1. Introduction
2. Understanding Psychotic Symptoms
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Symptoms Defined: Psychotic symptoms include hallucinations, delusions, disorganized behavior, and speech.
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Associated Disorders:
3. Causes of Psychotic Symptoms
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Breakthrough Symptoms: These can occur even in individuals who are generally functional.
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Causes:
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Unmedicated State: By choice or due to forgetfulness.
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Medication Non-compliance: Due to side effects or difficulty maintaining a regimen.
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Stress: A major trigger for acute episodes.
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Medication Imbalances: Can be caused by dehydration, heat, dietary changes, weight fluctuations, and drug interactions (e.g., antibiotics, caffeine, nicotine).
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Other Factors: Conditions like hypoglycemia, severe sleep deprivation, and chronic stress can exacerbate symptoms.
4. Strategies for Support
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Medication Management: Ensuring compliance and adjusting for lifestyle changes.
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Stress Reduction:
- Identify stressors (physical, cognitive, emotional) and work to mitigate them.
- Develop emergency plans to address prodromal symptoms (early signs of relapse).
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Cognitive Behavioral Therapy (CBT) for Psychosis:
- Typically more effective during remission than in acute episodes.
- Focuses on reducing symptoms, distress, and interference with quality of life.
- Techniques include relaxation training, graded exposure, scaffolding, and activity scheduling.
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Environmental Modifications: Adjusting surroundings to minimize stressors and support daily functioning.
5. Recognizing and Managing Prodromal Symptoms
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Prodromal Symptoms:
- Chronic anxiety, mood swings, sleep disturbances, memory problems, social withdrawal, decline in hygiene, and inability to perform daily tasks.
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Early Intervention: Recognizing these signs allows for early intervention to prevent full-blown episodes.
6. Addressing Hallucinations and Delusions
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Safety and Reality Testing:
- Initially, join the individual in their reality to establish safety.
- Avoid arguing or reasoning with delusional beliefs during acute episodes.
- Use CBT techniques to challenge and reframe delusions during remission.
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Behavioral Strategies: Encourage comparison of their behavior to others, use of distraction techniques, and reinforcing positive behaviors.
7. Enhancing Functionality
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Daily Living Support: Use lists, schedules, and guides to help individuals manage daily tasks.
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Token Economies: Reward systems to encourage participation in therapeutic activities.
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Environmental Prompts: Reminders and tools to support memory and task completion.
8. Cognitive and Executive Functioning
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Support Strategies:
- Break tasks into smaller components (chunking).
- Minimize distractions and create structured environments.
- Roleplay problem-solving scenarios.
- Use alarms and reminders for medication and daily tasks.
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Cognitive Behavioral Therapy (CBT): Applied during remission or prodromal phases to manage residual symptoms and improve quality of life.
9. Final Considerations
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Relapse Prevention:
- Continuous monitoring of stress levels and medication effectiveness.
- Developing a strong support system and improving stress management skills.
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Therapeutic Engagement: Ensuring clients feel safe and validated in discussing their symptoms.
10. Conclusion
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Further Resources: Dr. Snipes mentions an upcoming on-demand class for more in-depth learning about CBT for psychosis.
Chapters:
00:00:00 - Supporting Functional Individuals with Psychotic Symptoms
00:06:51 - Factors Affecting Psychosis Management
00:13:38 - Managing Prodromal Symptoms and Breakthrough Episodes
00:20:25 - Understanding and Supporting Disorganized Behavior
00:27:09 - Token Economy and Motivational Enhancement
00:34:00 - Scaffolding for Learning and Cognitive Impairment
00:40:43 - Managing Hallucinations and Delusions
00:47:14 - Understanding the Pre-Delusional Beliefs
00:54:14 - Addressing Hallucinations and Delusions
01:00:58 - Understanding Cognitive Behavioral Therapy for Psychosis
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Counselor Toolbox Podcast with DocSnipes