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Psychopathology > Lecture 11 - Psychosis > Flashcards

Lecture 11 - Psychosis Flashcards

1
Q

Define psychosis

A
  • umbrella term
  • variety of syndromes + symptoms
  • at disorder level: group of disorders distinguished by configuration, duration, relative pervasiveness
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2
Q

What are the 5 key psychotic symptoms?

A
  • delusions
  • hallucinations
  • grossly disorganised or abnormal motor behaviour (incl. catatonia)
  • disorganised thought (speech)
  • negative sx
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3
Q

What are delusions? What are the 2 specifiers? What are the 6 types?

A
  • fixed beliefs, not amenable to chance in light of conflicting evidence
  • bizarre v. non-bizarre
  • primary v. secondary
  • PERSECUTORY: one is going to be harmed/harassed
  • REFERENTIAL: certain gestures/comments/environmental cues are directed at oneself
  • GRANDIOSE: exception abilities, wealth, fame
  • EROTOMANIC: falsely believe others are in love with them
  • NIHILISTIC: major catastrophe will occur
  • SOMATIC: preoccupations regarding health + organ function
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4
Q

What are hallucinations?

A
  • perception-like experiences that occur without an external stimulus
  • auditory most common (but can be any sense)
  • hallucinations may be a normal part of religious experience in certain cultural contexts
  • hearing voices network > normalising it in everyday life
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5
Q

Explain disorganised thought/speech

A
  • aka formal thought disorder

typically inferred from individual’s speech:

  • derailment or loose associations
  • tangentiality
  • incoherence or ‘word salad’
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6
Q

Explain disorganised or abnormal motor behaviour

A
  • manifest in a no. of ways (range from childlike silliness to unpredictable agitation)
  • catatonia: marked decrease in reactivity to the environment
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7
Q

Explain the negative symptoms of psychosis

A
  • DIMINISHED EMOTIONAL EXPRESSION: in face, eye contact, intonation of speech (prosody) + movements in hand, head and face that typically give emotional emphasis
  • AVOLITION: decreased motivation for self-initiated, purposeful activities
  • ALOGIA: diminished speech output
  • ANHEDONIA: decrease ability to experience pleasure
  • ASOCIALITY: lack interest in social interactions (may be associated with avolition, can also manifest limited opps for social interaction)
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8
Q

What is delusional disorder?

A
  • 1+ delusions
  • > 1 mth
  • specifiers: erotomantic, grandiose, jealous, persecutory, somatic, mixed, unspecified
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9
Q

What is brief psychotic disorder? What are the specifiers?

A
  • 1+ of delusions, hallucinations, disorganised speech, grossly disorganised behaviour
  • 1 day to 1 month, eventual full return to premorbid level of functioning
  • specifiers: without/with marked stressor, postpartum onset, catatonia
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10
Q

What is schizophreniform disorder? What are the specifiers?

A
  • 2+ of delusions, hallucinations, disorganised speech, grossly disorganised behaviour, -ve sx
  • 1-6mths
  • specifiers: with/without good prognostic features; catatonia
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11
Q

What is schizophrenia?

A
  • 2+ of delusions, hallucinations, disorganised speech, grossly disorganised behaviour, -ve sx
  • 6+ mths (1+mth of active sx)
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12
Q

What is schizoaffective disorder?

A
  • major mood episode (depression or mania) co-occurs with schizophrenia A criteria
  • delusions/hallucinations for >2wks without mood (but majority of time mood episode present)
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13
Q

What are the other DSM-5 psychotic disorders?

A
  • substance/medication induced psychotic disorder
  • psychotic disorder due to another medical condition

CATATONIA

  • catatonia associated w another mental dx
  • catatonia dx due to another medical condition
  • unspecified catatonia
  • other specified scz spectrum and other psychotic dx
  • unspecified scz spectrum and other psychotic dx
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14
Q

Explain the psychosis symptom severity ratings

A
  • scales for dimensional assessment of primary psychosis sx
  • captures variation in severity of sx which may help treatment planning, prognostic decision-making and research
  • for: hallucinations, delusions, -ve sx (facial expressibility, prosody, gestures, self-initiated behaviour)
  • scale:
  • 0: not present
  • 1: equivocal (severity/duration not sufficient to be considered psychosis)
  • 2: mild (little pressure to act upon H/D or not very bothered by H/D; mild -ve sx)
  • 3: moderate (some pressure to act upon H/D or somewhat bothered by H/D; mod -ve sx)
  • 4: severe (severe pressure to act upon H/D or very bothered by H/D; severe -ve sx)
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15
Q

What are the associated features of psychotic disorders?

A
  • depression
  • suicide (5-10% complete)
  • anxiety
  • PTSD (trauma may be experience of psychosis itself; may be associated with treatment - police, restraint, hospital etc.)
  • substance use
  • poor QOL (occupational, rship, social, emotional functioning)
  • stigma
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16
Q

What is the prev, gender split and onset of psychotic disorders?

A
  • lifetime prev: 1-2% schizophrenia, 0.2% delusions, 0.3% schizoaffective
  • higher in migrants, developing countries, urban
  • SCZ gender split 3:2 M:F
  • onset: peak late adolescence/early adulthood (women, also peak at menopause)
17
Q

What are the stages of the illness course of psychotic disorders? (6)

A 
premorbid
prodrome
acute
early recovery
late recovery
relapse
18
Q

Explain the premorbid phase

A
  • assessed retrospectively
  • social functioning deficits
  • premorbid adjustment scale
  • home movies study > poorer motor skills, more motor abnormalities
  • better premorbid hx: older age of onset, late age at first hospitalisation, later first neuroleptic use
19
Q

Explain the prodromal phase

A
  • retrospective
  • average: 2 years
  • non-specific changes followed by specific
  • can resolve! 65% don’t do on to develop psychosis
20
Q

Explain the acute phase

A
  • emergence of persistent +ve and -ve sx
  • duration untreated psychosis (DUP): longer DUP = longer time for treatment response
  • DUP influenced by health professionals + lacking help-seeking/resources + stigma
21
Q

Explain the early and late recovery phases

A

EARLY

  • few few mths post starting treatment
  • sig. of episode/illness may be considered
  • integration: into sense of self, accomodate illness > better outcome!
  • sealing-over: lack insight/integration > poorer outcomes

LATER

  • resume work/study
  • social reconnection
  • up to 80% FEP have relapse within 5yrs
  • 7yr follow up FEP: sx remission 37-50%; social/vocational recovery 31%; both 25%
22
Q

What are the risk factors for relapse? What does relapse not depend on?

A

RISK

  • substance use
  • medication non-adherence (due to stigma, dampening of motivational drives)
  • carer critical comments
  • poor premorbid adjustment
  • expressed emotion: families (conflict, criticism, hostile, over-involved)

DOESN’T MATTER

  • age of onset, gender, education, employment, marital status
  • insight, DUI, DUP
  • +ve/-ve/affective sx
23
Q

What is the impact of relapse/chronic illness?

A
  • unemployment
  • housing difficulties
  • poor physical health
  • side-effects of anti-psychotics
  • neglect children
24
Q

Explain the history of SCZ

A

KRAEPELIN: dementia praecox

  • deteriorating course, early onset
  • diff from manic depression (worse prognosis)
  • sx: hallucinations, delusions, negativism, attn. diffs, stereotypes, emo dysregulation

BLEULER: manic depression + SCZ on continuum

  • not necessarily early onset/deteriorating
  • sx: disturbed thought + affect, ambivalence, autism, avolition

SCNEIDER: first rank sx

  • hallucinations (somatic, voices of self/other)
  • thought withdrawal/insertion/broadcasting
  • delusional perception (ideas of reference)
  • made feelings/actions/impulses

1970s: varying rates, no standard criteria. Criteria made.

1980: DSM-III
- narrow (neo-Kraepelin) view
- inclusion, exclusion, duration
- impaired functioning
- 5 subtypes: paranoid, disorganised, catatonia, undifferentiated, residual

CURRENT

  • over-focus on chronic samples > representative of very poor outcomes + contaminated by institutions, med side-effects etc.
  • need to look more at FEP and prodrome
  • must study psychotic sx not SCZ as a construct
25
Q

Explain the aetiological models of psychosis

A

STRESS-VULNERABILTY
- diff predispositions, need diff levels of environmental factors to push us over

GENETICS

  • adoption studies, GxE interactions
  • risk increases as degree of genetic relatedness increases

NEUROTRANSMITTERS

  • DA hypothesis > excessive
  • drugs that reduce DA help; amphetamines release DA can can cause sx
  • BUT not high DA in scz patients > maybe overly sensitive receptors? maybe only associated with +ve sx?
  • also NE and 5HT

BRAIN STRUCTURE + FUNCTION

  • enlarged ventricles
  • smaller PFC + hippocampus
  • lower IQ and WM + worse exec functioning

FAMILY

  • discredited: schizophrenogenic mother (cold, overprotective, domineering, aloof etc)
  • communication deviance model: deviant communication patterns in fam (incoherent, confused, vague, incomplete verbal exchanges)

SOCIAL

  • urban environment
  • migration (minority group)
  • social exclusion
  • cannabis

CHILDHOOD TRAUMA
- sexual/physical abuse > often ignored in literature, but some suggest it may play a causal role

26
Q

Explain the cog model of psychosis

A
  • culturally unacceptable interpretations of intrusions into awareness
  • role of appraisal is central!!
  • interpretations result from fault sense of self/others > misattribute thought to external source
  • response increases likelihood of future intrusions: mood disturbance, physiological arousal, behavioural change, cognitive change
27
Q

What are the 2 tasks in UHR research?

A

1: accurate identification of young people at risk of psychosis
- fam hx, attenuated sx, BLIPS
- 6mths: 28% transitioned to scz; 37% at 12mths
- if no transition > high comorbidity + dev other dx

2: develop preventative interventions
- aim: reduce transition rates + reduce impact on functioning/delay psychosis
- psych interventions + omega-3 over anti-psychotics

Psychopathology (14 decks)

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