Chapter 9: Schizophrenia Spectrum and Other Psychotic Disorders Flashcards
Most severe and disabling mental health condition
Schizophrenia
Schizophrenia
One of the most serious psychological disorders, characterized by delusions, hallucinations, and disorganized speech. There are overall, adverse changes in thought, perception, emotion, and motor behaviour, and a feeling of depersonalization. Behaviour in some instances appears to be “autistic,” in the sense of being governed by internal stimuli or private events. The individual may be unresponsive to environmental stimuli that would normally prompt reactions, or may respond in a way that suggests a distorted interpretation of the stimuli. Ordinary objects or events seem to take on a marked personal significance. There is pronounced disruption of cognitive transactions: thought and language appear to become loosened from the normal constraints that make for coherent sequences of ideas and distinguish fantasy from reality. Often, some notion or theme involving malevolent forces or inordinate personal power increasingly commands the individual’s attention. Many people with schizophrenia appear to lose their intensity. Language may become impoverished, with little apparent effort or success at communication. They may become withdrawn socially and exhibit little interest in formerly enjoyable pursuits. Attention span may be markedly reduced. From the Greek schizein, “to split,” and phrenos, “mind.”
Psychosis
Refers to the loss of touch with reality that is characterized by symptoms such as hallucination and delusions that are observed in schizophrenia
Egosyntonic
They do not view their disorder as a problem
Egodystonic
They view their disorder as a problem
Past and madness
People drew on spiritual interpretations for such behaviour and considered “madness” to be the result of divine punishment or demonic posession
German psychiatrist Emil Kraepelin
Introduced the term dementia praecox to describe what is now known as schizophrenia
Bleuler then described the heterigeneity of the disorder (variability and diversity of clinical and biological features that are seen)
He believed that schizophrenia is better described as a group of schizophrenias rather than one singular condition
Positive symptoms
Abnormal additions to lie, including the hallucinations, delusions, and disorders thought frequently experienced by patients with schizophrenia
Basic symptoms
Disorganized communication, motivational impairments, mood disturbance, and withdrawal from the world
First rank symptoms
Symptoms included hearing voices conversing with each other or commenting on what the person was doing, believing that one’s own thoughts were being broadcast for other people to hear, or believing that one’s thoughts or behaviour were under the control of an outside source
Schizophrenia criteria
These criteria outline a combination of symptoms and clinical features that define the disorder and include core symptoms (Criterion A); problems with work or social functioning (Criterion B); continuous signs of the disturbance for at least six months, including at least one month of active symptoms (Criterion C); the exclusion of concurrent schizoaffective or mood disorders during the active phase of schizophrenia symptoms (Criterion D); the fact that the disturbance cannot be caused by substance use or medical conditions (Criterion E); and consideration of any history of autism spectrum disorder or a communication disorder of childhood onset as contributing to the disorder (Criterion F).
Five core symptoms of schizophrenia include
delusions (Criterion A1), hallucinations (Criterion A2), disorganized speech (Criterion A3), grossly disorganized or catatonic behaviour (Criterion A4), and negative symptoms (Criterion A5).
The first foe symptom-related diagnostic criteria represent positive symptoms
- delusions, hallucinations, disorganized speech, grossly disorganized or catonic behaviour
Negative symptoms
Comprise behavioural deficits, including loss of motivation, lack of emotional expression, and lack of interest in environment
Schizophrenia
Is not defined by any one symptom or cluster of symptoms, rather a selection of qualitatively different symptoms are required for a diagnosis
Schizoaffective Disorder
Contains the added element of a diagnosed mood episode that occurs at the same time as the symptoms of schizophrenia
This period of co occuring symptoms must have been preceded or followed by at least 2 weeks of delusions or hallucinations without the mood symptoms
Two subtypes of schizoaffective disorder
1) Bipolar type= episodes of mania
2) Depressive type= episodes of major depressive episodes
Schizophreniform disorder
Same criteria as schizophrenia, yet only lasts between 1-6 months
The symptoms must be present for a significant portion of time during a one month period. There is not requirement for a decline in functioning
Diagnosis is often withheld until at least 6 months, if they do not get better= they have schizophenia
Delusional disorder
Characterized by experiencing delusions for at least one month and not experiencing any other psychotic symptoms
-Functioning is not markedly impaired, and behaviour is not that bizarre or odd
Brief Psychotic Disorder
Is diagnosed if positive symptoms of schizophrenia are present for more than one day and remit by another month
If symptoms persist for between one and six months= then schizophreniform disorder would be diagnosed, and longer than 6 months would result in a diagnosis of schizophrenia
A substance/medication induced psychotic disorder
Diagnosed when the positive symptoms of schizophrenia occur to due the initiation or withdrawal from a drug, medication, or toxin
Substance/Medication Induced Psychotic Disorder
can be distinguished by relationship of substance use and substance withdrawal
Substance use
Recurrent substance use that results in significant adverse consequences in social or occupational functioning, or use of a substance that impairs one’s performance in hazardous situations, for example drinking and driving
Substance withdrawal
Unpleasant and sometimes dangerous symptoms such as nausea, headache, or tremors experienced when an addictive substance is removed from the body.
Psychotic Disorder due to Medical Condition
The characteristic features of psychotic disorders due to another medical condition are prominent hallucinations or delusions caused by the physiological effects of a medical condition. For this diagnosis to be considered, a medical condition must be present that is capable of producing psychotic symptoms (e.g., epilepsy) and the symptoms cannot be explained by another mental disorder. Psychotic disorder due to another medical condition is more common in people older than 65 years of age compared to younger people
Other Psychotic Disorders
Not enough information to make one of the above diagnoses, but symptoms of psychosis are present
-Other specified schizophrenia-spectrum and other psychotic disorder
Typical symptoms of schizophrenia spectrum disorders
The characteristic symptoms of schizophrenia-spectrum disorders may be broadly classified as positive and negative symptoms. However, schizophrenia is also associated with other symptoms including disorganized, motor, affective, and cognitive symptoms.
Positive symptoms
Refer to many of the obvious signs if schizophrenia.
They refer to the addition of an experience that is in excess of normal psychological functioning
Positive symptoms include
Hallucinations, delusions, and disorganized thinking
Hallucinations
Are abnormal perceptual experiences that occur in the absence of external stimuli. They can occur in any sensory modality: hearing, seeing, smelling, tasting, or feeling things that are not actually there
Most common type of hallucinations
Auditory hallucinations- up to 80% of people have this kind of hallucination
The experience of hearing sounds like voices that do not actually exist
Command hallucinations
When voices give the person commands to do things
Visual hallucinations
Very rare for someone to see a fully formed person or animal that interacts with them.
Instead, people may see partially formed images and objects, yet they disappear when person tries to interact with them
-they rarely if ever look exactly like things that are actually in the world around the person and interact with them
Clear sensorium
A term referring to a clear mental state not clouded by substance use, fatigue, or a neruological conditions
Hypnogogic Hallucinations
Occur as someone is falling asleep
Hypnopompic hallucinations
are generally considered a regular part of human experience and are not diagnostic of psychosis
Delusions
Are fixed false beliefs that are unfounded and highly resistant to contradictory evidence
-types of delusions are often defined based on the theme of the delusion and include grandiose, persecutory, somatic, and referential delusions
Persecutory delusions/paranoid delusions
Involve the belief that one is being conspired against, spied upon, or persecuted
-Most common
-may believe that the government or criminal organizations are monitoring them and intent on harming them
Grandiose delusions
Involve the belief that one possesses special powers, abilities, or knowledge
Religious delusions
Involve unfounded or unrealistic beliefs regarding religious themes and can often involve the person taking on the role of a religious icon
Somatic delusions
Involve beliefs that one’s body is changing
Referential beliefs
Involve a belief that common events (song playing on the radio), objects (a tree) or other individuals (stranger sitting in a cafe) hold a personally relevant and significant meaning to the affected individual
-ex someone might think that the way papers are arranged on a desk contain a special message for them
Bizarre delusions
Are completely impossible and do not derive from ordinary life experiences
-thinking aliens planted a chip in someone’s head
Non bizarre delusions
Involve circumstances that could occur in reality but the likelihood of them being true is extremely low (monitored by government organization)
Delusions- thought withdrawal
These include the belief that one’s thoughts have been removed by some outside force
Thought insertion
The idea that external thoughts have been put into one’s mind
Delusions of control
One’s body or actions are being acted on or manipulated by some outside force
Capgras syndrome/Imposter syndrome
Specific type of delusional condition
-Can occur in psychotic disorders as well as neurological conditions such as dementia and stroke
-They believe that people well known to them, such as family members, have been replaced by substitutes
-They may believe they have been replaced by an imposter
Thought disorder
Refers to disorganized linguistic communication through verbal or written means
Thought- Loosening of associations
Occurs when speech switches from topic to topic with little oblivious connection to them
Tangentiality
Occurs when someone’s response is completely unrelated to the topic being discussed
Perseveration
is an example of thought disorder in which the person becomes fixated on a specific word or idea and repeats it over and over.
Neoliogisms
More severe forms of thought disorder- the use of words that are completely made up or the use of a real word in an irregular context= You can tell the time by looking at the cow
Salad
The most severe form of thought disorder occurs when all connections between words in a sentence are lost and speech become incoherent and impossible to understand
Negative symptoms
Represent a deficit in psychological functioning
-They can be classified as either experiential or expressive
Experiential negative symptoms
involve a decrease in ability to experience enjoyment from situations and to motivate oneself to do things.
Expressive negative symptoms
refer to impairments in the ability to interact with the social world as a result of limited speech or difficulty with the nonverbal expression of emotions.
Negative symptoms can be summarized by the five A’s
avolition, anhedonia, asociality, alogia, and affective flattening
Avolition/Apathy
A lack of motivation (decreased ability to initiate and persist in activities) and lack of interest in daily activities
