Running head: PSYCHOSIS 1

DIAGNOSIS ASSIGNMENT
Psychosis

Katherine Koplow
University Neuropsychiatric Institute
Recreational Therapist intern
Summer 2014




























Running head: PSYCHOSIS 2


Psychosis is the depth of the illness or the seriousness of the illness, not the name of an
illness.

Definition:

Psychosis: symptom of mental illness characterized by a radical change in personality, and
a distorted or diminished sense of reality.

The person may:

Have false beliefs about what is taking place, or who one is (delusions).
See or hear things that arent there (hallucinations).
Have a loss of motivation and social withdrawal.

Causes:

Alcohol and illegal drugs
o both during usage and during withdrawal
Brain diseases
o Ie: Parkinson disease, Huntington disease, chromosomal disorders
Dementia
Brain tumors or cysts
HIV and other infections that affect the brain
Prescription drugs
o Ie: steroids and stimulants
Stroke
Some types of epilepsy
Most people experiencing schizophrenia
Side affect of some diagnosis
Some personality disorders
Sleep depravation deprivation

Types:

Brief Reactive Psychosis
o Extreme personal stress
Ex: death of family member
Recover in a few days
Drug or Alcohol-Related Psychosis
o Use of alcohol and drugs
Recover when the effect of the alcohol or drug wears off, but
not always
Organic Psychosis
o A head injury or illness that affects the brain




Running head: PSYCHOSIS 3
Disorders:

Bipolar Disorder
o Type I- can have psychosis during mania
o Type II- can have psychosis during depression
o Mood swings
High and positive mood- might have thoughts of special
powers.
Low and depressed mood- symptoms of feeling sad, angry,
frightened, might have thoughts of harming self or others.

Delusional Disorder
o Belief things that arent real
Common themes:
Being followed/spied on
Being ridiculed
Being cheated on
Special abilities or powers
o Could be neurosis (a relatively mild mental illness that is not caused by
organic disease, involving symptoms of stress (depression, anxiety, obsessive
behavior, hypochondria) but rather a radical loss of touch with reality.

Psychotic Depression
o Major depression with psychotic symptoms

Schizophrenia
o Psychosis that lasts longer than six months. Must have 1 delusion and 1
hallucination for a period or if acute called NOS.
o Life long disease
1/3 never get better
1/3 wax and wane (come and go)

Shared psychotic disorder
o Rare and atypical psychotic disorder when secondary partner believes that
delusions of primary partner who is already suffering from a psychotic
disorder with delusions.
Folie a deux

Brief psychotic disorder/ Psychosis NOS
o Experiences one of the major symptoms of psychosis for less than one month
o Usually younger people have a shorter rebound similar to a first psychotic
break with schizophrenia.







Running head: PSYCHOSIS 4
Stages:

Affects men and women equally. Comes on at a younger age for men, 17-23 and for women
20-26ish.

Early
Difficulty concentrating
Depressed mood
Sleep changes- too much or not enough
Anxiety
Suspiciousness
Withdrawal from family and friends
Ongoing unusual thoughts and beliefs

Later
Delusions
Hallucinations
Disorganized speech- switching topics erratically
Depression
Anxiety
Suicidal thoughts or actions
Difficulty functioning

Symptoms:

Disorganized thinking and speech
o Thoughts that jump between unrelated topics
o Confused cognition due to psychotic process
o Psychotically impaired judgment and insight

Delusions
o Persecutory Delusions/ Paranoia / Fixed Paranoid Delusions
These are the most common type of delusions and involve the theme of
being followed, harassed, cheated, poisoned or drugged, conspired against,
spied on, attacked, or obstructed in the pursuit of goals. Sometimes the
delusion is isolated and fragmented (such as the false belief that co-
workers are harassing), but sometimes are well-organized belief systems
involving a complex set of delusions ("systematized delusions"). A person
with a set of persecutory delusions may be believe, for example, that he or
she is being followed by government organizations because the
"persecuted" person has been falsely identified as a spy. These systems of
beliefs can be so broad and complex that they can explain everything that
happens to the person.
o Grandiose delusions
Inflated self-esteem (self-confidence), or inflated appraisal of ones
talents, powers, abilities, accomplishments, knowledge, importance, or
identity,
An individual exaggerates his or her sense of self-importance and is
convinced that he or she has special powers, talents, or abilities.
Sometimes, the individual may actually believe that he or she is a famous
Running head: PSYCHOSIS 5
person (for example, a rock star or Christ). More commonly, a person with
this delusion believes he or she has accomplished some great achievement
for which they have not received sufficient recognition.
o Somatic delusions
A delusion with content that pertains to bodily functioning, bodily
sensations, or physical appearance. Usually the false belief is that the body
is somehow diseased, abnormal, or changed.
Ex: Think they have a terminal illness when they are actually healthy, a
person who believes that his or her body is infested with parasites
o Delusion of control
This is a false belief that another person, group of people, or external force
controls one's thoughts, feelings, impulses, or behavior. A person may
describe, for instance, the experience that aliens actually make him or her
move in certain ways and that the person affected has no control over the
bodily movements. Thought broadcasting (the false belief that the affected
person's thoughts are heard aloud), thought insertion, and thought
withdrawal (the belief that an outside force, person, or group of people is
removing or extracting a person's thoughts) are also examples of delusions
of control.
o Nihilistic delusion:
A delusion whose theme centers on the nonexistence of self or parts of
self, others, or the world. A person with this type of delusion may have the
false belief that the world is ending.
o Delusional jealousy (or delusion of infidelity)
A person with this delusion falsely believes that his or her spouse or lover
is having an affair. This delusion stems from pathological jealousy and the
person often gathers "evidence" and confronts the spouse about the
nonexistent affair.
o Delusion of guilt or sin (or delusion of self-accusation)
This is a false feeling of remorse or guilt of delusional intensity.
Ex: believe that he or she has committed some horrible crime and should
be punished severely, a person who is convinced that he or she is
responsible for some disaster (such as fire, flood, or earthquake) with
which there can be no possible connection.
o Delusion of mind being read
The false belief that other people can know one's thoughts. This is
different from thought broadcasting in that the person does not believe that
his or her thoughts are heard aloud.
o Delusion of reference
The person falsely believes that insignificant remarks, events, or objects in
one's environment have personal meaning or significance. For instance, a
person may believe that he or she is receiving special messages from the
news anchorperson on television. Usually the meaning assigned to these
events is negative, but the "messages" can also have a grandiose quality.
o Erotomania
A delusion in which one believes that another person, usually someone of
higher status, is in love with him or her. It is common for individuals with
this type of delusion to attempt to contact the other person (through phone
calls, letters, gifts, and sometimes stalking).
o Religious delusion
Any delusion with a religious or spiritual content. These may be combined
Running head: PSYCHOSIS 6
with other delusions, such as grandiose delusions (the belief that the
affected person was chosen by God, for example), delusions of control, or
delusions of guilt. Beliefs that would be considered normal for an
individual's religious or cultural background are not delusions.

Hallucinations
o Sensory perception in the absence of external stimuli. All 5 senses can be
affected.
o Auditory and/or visual hallucinations
Ex: might hear things that dont exist or talk to people when alone
Auditory hallucinations more often with schizophrenia
Visual hallucinations more common with alcohol withdrawal
o 50% of people can tell they are having a hallucination or at lease know that its
not normal.

Catatonia
o Profoundly agitated state where the experience of reality is impaired. Generally
no reaction to anything outside of themselves
Classic presentation-
Person doesnt interact or move with the world at all while awake
Experience waxy flexibility- person stays in the same position
even if someone moves part of his or her body.
Excessive and purposeless motor behavior and extreme mental
preoccupation which prevents the intact experience of reality
Someone walking around in circles with one focus

Diagnosis/Exams and Tests:

Psychiatric evaluation
Doctors watches a persons behavior and questions what they are experiencing

Lab testing and brain scans can help lead to a diagnosis
Blood tests for:
o Abnormal electrolyte and hormone levels
o Syphilis and other infections
Drug screens
MRI of the brain

Treatment:

Depends on the cause of the psychosis. Often care needs to take place in a hospital
so patient is safe.
Antipsychotic drugs help with hallucinations and delusions and improve thinking
and behavior
o rapid tranquilization and anti seizure medication
Cognitive Behavioral Therapy- patient talks with mental health counselor about
their thinking and behaviors which helps lead to permanent changes
Electroshock therapy (ECT)
o Helpful treatment for depression and bipolar(Which sometimes overlap or
resemble schizophrenia) but generally has little benefit for schizophrenia;
Running head: PSYCHOSIS 7
may be useful for schizo-affective (because of the mood component,
affective).

Goals:

Short Term
Follow single step prompts to complete ADLs with support and staff assistance.
Be able to respond to staff redirection.
Display decreased agitation.
Have no episodes of violence toward staff, peers or property.
No longer require emergent medications to maintain safety of self or others.
Have no episodes of seclusion and restraint.
Be able to meet with treatment team.
Accept medications to decrease acute symptoms.

Long Term
Actively participate in treatment, demonstrated through attendance in groups, staff
reports of engagement in milieu and verbalization of symptoms/side-effects and
notable changes in mood state during interviews with treatment team as able.
Report symptoms to treatment team during interviews and begin to reality test with
treatment team.
Receive education on diagnosis and recommendations for treatment. Demonstrate
ability to recall the information given and formulate a safety plan in accordance with
the education provided.
Develop a safety plan, include warning signs of decompensating in mental status
and effective coping skills which he/she will practice on unit, identify people/crisis
numbers/resources he/she can contact in crisis and reality test prior to discharge.
Identify an aftercare plan including follow up with a therapist, medication
management and community resources prior to discharge.
Report and decrease symptoms of psychosis prior to discharge, evident through
linear speech during interviews with patient, ability to reality test with the
treatment team, decrease in thought blocking and staff reports of appropriate
engagement and functioning in the milieu.
Complete ADLs without prompts and function independently in the structure of the
milieu without requiring redirection more than several times/day by staff.
Decrease in disorganized thinking.
Decrease in internal preoccupation
Decrease delusional content when meeting with the treatment team and in groups
Participate in treatment planning with the treatment team
Fewer grandiose statements.
No longer have pressured speech.
Improved sleep hygiene
Sleeping 6-8 hours per nights and no episodes of agitation.
Interact with others without defensiveness or anger. Report less suspicion around
others and have more open communication with staff/peers.
Express less suspiciousness about persons both in the hospital and outside the
hospital.

Prevention:

Running head: PSYCHOSIS 8
Psychosis affects 3 out 100 people.
Depends on the cause
Avoiding alcohol abuse helps prevent alcohol-induced psychosis
Avoiding hallucinogens from LSD, Marijuana, Ecstasy, ect.
People with psychotic disorder who use are 50% more likely to relapse because
street drugs are more potent than prescription drugs.

Helpful Terms:

Malaise- feeling something is wrong but unable to localize symptoms.
Delirium- confusion caused by infection, intoxication, deprivation. Can come and go.
It isnt a permanent state, but a symptom of something else that is wrong.
Anosognosia- disbelief one has an impairment despite obvious evidence to the
contrary. About 50% of chronic mental illnesses have no insight into their condition.
Abreaction- Opening a wound in order to release the poison and in order to heal.
Catharsis- The process of releasing emotions (a medium of expression) through
talking, crying, laughing, doing art and dancing, etc.
Apophenia- seeing meaningful patterns in random meaningless arrangements.
Alexithymia- Inability to describe emotions, distinguish the emotions and physical
sensation. Ex: tired, hungry, pained
Confabulation- filling in the blanks of memory with what you think happened but
accepting them as pure act (to oneself and others.)


Reference:

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http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002520/#adam_001553.d
isease.causes
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2014, from
http://www.nami.org/Content/NavigationMenu/First_Episode/About.htm
Psychosis. (n.d.). - Knowledge Encyclopedia. Retrieved July 15, 2014, from
http://www.minddisorders.com/knowledge/Psychosis.html
Psychosis. (n.d.). : Symptoms, Causes & Risk Factors. Retrieved July 15, 2014,
from http://www.healthline.com/health/psychosis#Overview1
Welcome to Encyclopedia of Mental Disorders. (n.d.). Encyclopedia of Mental
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