Paranoia and delusions Process and product

Thinking psychologically about psychotic symptoms, a useful distinction can be made between paranoid thinking (characterised by particular cognitive distortions) and delusional ideation. The former can be considered to be a perceptual process, involving attending to stimuli salient to the individual because they are threatening. Delusions are considered as the explanatory hypotheses developed by the individual to account for the strange perceptions. This conceptualisation is a development of...

Session 1 Engagement and developing alternative explanations

The first thing that I noticed upon entering Kathy's house was the number of cats that she possessed. There must have been at least half a dozen of different breeds roaming about the house. As I began the session, the cats began climbing all over me, trying to take the pen from my hand. This was becoming a distraction so I asked Kathy if it was possible to use a room where the cats would not disturb us. Unfortunately Kathy was unable to feel comfortable without the cats, so they became a...

David Kingdon and Jeremy Pelton

Supervision is fundamental to developing skills in CBT, especially for patients with psychoses because of the need to adjust techniques learned in training to the realities of everyday clinical practice and to a very variable group of patients. Its goal has been described as modifying in-therapy behaviours by support and training. It can particularly enable the therapists to step back and review and reflect on their practice to learn and prepare for the next session. It is complementary and at...

Normalising

For many people the experience of psychosis is worsened by the fear that they see themselves as mad, a lunatic, a nutter. They are subject to the media portrayal of mental illness and fear the arrival of the knife wielding maniac that lies dormant within them. Many people diagnosed as having schizophrenia have little idea of what this actually means, clutching onto beliefs that it has something to do with a split personality or two minds. Along with that belief is the fear of the implications...

Case 9 Carole Ronald Siddle

I was initially trained as a psychiatric nurse. I left school at 15 having just sat my GCE O levels and was persuaded by a friend to apply to the local psychiatric hospital as a cadet nurse. After two years of working in the various departments of the hospital I started training as a student nurse. Towards the end of the RMN training I applied for the shortened post-registration RGN course and was able to finish that training in about a year and a half. Swiftly returning to the safety of...

Psychosocial Intervention Courses

'Thorn' courses and other courses in psychosocial interventions (e.g. in Sheffield) are more available around the UK, but these have generally recruited nurses and occupational therapists rather than other professions. These courses were originally set up in the early 1990s with a remit that was initially case management and family work, but the original courses at London and Manchester began to include CBT in the early-1990s and courses established since (e.g. in Nottingham, Hackney,...

Psychometric assessment

Three psychometric tools were used to assess Jane. Firstly, the modified KGV Scale (Krawiecka, Goldberg & Vaughan, 1977) highlighted the severity of any psychological phenomena present. This is a 14-point assessment tool, six areas being elicited by questioning and eight by observation. Secondly, the Social Functioning Scale (SFS Birchwood et al., 1990) examined Jane's social capability and highlighted any areas of concern. Finally, the Liverpool University Neuroleptic Side Effect Rating...