How to Coach Yourself and Others Coaching and Counseling in Difficult Circumstances | Page 34
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• Brief reactive psychosis: psychotic symptoms arise suddenly in response to a major stress in the patient’s
life. The patient makes a quick recovery in a few days.
• Organic psychosis: physical injury or illness, such as a brain injury, encephalitis, AIDS or a tumour, may
cause psychotic symptoms.
• Schizophrenia: psychotic illness in which the symptoms have been continuing for at least 6 months. The
symptoms and the length of the illness vary.
• Bipolar disorder (manic depression) and psychotic depression: psychotic symptoms appear as part of a
more general disturbance of mood. When psychotic symptoms are present, they tend to fit in with the person’s
mood. For example, someone who is depressed may hear voices telling them they should kill themselves.
Someone who is unusually excited (manic) may believe that they have special powers and can perform
amazing feats.
What causes psychosis?
Schizophrenia is probably caused by a combination of biological factors (such as a family history of
schizophrenia) that create a vulnerability to experiencing psychotic symptoms. The symptoms often emerge in
response to stress (e.g. breakdown of a relationship, being held in solitary confinement, bullying), drug abuse or
social changes in vulnerable individuals. This theory of causation is known as the ‘stress–vulnerability model’.
It helps to explain why psychosis is usually an episodic problem, with episodes triggered by stress and patients
often quite well between episodes. It also helps to guide management. International studies show that once a
person has schizophrenia, the environment in which he/she lives can help them to stay well or can make them
worse. In a calm environment and one where people provide plenty of support and encouragement, those with
schizophrenia will suffer fewer psychotic episodes than if they are surrounded by people who push, frighten or
criticise them.
Prognosis: do people get better?
Schizophrenia usually begins in early adult life but may occur at any time in an individual’s life. Those who
develop schizophrenia at a very early age do not tend to do as well as those whose illness begins in middle or
old age.
Although for some schizophrenia will be a life-long concern, others experience only one episode of the illness
and never have a further episode. Generally, 20% of people recover completely, 35% are stable for long periods
but have some further episodes of psychosis, and 45% experience long-term problems requiring continuing care.
One-quarter of the latter group deteriorate more severely and rapidly and need very high levels of care and
support.
When someone is in a very distressed, acutely ill state, it can be hard to believe that they will ever get better.
Realistic hope is one of the most important treatments a nurse or healthcare officer has to offer.
What are the treatments?
• Assessment: first stage of treatment involves assessment, usually over some time. Mental-health specialists
need to develop an understanding with the patient of how and why these symptoms affect them. A range of
measures may form part of the assessment, eg the ‘Delusion Rating Scale’ and the ‘Belief about Voices’
questionnaire.
• Medication: along with other forms of treatment, medication plays a fundamental role in recovery from a
psychotic episode and in the prevention of future episodes. The monitoring of side-effects is critical to avoid
or reduce distressing side-effects that can lead to a patient being unwilling to accept the medication central to
their recovery.
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