EXAM 3 - Psychotic Disorders Flashcards
Psychosis
gross departure from reality, which may include
Hallucinations
Sensory experiences in the absence of sensory input (e.g. hearing voices)
Delusions
Strong, inaccurate beliefs that persist in the face of evidence to the contrary
Schizophrenia
A pervasive type of psychosis characterized by disturbed thought, emotion, behavior
Psychosis: History Thinking
Emil Kraepelin – used the term dementia praecox to describe schizophrenic syndrome
Early subtypes of schizophrenia – Catatonia, hebephrenia and paranoia
Eugen Bleuler – introduced the term “schizophrenia”
“Splitting of the mind”
Psychosis: History Thinking
Bleuler’s 4 A’s (1857-1938)
Association (Thought disorder: loosening of associations where ideas have little connection to each other)
Affect (Decreased or inappropriate)
Ambivalence (Simultaneous opposite feelings)
Autism (Withdrawal from reality and illogical, fantasy-ruled thinking)
Positive (additive) Symptoms of Schizophrenia
Delusions Disorganized Speech Disorganized and bizarre behavior Hallucinations Unusual motor behavior
Negative Symptoms of Schizophrenia
Flat affect
Loss of energy
Loss of motivation
Loss of feelings of pleasure
Disorganized” Symptom Cluster
Confused or abnormal speech, behavior, and emotion
Nature of disorganized speech
Cognitive slippage – illogical and incoherent speech
Tangentiality – “going off on a tangent”
Loose associations – conversation in unrelated directions
Nature of disorganized affect
Inappropriate emotional behavior
Nature of disorganized behavior
Includes a variety of unusual behaviors
Catatonia
May be considered a psychotic spectrum disorder in its own right or, when occurring in the presence of schizophrenia, a symptom of schizophrenia
Subtypes of Schizophrenia: A Thing of the Past
Schizophrenia was previously divided in to subtypes based on content of psychosis
This is no longer the case in DSM-5, but outdated terms are still in partial use
Included paranoid, catatonic, residual (minor symptoms persist after past episode), disorganized (many disorganized symptoms) and undifferentiated
Former Subtypes of Schizophrenia in DSM-IV
Paranoid (Delusions of persecution or grandeur. May trust no one or be anxious or angry about supposed tormentors)
Disorganized (Incoherent speech and inappropriate, often silly, emotion. May be very withdrawn, have odd grimaces and mannerisms)
Catatonic (Bizarre physical movements, ranging from motionless stupor to violent hyperactivity, sometimes alternating)
Undifferentiated (Delusions, hallucinations, and incoherence, but doesn’t fit into any of the other subtypes)
Residual (Minor symptoms of schizophrenia lingering after a serious episode)
DSM-5 Diagnostic Criteria for Schizophrenia
A. Two or more of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3):
- Delusions.
- Hallucinations.
- Disorganized speech (e.g., frequent derailment or incoherence).
- Grossly disorganized or catatonic behavior. 5. Negative symptoms (i.e., diminished emotional expression or avolition).
B. For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning).
C. Continuous signs of the disturbance persist for at least 6 months.This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual percepptual experiences).
D.Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either 1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms: or 2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.
E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
F. If there is a history of autistic spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1 month (or less if successfully treated).
Specify if:
With catatonia
Incidence rate of Schizophrenia (1%)
Higher incidence rate for 1st degree relatives of individuals with schizophrenia, especially of parents and identical twins with schizophrenia
Schizophrenia: Statistics
Schizophrenia affects males and females about equally
Females tend to have a better long-term prognosis
Onset slightly earlier for males
The Course of Schizophrenia
Prodromal phase 85% experience 1-2 years before serious symptoms Less severe, yet unusual symptoms: Ideas of reference Magical thinking Illusions Isolation Marked impairment in functioning Lack of initiative, interests, or energy
Other Psychotic Disorders
Schizophreniform Disorder Schizoaffective Disorder (Bipolar or Depression types) Delusional Disorder Brief Psychotic Disorder Shared Psychotic Disorder (Folie A Deux)
Schizophreniform: DSM-5 Criteria
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Schizoaffective Disorder: DSM-5
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Schizoaffective disorder
Symptoms of schizophrenia + additional experience of a major mood episode (depressive or manic)
Psychotic symptoms must also occur outside the mood disturbance
Prognosis is similar for people with schizophrenia
Such persons do not tend to get better on their own
Delusional Disorder: DSM-5
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Catatonia
Unusual motor responses, particularly immobility or agitation, and odd mannerisms
Tends to be severe and quite rare
May be present in psychotic disorders or diagnosed alone, and may include:
Stupor, mutism, maintaining the same pose for hours
Opposition or lack of response to instructions
Repetitive, meaningless motor behaviors
Mimicking others’ speech or movement
Catatonia: DSM-5
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Psychotic Disorders Due to Other Causes
Psychosis may occur as the result of substance use, some medications and some medical conditions
Include:
Substance/medication-induced psychotic disorder
Psychotic disorder associated with another medical condition
Substance/Medication-Induced Psychotic Disorder
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Psychotic Disorder Associated with another Medical Condition
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Brief Psychotic Disorder
Positive symptoms of schizophrenia (e.g., hallucinations or delusions) or disorganized symptoms
Lasts less than 1 month
Briefest duration of all psychotic disorders
Typically precipitated by trauma or stress
Brief Psychotic Disorder: DSM-5
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Causes Etiology of Schizophrenia - Psychoanalytic Theory
Weak Ego
Breakdown of Defense Mechanisms
No evidence
Causes Etiology of Schizophrenia - Neofreudians
Parent-child relations that are hostile and results in anxiety
The individual, therefore, withdraws from reality and people
No evidence
Causes Etiology of Schizophrenia - Family Theories
Fromm-Reichman’s “schizophrenogenic mother” (double-bind communication)
No evidence
Causes Etiology of Schizophrenia - Existential Theory (R.D. Laing’s “Sanity, Madness and the Family”)
The False self has been stripped away
Psychosis is a break through toward the search for the authentic self
No evidence
Causes Etiology of Schizophrenia - Biological Theories
Genetic predisposition is evident
Higher concordance of schizophrenia in monozygotic twins than dizygotic twins
Gottesman & Shield (1972) found a concordance rate of 42% in MZ twins and 9% in DZ twins
This has been replicated several times
Adoption studies confirm genetic evidence
Multiple genes have been associated with schizophrenia and 3 genes in particular are implicated as risk factors (Sections of Chromosome 8 (NRG1), Chromosome 6 (DTNBP1), and Chromosome 22 (COMT). COMT plays a role in Dopamine metabolism, which is disrupted in schizophrenia.
Causes Etiology of Schizophrenia - Neurochemical Studies focus on dopamine
Neuroleptics block dopamine receptors and reduce the positive symptoms
Amphetamines at high doses can induce a psychotic-like state (they increase available dopamine)
There may be abnormalities in the migration of neurons in utero development during the 2nd trimester of pregnancy
Etiology of Schizophrenia
Recent PET scan study indicates that a tiny variation in a gene that makes the enzyme COMT may put individuals at risk for schizophrenia (Chromosome 22)
COMT breaks down dopamine
Dopamine and dopamine receptor sites are affected by antipsychotic medications thus the role of COMT is very important
Likely impacts communication among neurons
Biological Theories - Neuroanatomy (Abnormalities)
Prefrontal Cortex is likely involved
Hippocampus (temporal lobe); smaller neurons
Enlarged ventricles in some patients
Changes in the organization of the nerve cells
Possibly higher incidence of maternal flu during the second trimester of pregnancy (weak evidence)
Other Neurobiological Influences
Marijuana use also increases the risk for developing schizophrenia in at-risk individuals
Conclusions about neurobiology and schizophrenia
Schizophrenia reflects diffuse neurobiological dysregulation
Structural and functional brain abnormalities
Not unique to schizophrenia
Medications Used To Treat Schizophrenia
Older (“first generation”) antipsychotics (neuroleptics)
Thorazine the first FDA approved antipsychotic (mid 1950’s)
Haldol, Navane
Had a lot of side effects (ex., tardive dyskinesia)
Medications Used to Treat Schizophrenia
Atypical antipsychotics
Act on different dopamine receptor sites than the first generation antipsychotics, and also affect other neurotransmitters to varying degrees
Help 30% of patients who were nonresponsive to older antipsychotics
Cozaril, Risperidal, Seroqual, Zyprexa, Geodon, Abilify, Latuda
Fewer side effects too (especially Geodon and Abilify)
Integrative Treatment
Medication
Psychosocial Rehabilitation
Psychosocial Support
