5-minute first aid for psychosis

Because thought disorder worsens the longer a patient talks, suggest a 5-sentence rule during sessions. You and the patient try to speak no more than 5 sentences at a time before pausing to let the other person speak. Encourage the patient to monitor your speech and to indicate when you violate the rule. Monitoring your speech helps patients start monitoring their own.

Thought disorder worsens when patients experience negative emotions such as anxiety. When this occurs, move the discussion to a neutral topic or encourage deep regular breathing for 2 minutes to reduce anxiety.

MANAGING NEGATIVE SYMPTOMS

Negative symptoms of schizophrenia ( Table 5 ) overlap with depression and with medication side effects. Anhedonia and social withdrawal, for example, may reflect a patient’s depression and demoralization, rather than just schizophrenia’s biological core symptoms.

Similarly, limited facial expression may be caused by drug side effects, rather than absence of affect. Negative symptoms also can occur in the absence of depression or side effects, such as when a patient’s automatic thoughts related to expectations of failure lead to lack of motivation.

Negative symptoms usually bother patients much less than positive symptoms do. Thus, enlisting family members to help patients monitor and deal with negative symptoms can be very useful.

CASE SUMMARY

Ms. W’s stress-related psychotic symptoms resolved to baseline with cognitive therapy done in a regular medication management clinic. Throughout this episode, her medication dosages remained unchanged. The interventions added about 10 minutes to sessions, effectively dealt with her symptom exacerbation, and prevented hospitalization.

Psychotropics remain a critical component of treating psychotic disorders, and psychotherapy can also be very helpful. But in the many situations when psychotherapy is not available, brief psychotherapeutic techniques can:

• increase patient and family satisfaction
  
• enhance the therapeutic alliance
  
• improve medication adherence
  
• promote recovery.