CP: Lecture 12 Psychotic Disorders Flashcards
sommige mensen met psychosis…
vinden het juist fijn om psychosis te hebben, bv niet alleen te voelen
wat moet je als psycholoog juist doen bij psychosis?
erover praten!! wat is de content??
-> meestal vroegen ze alleen naar de prevalentie, wanneer wel, wanneer niet etc. maar dit vinden de patienten zelf niet fijn
psychosis=
disruption in the experience of reality / reality testing
DSM defines psychosis in terms of…
symptoms of psychosis (this is broader than reality testing)
how is psychosis defined
➢ Symptoms can be subdivided in different ways
➢ In all models: positive (P) and negative (N)
➢ Some models add domains, for example:
➢ Disorganized (DSM)
➢ Thought disorder (ICD-10)
hallucinations =
Perception-like experiences which occur without an external stimulus
➢ Lifelike
➢ Full force and impact of normal perceptions
➢ Can occur in all modalities
➢ Most common: auditory (‘voices’)
In some (sub)cultures, hallucinations are considered normal (religious) experiences
prevalence psychotic symptoms
Audiovisual hallucinations:
➢ Children around 8 years old: +/- 9%
➢ Generally don’t persist: 76% no longer at 12/13 years old
➢ General population: 5% – 28%
Imaginary friends:
➢ Children 5-12 yrs old: 46%
wat was de definitie in de DSM-IV
‘Delusions are erroneous beliefs that usually involve a
misinterpretation of perceptions and experiences’
wat is de definitie in DSM 5
Delusions are fixed beliefs that are not amenable to change in light of conflicting evidence
dus verschil dsm iv en dsm 5
gaat om of het veranderd kan worden
wat is nu de consensus mbt religie
is er een subgroup die hetzelfde denkt? of niet? want als dit wel zo is, dan kunnen we het niet pathologisen.
hoe ga je vanaf belief naar delusion
belief - mutability - delusion
mutability=
can we change the beliefs? if not, it becomes a delusion
which two symptoms are positive
delusions and hallucinations
most common type of delusion =
persecutory
persecutory delusion =
thinking people are out to get you
second most common type of delusion =
referential
less common types of delusions =
o Somatic (body experiences, eg. bugs under the skin)
o Grandiosity
o Erotomanic (‘celebrity X is in love with me’)
o Nihilistic (‘impending catastrophe’)
difference schizophrenia and delusional disorder
In contrast to schizophrenia which, in addition to delusions, comes with prominent hallucinations, negative, and cognitive symptoms, DD is usually considered a disorder of delusions only.
referential delusion =
The term ‘referential delusions’ refers to the mistaken belief that ordinary events and normal human behavior have hidden meanings that somehow relate to the individual experiencing the delusions.
bv bij de wereld draait door: denken dat de presentator specifiek tegen hen praat
= ideas of reference
dsm IV definitie van bizarre delusion
‘‘clearly implausible and not understandable and not derived from ordinary life experiences.’
en nu dsm 5 definitie bizarre delusion
“Delusions are deemed bizarre if they are
clearly implausible and not understandable to same-
culture peers and do not derive from ordinary life
experiences. ”
dus bizar = vinden andere mensen van dezelfde groep dit ook?
negative symptoms most common
reduced expressivitiy
avolition
avolition =
reduced self-motivation, reduced goal-oriented activities
less common negative symptoms
alogia
anhedonia
asociality
alogia=
reduced speech
anhedonia=
reduced enjoyment
asociality =
reduced interest in social activities
disorganized symptoms
disorganized speech
severely disorganized or catatonic behaviour
other symptoms
anosognosia
disrupted self experience
schizophrenia dsm 5
for at least 1 month, unless treated, a significant proportion of time:
2 of these (at least one must be 1/2/3):
halucinations
delusions
disorganized speech
grossly disorganized or catatonic behaviour
negative symptoms
impact on functioning
continued signs of disturbance for 6 months
when is the onset of schizophrenia usually
between 16-30 years
onset for men
early-mid 20s
onset for women
late 20s
schizoaffective disorder dsm 5
uninterrupted period of illness during which there is a major mood episode (depression or mania) concurrent with criterion A of schizophrenia:
2 or more, at least 1/2/3:
delusions
hallucinations
disorganized speech
disorganized behaviour or catatonic
negative symptoms
delusional disorder DSM 5
presence of one or more delusions with a duration of 1 month or longer
criteria A of schizophrenia has never been met
functioning is not markedly impaired apart from the delusions, and behaviour is not bizarre
differential diagnoses of delusional disorder=
With OCD or BDD: even if the belief of catastrophe / body
experience is extremely solidified, and there is anosognosia,
OCD or BDD fits better than delusional disorder
or
With mood disorders: similar to schizoaffective disorder,
symptoms of mood have to be relatively short compared to
symptoms of delusional disorder
6 soorten other psychotic disorders
delusional disorder
brief psychotic disorder
schizophreniform disorder
schizoaffective disorder
substance/medication induced psychotic disorder
psychotic disorder due to another medical condition
niet te verwarren met de PERSONALITY disorders van odd/eccentric cluster, namelijk….
paranoid - distrusting
schizoid - distant
schizotypical - strange perceptions and behaviour
ezelsbruggetje voor schizoid verschil met schizotypical (PERSONALITY DISORDERS!!!)
schizotypical = abnormal behaviour, dus niet zo typical
delusional disorder=
delusions are present but not enough for schizophrenia criterion A.
functioning is not impaired
brief psychotic disorder
one or more symptoms present for a day or more but less than a month.
return to normal functioning
schizophreniform disorder
duration longer than 1 month, less than 6 months (can be a temporal diagnosis if u suspect schizophrenia)
schizoaffective disorder
criterion A for schizophrenia is met (hallucinations, delusions, disorganized behaviour and speech, negative symptoms) but not B (social dysfunction) or F (autism or communication disorder)
presence of major mood episode (depression/mania)
wat is het verschil tussen schizoaffective disorder en depression or bipolar with psychotic ft:
bij schizoaffective: delusions or hallucinations are present outside of mood episode as well. (dus schizo = hoofd + affective episode).
bij psychotic depression is depression = hoofd, en psychotic aspects
prevalence schizophrenia
rond de 1%
hoe kan je de diagnose stellen voor schizophrenia
semi structured interviews, bijvoorbeeld SCID of MINI plus
jumping to conclusions
mensen met schiz jump to conclusions with very limited information
hoe meet je neurocognition
via digit span test
dopamine hypothesis
dopamine is at the bottom of positive symptoms (but barely for negative symptoms)
aberrant salience model
The “aberrant salience” model proposes that psychotic symptoms first emerge when chaotic brain dopamine transmission leads to the attribution of significance to stimuli that would normally be considered irrelevant.
dus: dopamine -> irrelevant stimuli become salient
being a migrant is a risk factor for schizophrenia
oke
urbanicity is also a risk factor for schizophrenia
oke
relationship to trauma
50-98% of schiz patients have a trauma
80% finds their psychotic episodes traumatic too
prevalence of comorbid ptsd = 16%
but 90% of case files do not mention PTSD, though it is
present
psychosis =
loss of contact with reality
voorbeeld van hoe mentalizing ontstaat
Develops in early childhood, environment-driven
➢ Deafness / deprivation impedes development
➢ Association found between hearing difficulties, trauma in
development, and later psychotic symptoms / disorders
kijken naar cognitive model van morrison et al
oke
social defeat hypothesis =
sense of social exclusion (migrants, deaf children) leads to dopamine sensitization -> increased risk of psychotic disorders
wat is de overlappende etiology
biopsychosocial model en diathesis stress model
wat voor treatment voor psychotic episodes
antipsychotics (maar hele heftige side effects, vooral motor skills (parkinsonism)
en psychosocial interventions?
psychotherapy kan enorm helpen
kijken naar het model van cognitive behavioural therapy
oke
wat voor treatment voor de trauma
treating trauma in psychosis TTIP
EMDR
wat doet de staging model
describes schizophrenia in stages
every stage is increased severity and duration
treatment is intended to avoid progression to the next stage
stage 1:
prodromal phase/at risk mental state
subclinical positive symptoms
present negative symptoms
functional deterioration
mood swings
indications of cognitive problems
stage 2:
first episode
positive symptoms
not very different from chronic phase
worsening cognitive symptoms
stage 3:
multiple episodes with stable phases or remission
progress is very different per person!
wat is de outcome van stage 3
incomplete remission of first episode
new episodes with less recovery
more relapse with further reduction in functioning
there are no indications of progressive
neurodegeneration until about 65 yrs old
oke
wat is de prognosis voor schizophrenia?
➢ Depends on your definition of recovery
➢ Symptom-free? Unlikely – 20 %
➢ Meaningful personal recovery: very possible
