Lecture 21 - Schizophrenia Spectrum and Other Psychotic Disorders Flashcards
What are positive psychotic symptoms?
Symptoms that ‘add’ to the individual’s experience of the world, e.g. hallucinations, delusions.
What are negative psychotic symptoms?
Symptoms that ‘take away’ from an individual’s experience, e.g. anhedonia, emotional blunting, confusion.
What do hallucination symptoms involve?
Perception-like experiences that occur in the absence of external stimuli. They must be vivid, clear and not under control. Auditory are the most common.
What do delusion symptoms involve?
False firmly held beliefs despite contrary evidence, and these beliefs are not socially accepted. Categorised based on content and bizareness.
What does thought disorder involve?
Disturbances in the flow and/or form of speech (not content). Can be either negative (poverty of speech) or positive (derailment) manifestations.
What does disorganised behaviour involve?
Grossly disorganised and abnormal motor behaviour, similar to childlike behaviour. Resistant to instruction, immobility and excessive purposeless activity are present (reduced with medication).
What are the four stages of psychotic disorder development?
- Prodromal phase: symptoms begin to develop over two years.
- Acute phase: year(s) between onset of symptoms and treatment.
- Early recovery phase: begin treatment. Improvement of symptoms but depression/anxiety may develop.
- Late recovery phase: re-integrated back into society but there is a 80-90% relapse rate in 3-5 years time.
List the various biological/etiological vulnerabilities/factors associated with psychotic disorders (5).
- Genetics: some degree of heritability.
- Biochemical factors: oversensitive dopamine receptors.
- Neuroanatomy: enlarged ventricles, tissue loss in PFC and smaller hippocampus than control. Appear to predate onset and worsen over time.
- Birth trauma and maternal viral infections: influenza, nutritional deficiencies, etc.
- Increased risk in urban environments and in winter/spring.
What medical treatments are available to psychotic disorders?
Neuroleptic medication, which blocks D2 and D3 dopamine receptors. Significant side effects (sedation, weight gain, heart disease) which makes compliance difficult. Side effects are treated with Parkinson’s medication.
What is the aim of CBT?
Patients are taught to notice early warning signs, understand the relationship between thoughts, feelings and behaviours, cope with symptoms/stress, evaluate evidence supporting delusional beliefs vs. alternative beliefs, and learn to attribute inner experiences as voices and not external ones.
How effective is CBT?
Reduced relapse, hospitalisation, symptom occurrence/severity, improved social functioning and these were maintained at two year follow up.
Overall, how effective are treatments of psychotic disorders?
60% of patients’ positive symptoms remit but negative symptoms persist (with medication). 10-20% do not improve with meds and relapse at one year is high (40%). Psychological interventions are more about coping with the symptoms.
