosis
• prodromal
• active
• residual

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PRODROMAL PHASE / EARLY SIGNS

• Characterised by the slow and insidious
  development of a number of signs and symptoms.
• Early recognition and management of psychosis
  leads to a better long-term prognosis.
• Common signs and symptoms include
• Behaviour- social withdrawal, decrease in school
  or work performance, deterioration in hygiene and
  grooming.
• Mood swings- uncharacteristic suspiciousness,
  depression, anxiety, anger.
• Thoughts- odd ideas, vagueness, poor
  concentration.
• Physical- sleep disturbances, loss of energy,
  motivation or appetite.

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ACTIVE PHASE

• Usually positive psychotic symptoms, such as
  hallucinations, delusions and confused thoughts.
• The hallucinations and delusions in the active
  phase are usually alarming enough for family
  members and friends to seek professional
  intervention. Possibly aggression.
• Sufferers may move into the active phase as they
  relapse.

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RESIDUAL PHASE

• usually follows the active phase of psychosis as
  symptoms become more controlled.
• may experience psychotic episodes of lesser
  intensity than those in their most recent active
  phase or no symptoms at all.
• may appear to need less care since they may be
  perceived as being stable.
• Negative symptoms are common during residual
  phases. These symptoms contribute to social
  withdrawal.

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Break
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Hallucinations

• Usually the most distressing aspect of psychosis.
• Experienced by over 60 of people diagnosed with
  schizophrenia
• Most likely to be auditory- but not everyone that
  hears voices is in touch with mental health
  services.
• They are very real to people- pervasive and
  compelling.
• Paranoia

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Delusions

• A strongly held belief that is also culturally
  inappropriate, but a nugget of truth

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So what is it like?

• EXERCISE Hearing voices. Groups of 3
• One person volunteer to be the subject
• Other person talk to the subject on a normal
  topic of conversation, e.g., last holiday
• Voice whisper into ear of subject whilst they
  are conversing to other person nothing too nasty
  Do this for 3 minutes each / swop around ?
  Feedback

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So what was it like?

• Feedback and debrief.

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Who gets Psychosis, and Why?
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Who gets psychosis?

• 3 of the population will be diagnosed with some
  form of psychosis.
• Onset age range is from 18-24 yrs
• Psychosis seems to affect men and women equally.
• Psychosis is more prevalent in urban areas than
  rural areas.
• The average treatment lag from onset of symptoms
  to onset of treatment is one year.
• Evidence suggests that the longer the treatment
  lag, the worse the prognosis.
• Around 20 have only one episode

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Vulnerability factors for psychotic experiences

• Social, biological and psychological causes of
  psychotic experiences are all important and
  interact with one another.
• Life circumstances e.g. research now
  demonstrates that a trauma history actually
  predicts psychosis.

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Social psychological explanations

• Labels leads to or perpetuate oppression,
  social exclusion and stigma
• Stress vulnerability. (eg. Bereavement, academic
  pressure, trauma, isolation).
• Cognitive understanding of delusions
• Jumping to conclusions
• Thinking bias/ selective attention.
• Making sense of their world.

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Biological/ Medical explanations

• Neurological damage (head injury/ birth
  complications)
• Dopamine Hypothesis (chemical imbalances in the
  brain).
• Substance misuse
• Genetic Factors

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EFFECTS ON FAMILIES CARERS

• Day-to-day care of a person with psychosis can be
  demanding.
• Lack of understanding and information can leave
  carers feeling anxious, depressed, physically
  ill, guilty or confused.
• Caring for a user with psychosis can also add to
  the financial burden felt by carers.
• Carers are an important contact point for
  checking
• a users progress.
• The carers personal health may also suffer.

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Main Points

• GRIP is a specialist service for psychosis in
  Gloucestershire
• Psychosis doesnt present in neat packages
• Psychosis early signs are difficult to spot
• 20 only have one episode
• Psychosis can go in phases
• Some people are more vulnerable than others
• Various explanations for psychosis, but often a
  combination
• Carers often cope with a considerable amount of
  distress.

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Anything else?

• Unanswered questions
• Concerns
• Evaluation thingy
• Confidence line revisited