How to Help People With Psychosis or Psychotic Disorders
Psychosis or Psychotic Disorders represent a group of serious, chronic and persistent brain disease. The group includes schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional disorder, brief psychotic disorder, and shared psychotic disorder. Schizophrenia is the most serious of them all. Psychotic disorders are characterized by five major problems, i.e. disorder of thought, disorder of perception, emotional difficulty, disorganized behavior, and impaired ability for relationships.
1. Disorder of Thought: Patients with psychosis may suffer from a disorder of thought. This problem is classified into disorder of thought content and disorder of thought content. Problems of thought content include various delusions such as paranoid, grandiose, religious, somatic, nihilistic, persecutory, thought broadcasting, thought insertion, thought control, hypochondriacal, erotomanic, and jealous delusions. Delusions are fixed false beliefs held by the patient. Paranoid patients believe there is someone out there persecuting or trying to do some harm to them. Grandiosity means the patient believes he has some special powers or possessions. In religious delusions, the patients may claim to be God. Delusion of thought broadcasting means the patient believes someone, or some media is broadcasting what is in his mind. The second aspect of thought disorder is disorder of thought process. This includes memory difficulty, attention difficulty, poor concentration, poor insight, poor judgment incoherence, circumstantiality (in a conversation, patient responds with various digressions before making his point), tangentiality (patient veers off completely with various digressions and never comes back to the original topic), and clanging (patient responds, using meaningless combination of words that rhyme together).
2. Disorder of Perception: This includes various hallucinations such as auditory hallucination (hearing sound or voice that does not exist), visual hallucination, olfactory hallucination (smelling odor that does not exist), gustatory hallucination (unreal taste), tactile hallucination (unreal touch such as a bug crawling on his skin), cenesthetic hallucination (feeling internal body functions such as urine forming in his kidneys), kinesthetic hallucination (feeling that his body or part of his body is moving while it is not), and command hallucination (hearing a voice commanding him to do something such as to kill himself or hit somebody).
3. Emotional Difficulty: The patient may experience a mood or affect disorder. Mood is the patient’s tone of feeling as expressed by the patient. Affect is the patient’s tone of feeling as observed by someone else, such as the nurse or therapist. Patient’s mood may be sad, depressed, alexithymic (inability to describe the mood), apathetic (lack of feeling or interest), anhedonic (inability to experience pleasure), anxious, or angry. The affect may be described as bizarre (e.g. grimacing, giggling, mumbling), blunted (i.e. minimal emotional response), flat (completely blank look), incongruent (inappropriate with reality, e.g. laughing while saying something sad), or labile (rapidly changing).
4. Disorganized Behavior. The patient may exhibit the following behavior: motor agitation e.g. running around, apraxia (difficulty with motor activity), echopraxia (imitation of the movements of someone else), echolalia (imitating what someone else says), waxy flexibility (prolonged maintenance of a posture), agitation and aggressive behavior, and stereotyped behavior (repeating the same action over and over).
5. Impaired Ability for Relationships: The patient may exhibit withdrawal to himself or isolation. This may be due to delusions, hallucinations, apathy, anhedonia, deteriorating social skills, lowered self esteem, anxiety, stigma and sense of helplessness.
Classification of Symptoms: All the symptoms classified into the 5 categories above may actually be classified into 2 categories, i.e. positive and negative symptoms of psychosis. Positive symptoms include delusions, hallucinations, thought disorders, disorganized speech, bizarre behavior, and inappropriate affect. Negative symptoms include flat affect, anhedonia, apathy, attention deficit, social withdrawal, and poverty of speech.
Causes: There are various theories put forward to explain schizophrenia and other forms of psychosis. The genetic theory explains that 15-35% of schizophrenia is genetic. The neural theory says problems with the frontal, temporal and limbic regions of the brain are the cause. Some have implicated
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