Adult Treatment Planner
34: Psychoticism
SNOMED Terms
- Alcohol-induced psychotic disorder with delusions
- Amphetamine-induced psychotic disorder with hallucinations
- Atypical depressive disorder
- Bipolar II disorder, most recent episode major depressive
- Cannabis-induced psychotic disorder with hallucinations
- Chronic bipolar II disorder, most recent episode major depressive
- Chronic schizophreniform disorder
- Cocaine-induced psychotic disorder with hallucinations
- Delusional disorder
- Depressive disorder
- Drug-induced delusional disorder
- Induced psychotic disorder
- Inhalant-induced psychotic disorder with delusions
- Inhalant-induced psychotic disorder with hallucinations
- Mild bipolar II disorder, most recent episode major depressive
- Mixed anxiety and depressive disorder
- Moderate bipolar II disorder, most recent episode major depressive
- No diagnosis on Axis III
- Opioid-induced psychotic disorder with delusions
- Opioid-induced psychotic disorder with hallucinations
- Organic delusional disorder
- Personality change due to medical disorder
- Psychotic disorder
- Schizoaffective disorder
- Schizophreniform disorder
- Sedative, hypnotic AND/OR anxiolytic-induced psychotic disorder with delusions
- Sedative, hypnotic AND/OR anxiolytic-induced psychotic disorder with hallucinations
- Severe bipolar II disorder, most recent episode major depressive with psychotic features
- Severe bipolar II disorder, most recent episode major depressive without psychotic features
- Severe bipolar II disorder, most recent episode major depressive, in partial remission
- Severe bipolar II disorder, most recent episode major depressive, in remission
- Single major depressive episode, severe, with psychosis
Goals
- Control or eliminate active psychotic symptoms so that supervised functioning is positive and medication is
taken consistently.
- Eliminate acute, reactive, psychotic symptoms and return to normal functioning in affect, thinking, and
relating.
- Increase goal-directed behaviors.
- Focus thoughts on reality.
- Normalize speech patterns, which can be evidenced by coherent statements, attentions to social cues, and
remaining on task.
Behavioral Definitions
- Bizarre content of thought (delusions of grandeur, persecution, reference, influence, control, somatic
sensations, or infidelity).
- Illogical form of thought/speech (loose association of ideas in speech, incoherence; illogical thinking;
vague, abstract, or repetitive speech; neologisms, perseverations, clanging).
- Perception disturbance (auditory, visual, or olfactory hallucinations).
- Disturbed affect (blunted, none, flattened, or inappropriate).
- Lost sense of self (loss of ego boundaries, lack of identity, blatant confusion).
- Volition diminished (inadequate interest, drive, or ability to follow a course of action to its logical
conclusion; pronounced ambivalence or cessation of goal-directed activity).
- Relationship withdrawal (withdrawal from involvement with external world and preoccupation with egocentric
ideas and fantasies, alienation feelings).
- Psychomotor abnormalities (marked decrease in reactivity to environment; various catatonic patterns such as
stupor, rigidity, excitement, posturing, or negativism; unusual mannerisms or grimacing).
- Extreme agitation, including a high degree of irritability, anger, unpredictability, or impulsive physical
acting out.
- Bizarre dress or grooming.
Diagnoses
- Delusional Disorder
- Brief Psychotic Disorder
- Schizophrenia
- Schizophrenia, Paranoid Type
- Schizoaffective Disorder
- Schizophreniform Disorder
- Bipolar I Disorder
- Bipolar II Disorder
- Major Depressive Disorder
- Personality Change Due to Axis III Disorder
Objectives and Interventions
- Describe the type and history of the psychotic symptoms.
- Demonstrate acceptance to the client through calm, nurturing manner; good eye contact; and active
listening.
- Assess the pervasiveness of the client's thought disorder through clinical interview and/or
psychological testing.
- Determine whether the client's psychosis is of a brief reactive nature or long-term with prodromal
and reactive elements.
- Client or significant other provides family history of serious mental illness.
- Explore the client's family history for serious mental illness.
- Accept and understand that distressing symptoms are due to mental illness.
- Provide supportive therapy to alleviate the client's fears and reduce feelings of alienation.
- Explain to the client the nature of the psychotic process, its biochemical components, and the
confusing effect on rational thought.
- Take antipsychotic medications consistently with or without supervision.
- Refer the client for an immediate evaluation by a psychiatrist regarding his/her psychotic symptoms
and a possible prescription for antipsychotic medication.
- Monitor the client for psychotropic medication prescription compliance, effectiveness, and side
effects; redirect if the client is noncompliant.
- Accept the need for a supervised living environment.
- Arrange for the client to remain in a stable, supervised situation (e.g., crisis adult foster care
placement or a friend's/family member's home).
- Make arrangements for involuntary commitment to an inpatient psychiatric facility if the client is
assessed to be unable to care for his/her basic needs or is potentially harmful to himself/herself
or others.
- Describe recent perceived severe stressors that may have precipitated the acute psychotic break.
- Probe causes for the client's reactive psychosis.
- Explore the client's feelings surrounding the stressors that triggered his/her psychotic episodes.
- Assist the client in reducing threat in the environment (e.g., finding a safer place to live,
arranging for regular visits from caseworker, arranging for family members to call more frequently).
- Report diminishing or absence of hallucinations and/or delusions.
- Refer the client for an immediate evaluation by a psychiatrist regarding his/her psychotic symptoms
and a possible prescription for antipsychotic medication.
- Monitor the client for psychotropic medication prescription compliance, effectiveness, and side
effects; redirect if the client is noncompliant.
- Assist the client in restructuring his/her irrational beliefs by reviewing reality-based evidence
and his/her misinterpretation.
- Encourage the client to focus on the reality of the external world versus his/her distorted
fantasy.
- Differentiate for the client the source of stimuli between self-generated messages and the reality
of the external world.
- Begin to show limited social functioning by responding appropriately to friendly encounters.
- Assist the client in restructuring his/her irrational beliefs by reviewing reality-based evidence
and his/her misinterpretation.
- Reinforce the client's socially and emotionally appropriate responses to others.
- Think more clearly as demonstrated by logical, coherent speech.
- Refer the client for an immediate evaluation by a psychiatrist regarding his/her psychotic symptoms
and a possible prescription for antipsychotic medication.
- Gently confront the client's illogical thoughts and speech to refocus disordered thinking.
- Reinforce the client's clarity and rationality of thought and speech.
- Verbalize an understanding of the underlying needs, conflicts, and emotions that support the irrational
beliefs.
- Assist the client in restructuring his/her irrational beliefs by reviewing reality-based evidence
and his/her misinterpretation.
- Probe the client's underlying needs and feelings (e.g., inadequacy, rejection, anxiety, guilt) that
trigger irrational thought.
- Family members increase their positive support of the client to reduce changes of acute exacerbation of
psychotic episodes.
- Arrange family therapy sessions to educate regarding the client's illness, treatment, and
prognosis.
- Assist the family in avoiding double-bind messages that increase anxiety and psychotic symptoms in
the client.
- Family members share their feelings of guilt, frustration, and fear associated with the client's mental
illness.
- Encourage the family members to share their feelings of frustration, guilt, fear, or depression
surrounding the client's mental illness and behavior patterns.
- Refer the family members to a community-based support group designed for the families of psychotic
patients.
- Gradually return to premorbid level of functioning and accept responsibility of caring for own basic needs,
including medication regimen.
- Monitor the client for psychotropic medication prescription compliance, effectiveness, and side
effects; redirect if the client is noncompliant.
- Monitor the client's daily level of functioning (i.e., reality orientation, personal hygiene, social
interactions, and affect appropriateness) and give feedback that either redirects or reinforces the
client's progress.
Index