Psychosis In Adults: A Therapeutic Approach

Psychosis is a mental state of altered sensory perceptions which is a collection of symptoms rather than a disease, where a person's mood, perceptions, thoughts or even behaviors might alter. A person may not function in self-care and everyday tasks with psychosis. The most common symptoms could be schizophrenia. In first stage of schizophrenia patient have euphoric perception of reality, during this period patient usually doesn’t have a normal sleep, in second stage, euphoric feelings turned into personal belief, in third stage patient becomes disoriented and breakdown of sensory processing occur and in fourth stage patient completely loose sensory perception with full hallucination and delusion. According to Vos, T., Barber, R. M., Bell, B., Bertozzi-Villa, A., Biryukov, S., Bolliger, I., & Duan, L. (2015), psychotic disorders are the primary causes of disability. For instance, empirical results indicate that in England, incidences of psychosis are 32 out of 100000 people. This paper will discuss the prevalence of psychosis as a mental health issue in adults (age between 25 and 65 years), identify and explain the potential risk factors of psychosis in adults by using biopsychosocial framework, impact of psychosis on individual throughout their life and evidence based non pharmacological therapeutic approach to manage psychosis in adults. Prevalence of psychosis among the adult population in different counties is evident. For instance, in the US, approximately 3 out of 100 people among the adults have experienced psychosis at a moment in their life. A community-based survey by Van Os, J., Linscott, R. J., Myin-Germeys, I., Delespaul, P., & Krabbendam, L. (2009) found out that the spread of psychotic symptoms is approximately 5 percent in adults. Psychosis is a prerequisite for developing mental disorders. People with psychosis may experience a myriad of mental problems, which may range from hallucinations to delusional thoughts.

The Biopsychosocial Framework of the Possible Contributing Factors of Psychosis

The biopsychosocial models consider interactions with genetic susceptibility, personality, stressful events, and with a patient's social context. Psychosocial factors may co-determine the patient's vulnerability and the illness's severity and the course. Biological factors, which may contribute to the acquisition of psychosis, can be genetics. Research has shown that an individuals’ potential risk of developing psychosis may be increased if there is a presence of a family member who has a psychosis disorder. According to Carey, a child born with a genetic mutation referred to as 22q.11.2 deletion syndrome has heightened chances of developing not only psychosis but schizophrenia at an early age. Biopsychosocial models adopt an assumption that the development of mental disorders is a cyclical process, which is initiated with panic, depression, and eventually psychosis.

Neurological disorders, such as stroke, have been associated with patients bearing or developing psychosis. For instance, before experiencing a seizure, people with stroke have been reported to experience olfactory hallucinations. Experiencing periods of hallucinations is a non-trivial symptom for people with psychosis. Bipolar disorder is a biological contributor to developing psychosis as well. People with bipolar disorder experience radical shifts in their moods.

Schizophrenia is characterized by lifelong psychosis disorder for people with a medical disorder. According to Brown, Goetz, & Hamera (2011) adults who have schizophrenia are relatively at a higher risk of having various cardiovascular diseases compared to the general population. Schizophrenics who have been prescribed antipsychotic drugs are vulnerable to metabolic syndrome culminating from weight gain, which results in insulin resistance. Psychological causes of psychosis are generally subjective; thus, their effects are only determined by the degree of coping to emotional, psychical and environmental changes of a person (Wigman, 2014). For instance, a study conducted by Phillips, L. J., Francey, S. M., Edwards, J., & McMurray, N. (2009) postulates that psychotic adults have esoteric methods of dealing with mental stress. Prior research has shown that traumatic experiences and stressful events can lead to the development of psychosis in adults, especially if the trauma was experienced during the adolescent stage. Moreover, Borderline Personality Disorder (BPD) has also been associated with an altered emotional response, which may culminate to the development of psychosis in the long-term (McIntosh, 2018).

The causes of psychosis from a social perspective have been a neglected area of research. However, according to Jarvis (2007), there is a significant contribution to poverty, migration, and racial discrimination to both the acquisition and development of psychosis. Drug and substance abuse can also increase the chances of acquiring other diseases like HIV/AIDS, which have been indicated to trigger psychosis in some patients. Moreover, the lack of physical activity has been cited as one of the causes of metabolic syndrome, which in turn triggers cardiovascular diseases, such as high blood pressure. People who are dependent on drugs suffered withdrawal symptoms akin to depression when they are deprived of the drugs (Carey, 2018).

The Spectral Changes of Patients with Psychosis

Adults with psychosis experience multiple spectrums of changes in cognitive ability, mood, physical abilities, behavioral and communication challenges. This section of the paper will discuss these changes in detail. It is worthwhile to reiterate that psychosis is composed of a myriad of heterogeneous conditions that are associated with mental disorders like schizophrenia (Varese, F., Smeets, F., Drukker, M., Lieverse, R., Lataster, T., Viechtbauer, W., & Bentall, R. P. (2012). Prior research has shown that cognitive deficits are one of the schizophrenia symptoms, which can further challenge mental health (Tripathi, Kar, & Shukla, 2018). The emotional process and its role in cognitive development that encompasses reasoning have now been proven to be a prerequisite for the psychosis.

Adults with psychosis experience mood extremes and thus, they exhibit periods of outbursts of unprecedented anger to periods of depression with little or no emotions. According to Russo, M., Levine, S., Demjaha, A., Di Forti, M., Bonaccorso, S., & Fearon, P., …& Reichenberg, A. (2013), approximately 90% of the patients who had depression during their first episode phase report having depression during the acute stage. According to the research conducted by Van Os et al. (2009), psychosis has the potential of being prone and persistent especially to adults who fail to cope with its adverse effects during the first episode in their adolescent years. Altered moods may be accompanied by disorganized speech and hallucinations, which cause people to respond to a non-existing outside stimulus. Borderline Personality Disorder (BPD) may result in impaired self-functioning, which may include identity crisis and stress. Research has linked BPD with heightened chances of getting cardiovascular diseases like obesity.

Therapeutic Approaches for Treating Psychosis in Adults

There is a myriad of therapeutic approaches to treating and coping with psychosis. One of the most common methods is Cognitive Behavioural Therapy (CBT), which enlightens the patients through therapy sessions with the implications of negative thoughts, which allows patients with mental health illnesses to become self-aware of the repercussions of negative thinking. The method was initially utilized for the therapeutic treatment for patients experiencing delusional thoughts and hallucinations. Cognitive Behavioural Therapy for Psychosis (CBT) assists patients to learn the interconnectedness of their behaviors, emotions, and thoughts (Hardy, N.D.).

Prior research evidence has proven that CBT can not only delay the development period, but also the transition of the psychosis if diagnosed at an early stage. In practice, CBTp has been regarded as an evidence-based method of treating psychosis that augments medical methods. There are different protocols of CBT, which include full CBT, CBT with informed interventions, and targeted CBT interventions. Full CBT is offered by a qualified CBT professional and therapy sessions are usually within six months. Informed CBT interventions, on the other hand, are applied to the provision of therapeutic treatment based on the historical information available, for instance, the presence of lack of coping with stress and delusional disorders. According to Freeman, D., Dunn, G., Startup, H., Pugh, K., Cordwell, J., Mander, H., ... & Kingdon, D. (2015), targeted CBT is offered to provide CBT with a specific mechanism, for instance, worry interventions. Brabban, A., Byrne, R., Longden, E., & Morrison, A. P. (2017) argue that CBT is offered through different phases namely; engagement and information disclosure, assessments of experience, formulation development, and application of the intervention and consolidation of skills respectively.

Critical Analysis of Cognitive Behavioural Therapy in the Presence of Psychosis (CBT)

The CBT approach has been used for the treatment of mental disorders for a while now. Despite the lack of interest by medical practitioners in the CBT approach, various researchers have reported the effectiveness of the method relative to other medical methods. For instance, Sarin, Wallin, & Widerlöv (2011) postulated that CBT is more effective due to the delayed impact, which renders the method to be more effective during follow-up activities. Moreover, the research has shown that there is a potential of suppression of the center of the brain, which perceives threats. This is significantly beneficial considering that some adults may already be pre-exposed to other mental illnesses like schizophrenia. In addition to that, CBT has been proven to significantly reduce positive symptoms related to other psychosocial interventions (Ehde, Dillworth, & Turner, 2014). Although CBT has garnered a reputation for reducing the susceptibility to suicide rates amongst patients with mental disorders like schizophrenia, the approach is still in the development stage. The application of CTB in health technology has proven to be a cost-efficient alternative to other methods of treatment of psychosis especially among the adults although access to these therapeutic sessions for patients has been limited.

Demerits of Cognitive Behavioural Therapy (CBTp)

One of the demerits that have hindered the research and development of CBTp is the heterogeneous nature of the symptoms exhibited by mentally ill people. Some therapy sessions have been rendered ineffective due to the incomprehensible and chaotic nature of mentally ill patients. Furthermore, some cultures are generally opposed to clinical methods of treatment due to beliefs and social norms. The rise of medical methods for diagnosis and treatment of psychosis have rendered the therapeutic methods, such as CBTp, to be uncommon in contemporary society and medical practice in general.

One of the most important considerations for people having mental disorders is befriending as a prerequisite for engagement. Befriending enables to create a good rapport before the engagement process begins. Furthermore, befriending also enhances the elimination of the possibility of misdiagnosis as a result of the delusional and anger issues of the patient. Medical practitioners are advised as well to be aware of internal mental distractions and cognitive impairments, which may result in a lack of concentration. Tactical withdrawal is advised to medical professionals when making continual engagement with a patient.

Conclusion

In conclusion, psychosis is fundamentally compounded by multiple mental disorders, which lead to its development. Studies in healthcare technology have led to the development of therapeutic methods, such as CBTp, which have been found to have a significant impact on not only decreasing the impact and development of psychosis but also the cost benefits associated with the approach. However, it is important to stress that therapeutic approaches augmented with medicinal approaches yield the best results in adults in the long-term. However, the method has been limited by its drawbacks, such as the lack of access to these therapeutic services; hence, medical approaches to treating psychosis have been prevalent.

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