Psychosis

1. Psychosis Information to increase understanding and inform responses.

2. Goals of this session Develop understanding of psychosis: • Causes • Understanding terms used. • Symptoms • Treatment options Increase confidence in working with people suffering from psychosis: • Coping strategies • Working with challenges • Role of Statutory services

3. Challenges and Opportunities for session • Not much time! • Different levels of knowledge and experience and work in different contexts. But • Opportunity to think about the person and reflect on what they experience as helpful – this may include “services” but this might form a relatively small part of their solution. • What can/might be your role as a housing worker?

4. Psychosis • Psychosis (also called a psychotic experience or episode) is when you perceive or interpret events differently from people around you. This could include experiencing hallucinations, delusions or flight of ideas. (Mind)

5. Psychosis – General term for loss of contact with reality, significant difference in perception from those around them. Two main symptoms being hallucinations and delusions. • Hallucinations- visual, auditory, olfactory, tactile, gustatory. Perception without an external stimulus.

6. Delusions- Firm, fixed belief, held with absolute conviction despite compelling proof / argument to the contrary. The content is implausible, false or impossible • Thought Disorder – disorganised thinking evidenced by disorganised speech.

7. Quiz- Answer the following as true or false • Hearing voices only occurs as a symptom of schizophrenia? • Psychosis is most likely to occur when stressed? • Approximately 10% pf the population experience psychosis?

8. Voices can sometimes be pleasant? • You should never enter into conversations with a resident about their unusual beliefs or voices? • Voices and delusions are meaningful and often relate to a person’s life experiences?

9. Psychosis Diagnosis • Paraphrenia • Paranoid Delusional disorder • Puerperal Psychosis • Bi Polar Affective Disorder

10. Schizophrenia Positive and negative Symptoms Positive Symptoms might inc- Hearing voices and or seeing visions (these are not always necessarily indications of psychosis) ;Delusions-persecutory; ideas of reference; erotomania; delusions of guilt; delusions of Jealousy; somatic delusions Thought Insertion; thought withdrawal; thought broadcasting Negative Symptoms- Loss of motivation; withdrawal; blunted emotions; more difficult to experience pleasure ;poverty of thought- Role of medication in neg symptoms and impact of positive symptoms.

11. What causes psychosis?Discussion • Studies have found a high correlation between psychotic experiences and past experiences of adversity and trauma e.g. abuse;torture;bullying • Psychosis can be viewed as an adaptive strategy to enable a person to survive adversity. • Delusions can emerge from real experiences of persecution and powerlessness. • Evidence Suggests that persecutory delusions act in an emotionally protective manner to protect low self esteem. • Attachment issues

12. Other explanations – more short term: • Physical injury / high fever / Infections. • Drugs / Medication • Lack of sleep • Hunger • Bereavement • Spiritual Experiences • Hereditary (nature / nurture debate) • Alcohol Withdrawal / Acute intoxication. Mind (2013)

13. What can we do to help?How can we empower people and help them to be less disturbed by their experiences? • Listen • Non judgemental • Be curious – having established trust • Reflect their terminology, but • Seek clarity on what they are describing • Check out strength of conviction, can they consider alternative explanations • Look for patterns / triggers for acute episodes. • Ascertain the level of impact this is having on their functioning e.g. have they stopped doing things they enjoy, are they socially isolated, have they lost confidence.

14. Immediate Intervention when a person is distressed. • Validate distress of their experience. • What can they / you do right now to help them feel safer. • Support them to identify and utilise coping strategies e.g. relaxation techniques, slow breathing, move to a quiet low stimulus space, listening to music, watching a programme, going for a walk, distraction with tasks. • Over time you can enable the person to learn what works best for them when feeling overwhelmed by these experiences, and support them to do this. • Relapse Prevention Plans and Crisis Plans

15. Oleg Police referral. “Eastern European man in his mid 50s. Appears “agitated”, seen talking to himself. Describes having been a victim of torture. Has told police he has a daily job. Refusing any assistance.” He sleeps at the same site, in the porch of a church that has been converted into a day centre, every night arriving around 6pm and leaving by 530am  Day centre say he avoids contact with staff and service users and there is little cross-over because of the hours he keeps.  He has been staying there for one year and initially he was around more, and even asked to use telephone and toilets.  When he has been seen more recently he appears much more wary. They believe he works as a cleaner at a wholesale green grocer and may have had contact with an organisation that works with victims of torture.

16. Oleg • What are your thoughts around his mental health? • The impact of his mental health on his functioning and well-being?

17. Oleg 2 • An outreach worker reports that they had tried to offer him help and had found him to be him “very disturbed”. He had appeared to be talking to himself when they approached but it transpired he was speaking into a dictating machine.  As they introduced themselves to him he had spoken into the machine, they could not hear the full content but it had seemed to refer to them and to some sort of conspiracy.  They felt he had appeared fearful of them and would not enter into any dialogue beyond shouting when they attempted to leave him some food. • They felt that he had appeared extremely thin but that his self-care had seemed ok. • What do you make of this?

18. The outreach team continue to visit Oleg. They hear him talking whilst on his own as they approach. They call out to him and walk up the path towards his sleep site. Initially rather than responding directly to them he continues to speak into his dictaphone, referring to them as “strangers who may be involved in the conspiracy”. They stop and ask him if its OK for them to speak with him, that they are homeless workers who were contacted by the police who were worried for his welfare. He asks them to stay where they are and a disjointed dialogue takes place with him speaking some of the time into his machine rather than directly to them and speaking over them when they attempt to speak, and the health workers establishing that he is more able to listen to them if they are speaking to each other.

19. -         He has come from Lithuania. • -         He isn’t in contact with any family members. • -         He is in his late 50s and he is gay • -         He used to work as a cook in the Soviet army. • -         He has been in England for 3 years. • -         He works every day as a cleaner (he is being paid less than the minimum wage). • -         He appears extremely thin.

20. -         His self-care, in terms of personal hygiene, seems good. • -         He appears fearful. • -         He left his home country as he was “being poisoned by Jehovah Witnesses”. •  -         He left his previous lodgings as he was “being gassed” • -         He has previously been healthy – but he is feeling weak some mornings because, “they are taking my blood and bodily fluids to experiment with”.  He won’t say who is doing this but suggests that the outreach workers already know. •  -         He does not agree to visit a potential hostel. • -         He does not object to the suggestion that they might return another day.

21. Oleg Questions • What are your thoughts about Oleg's mental health? • Do you think he might be psychotic? • What impact do you think his mental health problems might be having on him? • Based on what we know about him, what might be the background to his psychosis?

22. What happened to Oleg? • What role were his delusions playing? • How did he cope when they weren’t there?