🧠 Lecture 4
Psychiatry
Psychotic vs non-psychotic, hallucination vs illusion, 3 types of psychosis.
Psychotic vs Not
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FIRST question in ANY psych scenario: PSYCHOTIC or NON-PSYCHOTIC?
| Non-Psychotic | Psychotic |
|---|---|
| Has insight, reality-based → treat like Med/Surg | No insight, not reality-based → ID type |
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DELUSION = False, fixed BELIEF (just a thought — no sensory element)
Paranoid / Grandiose / Somatic
Paranoid / Grandiose / Somatic
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HALLUCINATION = Sensory with NOTHING THERE
Auditory (#1) / Visual (#2) / Tactile (#3)
Auditory (#1) / Visual (#2) / Tactile (#3)
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ILLUSION = Something IS there but MISINTERPRETED. Cord is there — they say it's a snake.
3 Types of Psychosis
| Type | Cause | Approach |
|---|---|---|
| Functional | Brain CHEMISTRY off (schizophrenia, bipolar) | 4 Steps: Acknowledge → Present Reality → Set Limits → Enforce |
| Dementia | Brain CELLS destroyed (Alzheimer's, stroke) | 2 Steps: Acknowledge → REDIRECT (NEVER present reality!) |
| Delirium | BODY chemical issue (UTI, meds, electrolytes) | 2 Steps: Acknowledge → REASSURE (safety & temporary) |
🧩 2nd Step starts with "Re"
Dementia → Re-direct | Delirium → Re-assure
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NEVER present reality to a DEMENTED patient — they can't learn it, just frustrates them!
Psychotic Symptoms
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Loose Associations: Flight of ideas, Word salad, Neologisms
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Narrowed self-concept: Refuses to change clothes / leave room → LEAVE THEM ALONE. Never force a psychotic!
📖 Notes for Dummies
🧠 Think of it this way…
Psychiatric patients are not "crazy" — their brain isn't working quite right. Your job is to meet them WHERE THEY ARE, not pull them into your reality. The approach changes completely based on the TYPE of problem.
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Psychotic or not — first question always:
Non-psychotic = they know what's real → talk to them like anyone else
Psychotic = they truly believe their false reality → use the specific approach
Non-psychotic = they know what's real → talk to them like anyone else
Psychotic = they truly believe their false reality → use the specific approach
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3 types — easy way to remember:
🧪 Functional = brain CHEMISTRY off (schizophrenia, bipolar) → CAN learn reality → teach it
🧠 Dementia = brain CELLS destroyed (Alzheimer's) → CANNOT learn → just redirect
⚡ Delirium = something ELSE causing it (UTI, meds) → TEMPORARY, will pass → reassure
🧪 Functional = brain CHEMISTRY off (schizophrenia, bipolar) → CAN learn reality → teach it
🧠 Dementia = brain CELLS destroyed (Alzheimer's) → CANNOT learn → just redirect
⚡ Delirium = something ELSE causing it (UTI, meds) → TEMPORARY, will pass → reassure
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Hallucination vs Illusion — super easy:
Hallucination = NOTHING is there (empty wall, voices) "HAll is empty"
Illusion = Something IS there but interpreted wrong (cord → "it's a snake!")
Hallucination = NOTHING is there (empty wall, voices) "HAll is empty"
Illusion = Something IS there but interpreted wrong (cord → "it's a snake!")
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#1 mistake students make: Telling an Alzheimer's patient their dead spouse is gone. DON'T — they can't retain it, so they re-grieve over and over. Just redirect: "Tell me about him!"
📝 What do you say?
Non-psychotic: "That must be really hard. Tell me how you're feeling."
Functional psychotic: "I can see you're scared. They are not plotting. Let's change the subject."
Demented patient: "That sounds nice! (acknowledge) Why don't we sit by the window? (redirect)"
Delirious patient: "You are safe. This feeling will go away as you get better. (reassure)"
Non-psychotic: "That must be really hard. Tell me how you're feeling."
Functional psychotic: "I can see you're scared. They are not plotting. Let's change the subject."
Demented patient: "That sounds nice! (acknowledge) Why don't we sit by the window? (redirect)"
Delirious patient: "You are safe. This feeling will go away as you get better. (reassure)"