DSM5 - schizophrenia and other psychotic disorders Flashcards
delusions
fixed beliefs that are not amenable to change in light of conflicting evidence. Their content may include a variety of themes
persecutory, referential, somatic, religious, grandiose
persecutory delusions
belief that one is going to be harmed, harassed, and so forth by an individual, organisation or other group\
most common delusions
referential delusions
belief that certain gestures, comments, environmental cues, and so forth are directed at oneself eg. the people on the tv are talking directly to me
also common
grandiose delusions
when an individual believes that he or she has exceptional abilities, wealth, or fame
erotomanic delusion
when an individual believes falsely that another person is in love with him or her
nihilistic delusions
involve the convictions that a major catastrophe will occur
somatic delusions
preoccupation regarding health and organ function
delusions that express a loss of control over mind or body
the belief that one’s thoughts have been “removed” by some outside force (thought withdrawal),
that alien thoughts have been put into one’s mind (thought insertion),
or that one’s body or actions are being acted on or manipulated by some outside force (delusions of control)
bizarre delusions
Delusions are deemed bizarre if they are clearly implausible and not understandable to same-culture peers and do not derive from ordinary life experiences
Delusions that express a loss of control over mind or body are generally considered to be bizarre
non-bizarre delusion
An example of a nonbizarre delusion is the belief that one is under surveillance by the police, despite a lack of convincing evidence
what differentiates a strongly held belief from a delusion
depends in part on the degree of conviction with which the belief is held despite clear or reasonable contradictory evidence regarding its veracity.
how to differentiate persecutory delusions from post-traumatic symptoms
Individuals who have experienced torture, political violence, or discrimination - these may represent instead intense fears of recurrence or posttraumatic symptoms.
A careful evaluation of whether the person’s fears are justified given the nature of the trauma can help to differentiate appropriate fears from persecutory delusions.
hallucinations
perception-like experiences that occur without an external stimulus.
They are vivid and clear, with the full force and impact of normal perceptions, and not under voluntary control.
which type of hallucination is most common in schizophrenia and related disorders
They may occur in any sensory modality, but auditory hallucinations are the most common in schizophrenia and related disorders.
how are auditory hallucinations usually experienced
Auditory hallucinations are usually experienced as voices, whether familiar or unfamiliar, that are perceived as distinct from the individual’s own thoughts.
to be considered auditory hallucinations, they must occur in the context of
a clear sensorium; those that occur while falling asleep (hypnagogic) or waking up (hypnopompic) are considered to be within the range of normal experience.
when an individual switches from one topic to another
derailment or loose associations
answers to questions are loosely related or completely unrelated
tangentiality
speech is so severely disorganized that it is nearly incomprehensible and resembles receptive aphasia in its linguistic disorganization
incoherence or ‘word salad’
glossolalia
speaking in tongues
some religious groups engage in this, difficult to differentiate from incoherence
possession trance
trance states in which personal identity is replaced by an external possessing identity
religious experience
glossolalia and possession trance are characterised as
disorganised speech
These instances do not represent signs of psychosis unless they are accompanied by other clearly psychotic symptoms. Less severe disorganized thinking or speech may occur during the prodromal and residual periods of schizophrenia.
catatonic behaviour
marked decrease in reactivity to the environment
types of catatonic behaviour
negativism - resistance to instructions
mutism and stupor - maintaining a rigid, inappropriate or bizarre posture; to a complete lack of verbal and motor responses
catatonic excitement - purposeless and excessive motor activity without obvious cause
which conditions does catatonia occur in
catatonia has historically been associated with schizophrenia, catatonic symptoms are nonspecific and may occur in other mental disorders (e.g., bipolar or depressive disorders with catatonia) and in medical conditions (catatonic disorder due to another medical condition)
negative symptoms in schizophrenia
two negative symptoms are particularly prominent in schizophrenia: diminished emotional expression and avolition
diminished emotional expression
Diminished emotional expression includes reductions in the expression of emotions in the face, eye contact, intonation of speech (prosody), and movements of the hand, head, and face that normally give an emotional emphasis to speech
avolition
Avolition is a decrease in motivated self-initiated purposeful activities. The individual may sit for long periods of time and show little interest in participating in work or social activities
other negative symptoms in schizophrenia
alogia, anhedonia, and asociality
alogia
diminished speech output
anhedonia
decreased ability to experience pleasure
asociality
the apparent lack of interest in social interactions and may be associated with avolition, but it can also be a manifestation of limited opportunities for social interactions
Schizotypal personality disorder
The diagnosis schizotypal personality disorder captures a pervasive pattern of social and interpersonal deficits, including reduced capacity for close relationships; cognitive or perceptual distortions; and eccentricities of behavior, usually beginning by early adulthood but in some cases first becoming apparent in childhood and adolescence. Abnormalities of beliefs, thinking, and perception are below the threshold for the diagnosis of a psychotic disorder.
schizophrenia vs. schizoaffective
Schizophrenia lasts for at least 6 months and includes at least 1 month of active-phase symptoms. In schizoaffective disorder, a mood episode and the active-phase symptoms of schizophrenia occur together and were preceded or are followed by at least 2 weeks of delusions or hallucinations without prominent mood symptoms.
psychotic disorders
may be induced by substances, medications, toxins, and other medical conditions. In substance/medication-induced psychotic disorder, the psychotic symptoms are judged to be a direct physiological consequence of a drug of abuse, a medication, or toxin exposure and cease after removal of the agent. In psychotic disorder due to another medical condition, the psychotic symptoms are judged to be a direct physiological consequence of another medical condition.
types of delusions
erotomanic type
grandiose type
jealous type
persecutory type
somatic type
mixed type
unspecified type
