4.1: psychotic disorder

Question 1

Difference Schizophrenia, delusion, psychosis

Answer 1

**Delusion: **firmly held but incorrect beliefs that usually involve a misinterpretation of perceptions or experience

**Psychosis: **collective name given to extensive range of disparate symptoms that can leave an individual feeling confused and scared.
- Presence of different combinations of these symptoms leads to diagnosis with one of a mummer of schizophrenia spectrum disorders.

• Schizophrenia: DSM diagnosis

Schizophrenia spectrum disorder: the name for separate psychotic disorders that range across a spectrum depending on the severity, duration and complexity of symptoms.

Question 2

DSM-5 Schizophrenia

Answer 2

A. characteristics symptoms: 2+ symptoms for a significant proportion of the time for 1+ months one symptom must be (1),(2),(3)
1. delusions
2. hallucinations
3. disorganised speech
4. grossly disorganised or catatonic behaviour
5. negative symptoms
B.social/occupational dysfunction
C. disturbance continues for +6 months

Question 3

nature of psychotic symptoms

Schizophrenia symptoms classsification

Answer 3

+ve//-ve symptoms

+ve symptoms: characteristics of psychotic symptoms which tend to reflect an excess or distortion of normal functions (ie. Developing inappropriate beliefs that things which are not there are)

-ve symptoms: symptoms characteristics of a diminution or loss of a normal function. (ie. Lack of initiative or emotional expression)

Question 4

Schiz

+ve symptoms

Answer 4

• delusions
• hallucinations
• disorganied speech

Question 5

schiz

-ve symptoms

Answer 5

• flattened affect
• reduced speech
• lack of initiative

Question 6

schiz +ve sympt

Delusions

Answer 6

firmly held but erroneous beliefs that (a) usually involve a misinterpretation of perceptions or experience and (b) become fixed beliefs that are resistant to change

types:
1. Persecutory delusions: delusion in which the individual believes they are being persecuted or chased, or spied on or are in danger. Usually as a result of some conspiracy.
2. Grandiose delusions: delusions in which the individual believes they are someone with fame or power and have exceptional abilities, wealth or fame. (ie. I am jesus)
3. Delusion of control: delusions where the person believes that his or her thoughts, feelings or actions are being controlled by external forces (ie. Extra-terrestrial)
4. Delusion of reference: where individual believes that independent external events are making specific reference to them.
5. Nihilistic delusions: where induvial believes that some aspect of either the world or themselves has ceased to exist (they believe that they are dead).
6. Erotomaniac delusions: relatively rare psychotic delusion where individual believes that a person of higher social status falls in love dan makes amorous advances towards them

Question 7

schiz +ve sympt

Hallucinations

Answer 7

: a sensory experience in which a person and see, hear, smell, or taste, or feel something that isn’t there.

-** Auditory (most common): **experienced by 80% of sufferers.
Usually involve hearing voices – commands to act, conversations between two or more voices or commentary on the individual’s thoughts.

Voices are distinct from individual’s thought
- Visual (second most common)- diffuse (colours/shapes) or specific (familiar person).
- Tactile/ somatic: tingling or burning sensation.
- Olfactory/gustatory: experiencing non-existent smell or taste.

Question 8

schiz +ve sympt

Disorganised Speech

Answer 8

• Derailment: quick changing of topic in conversation.
• Loose association: disorganised thinking, quick change of topic.
• Tangentiality: answers to questions tangential rather than relevant.
• Clanging: sounds more important than meaning.
• Neologism: making up new words
• Word salad: no link between one phrase/word and the next.

Question 9

schiz -ve sympt.

Answer 9

Negative symptoms are common within a diagnosis of schizophrenia but less so in other schizophrenia spectrum disorders.

1. Diminished emotional expression: a reduction in facial expression of emotion, lack of eye contact, poor voice intonation, lack of head and hand movements that would normally give ride to emotional expression.
2. Avolition: inability to carry out or complete normal day-to-day goal-oriented activities, and this results in the individual showing little interest in social or work activities.
3. Alogia: a lack of verbal fluency in which the individual gives very brief, empty replies to a question.
4. Anhedonia: inability to react to enjoyable or pleasurable events.
5. Asociality: a lack of interest in social interactions, perhaps brought about by a gradual withdrawal from social interactions generally.

Question 10

other psychotic disorders in DSM-5

delusional d, brief schiz, schizoaffective, subsance-induced.

Answer 10

delusional disorder DSM-5:
- 1+ delusions for 1+ month, no other symptoms, funtion normally, not due to external factors

brief psychotic disorder DSM-5
- sudden onset of 1+ psychotic symptom within 2 weeks due to emotional stress

schizoaffective disorder
- schizophrenia + mood episode (mania or depression)

substance-induced pscyhotic disorder
- hallucinations or delusions related to substance use

Question 11

the course of psychotic symptoms

Prodromal Stage

Answer 11

symptoms are starting but are difficult to identify as psychotic symptoms.
 the sooner you interfere the better the prognosis

Characteristics:
Initial symptoms:
- Withdraw from normal life and social interactions.
- Shallow or inappropriate emotions.
- Decline in personal care, work, or school performance.

Biological correlates:
- Possible grey matter loss in brain areas mediating social cognition.

Question 12

Diathesis-stress model:

Answer 12

Core idea = psychosis is a result from a combination of:
- Biological diathesis: Genetically inherited predisposition to psychotic symptoms.
- Environmental stressors: Critical life experiences trigger symptoms in vulnerable individuals.
- Examples: early rearing factors, dysfunctional family relationships, inability to cope with adolescent developmental stress.
 cortisol connection: stress exacerbates symptoms in genetically predisposed individual’s by influencing cortisol production.

Question 13

course of psychotic symptomsn

the active stage

Answer 13

the stage where an individual exhibits unambiguous symptom of psychosis such as:
- Delusions.
- Hallucinations.
- Disordered speech communication.
- A range of other full-blown symptoms.
First Episode Psychosis
* Definition: The first occurrence of a full-blown psychotic episode.
* Experience for the Individual:
o Often frightening, confusing, and distressing

Question 14

course of psychotic symptoms

the residual stage

Answer 14

the stage where the individual no longer exhibits prominent positive symptoms.
Remaining symptoms:
Negative symptoms persist, including: blunted affect, withdrawal from social interaction, difficulty with normal day-to-day activities.
Recovery and Relapse
* Recovery:
o Gradual for most individuals.
o 50% of sufferers remit after one or more active stages (Lally et al., 2017).
* Relapse:
o Around 50% alternate between active and residual stages (Wiersma et al., 1998).
o Relapse is common and often linked to:
1. Stressful life events or return to a stressful family environment after hospitalisation.
2. Nonadherence to medication

Question 15

the aetiology of pscyhotic symptoms

Biological theories: Genetics

Answer 15

Genetic factors: Psychotic symptoms tend to run in families suggests heritability/ genetic predisposition.
Concordance studies: show that psychosis has an inherited component.

2. DRD2 Gene:
   o Encodes dopamine receptors in the brain.
   o Supports the link between dopamine dysfunction and psychotic symptoms

Question 16

the aetiology of pscyhotic symptoms

Neurotrasmitters

Answer 16

Dopamine Hypothesis
* Argues that excess dopamine activity is related to the symptoms of schizophrenia.
* Supported by several lines of evidence:

1. antiosychotic drugs which target dopamine are effective
2. amphetamine psychosis- cocaine which releases dopamine can lead to schiz like symptoms
3. excessive dopamine release in basal ganglia observed in brain imaging of schiz patients
4. post mortem study- increased dopamine receptors particularly in limibic area

Question 17

dopamine pathway and schiz symptoms

Answer 17

1. Mesolimbic Pathway:
   o Linked to positive symptoms (e.g., hallucinations, delusions, disordered speech).
   o Excess dopamine activity in this pathway correlates with positive symptoms.
   o Antipsychotics block dopamine receptors here, reducing positive symptoms.
2. Mesocortical Pathway:
   o Projects to the prefrontal cortex.
   o Underactive dopamine activity in this pathway correlates with negative symptoms (e.g., flattened affect, lack of motivation).
   o Prefrontal cortex dysfunction affects working memory, planning, and motivated behaviour (Winterer & Weinberger, 2004).

Question 18

Neuroscience of Schizophrenia

Answer 18

1. enlarged ventricles
2. reduced gray matter in the prefrontal cortex
3. abnormalities in temporal cortex - limbic structures, basal ganglia, cerebellum
4. hippocampus - spurious associations, chaotic speech

Question 19

psychological theories schiz

Psychodynamic Theories:
Freud’s Hypothesis

Answer 19

• Cause of Psychosis:
  o Regression to an earlier ego state, specifically primary narcissism, characteristic of the oral stage of development.

o Regression is triggered by cold and unnurturing parents.
o Results in a loss of contact with reality.

• Symptoms Explained:
  o Thought disorders, communication disorders, and withdrawal are seen as evidence of a self-centred focus.
  o Hallucinations and delusions arise from attempts to re-establish contact with reality
• Primary Narcissism: Regression to a self-centred ego state from early development.
• Schizophrenogenic Mother: A cold and rejecting mother theorised to cause schizophrenia.
  Critique
• Limited empirical support for psychodynamic theories of psychosis.
• Genetic and biological accounts are now seen as more central to understanding the causes of psychosis, reducing the validity of older psychodynamic models.

Question 20

theories for schiz

behavioural theories

Answer 20

Behavioural theories focus on learning and conditioning to explain bizarre behaviours often observed in psychosis.

• These theories do not aim to fully explain psychosis but rather the development and maintenance of unusual behaviour patterns

key concepts:
1. Operant Reinforcement (Ullman & Krasner, 1975):
o Bizarre behaviours develop because they are reinforced by attention.
o Individuals with schizophrenia may:
 Struggle to focus on normal social cues due to attentional difficulties.

2. Evidence of Reinforcement and Extinction:
   o Reinforcement Study (Ayllon et al., 1965):
    A female psychiatric resident was rewarded for carrying a broom (e.g., cigarettes, tokens).

o Extinction Procedures:
 Inappropriate behaviours can be reduced by withholding rewards or removing attention

Question 21

aetiology schiz

Cognitive Theories and Sociocultural Theories

Answer 21

Cognitive Deficits
* Core feature of schizophrenia that evolves with the disorder.
* Types of Deficits:
o Dysfunction in working memory, attention, processing speed, visual and verbal learning.
o Deficits in reasoning, planning, abstract thinking, and problem-solving

Cognitive Biases
- attentional bias
- attributional bias
- reasoning bias
- interpretation bias
- theory of mind deficients

social factors:
- low socioeconomic status linked to higher stress
- Social-Selection Theory:
o Individuals with schizophrenia drift into low SES due to cognitive and motivational deficits
- social labelling theory influences behaviour- others reactions, self-role adoption

Question 22

treatment for pscyhosis

Answer 22

1. Early Intervention:
   o Subclinical symptoms addressed by early intervention teams.
   o Antipsychotic medications for positive symptoms during early episodes.
2. Psychological Therapies:
   o Focus on cognitive and behavioural deficits to improve social and occupational functioning.
3. Family-Based Interventions:
   o Create stable, stress-free environments to minimise relapse risks.
4. Long-Term Community Care:
   o Overseen by case managers:
    Medication adherence.
    Residential supervision.
    Vocational training.
    Regular access to mental health services.
5. Integrated Interventions:
   o NICE Recommendations (2016):
    Combine medications with psychotherapy for recovery planning.
   o Differing views across medical, psychological, and social disciplines on the best long-term treatment approaches.