After studying this chapter, you should be able to:• describe the challenges that face people experiencing mental health issues of a psychotic nature• discuss the factors that increase the risk of experiencing mental health issues of a psychotic nature – pathophysiology and social determinants• outline the principles underlying trauma-informed care• discuss the significant features of recovery principles• identify actions to support health promotion in relationship to mental health issues• describe the various nursing roles and settings when working with people experiencing mental health issues of a psychotic nature.
This chapter focuses on the complex nature of psychotic illnesses and describes the care approach known as trauma informed strength based holistic care. Psychotic illness has been defined as a ‘low prevalence’ condition, but it is often more severe and enduring than this would suggest, and can require complex care (Morgan et al., 2014; Sara, Burgess, Malhi, Whiteford & Hall, 2014).
Psychotic illnesses are conditions with varying symptoms. Each is an individual clinical presentation making diagnosis and treatment difficult. The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V) (American Psychiatric Association, 2013, p. 87) defines psychotic illnesses by abnormalities in one or more of the five areas of hallucination, delusions, disorganised thinking (speech), grossly disorganised or abnormal motor behaviour and negative symptoms. People experiencing psychotic illnesses may exhibit disturbances in thinking, perception, emotional responses and behaviour (Morgan et al., 2011).
The DSM-V (American Psychiatric Association, 2013) categorises a broad spectrum of psychotic illnesses with the most common being schizophrenia, bipolar disorder, schizoaffective disorder, schizotypal (personality) disorder, brief psychotic disorder and schizophreniform disorder. Age of onset is in the late teens to early adulthood, with males (3.7 cases per 1000) experiencing earlier episodes and more frequent episodes than females (2.4 cases per 1000). Early onset disrupts a person's development of critical life skills, education, employment and relationships (Morgan et al., 2011). Table 10.1 lists the features of different psychotic disorders.
In 2010, 4.5 people per 1000 in the Australian population, aged 18 to 64 years, were living with a psychotic illness and in contact with the public health system (Morgan et al., 2011). This accounts for a third of individuals living with a severe mental illness (Department of Health, 2013).