Module 5: Psychosis, schizophrenia, and bipolar disorders Flashcards
\What are positive symptoms?
Delusions and hallucinations
Disordered thought and speech, loose associations of ideas, disjointed concepts, trailing off sentences, confusing,
Can still speak normally, but do not pick up on somatic ques
disordered/abnormal motor behaviour - behaviours are not culturally normative
What are negative symptoms?
a decline in normal functioning - the 4 As of psychosis
Affective flattening (monotonous tone and immobile facial expressions
Anhedonia - lack of response to pleasurable events
Alogia (speech poverty, reduction in the quality or quantity of speech
Avolition (loss of drive, difficulty keeping plans)
Social withdrawal
What are the 4 A’s in psychosis negative symptoms?
- Affective flattening
- Anhedonia
- Alogia (speech poverty)
- Avolition (loss of drive/difficulty keeping plans)
What is the most common types of hallucinations in order?
“a perception like experience with the clarity and impact of a true perception but without the external stimulation of the relevant sensory organ”
- auditory
- visual
- olfactory
How common are hallucinations in the general population?
LP = 7.3% in nonclinical population, most often auditory and disappear with time, only a small percentage seek help for auditory hallucinations
Since auditory hallucinations are common in nonclinical populations, would schizophrenia be better understood with a dimensional approach?
What is the meta-cognitive theory about hallucinations?
people with schizophrenia struggle thinking about thinking,
cannot to take mental events and integrate into larger representations,
difficulty understanding mental events
What suggests a dysfunction with perception might be at play in hallucinations?
neuroimaging studies show altered activation in brain with speech sounds and production, suggesting alternates in auditory pathways in brain that may contribute to auditory hallucinations
What is the theory of misattribution from the internal forward model on hallucinations?
- when the brain goes to produce a motor action: 1) a motor command is generated to produce the movement and an efference copy, which is a prediction of the outcome of the movement
a) If the prediction of the motor is aligned with what then occurs in reality - then the two processes cancel out and perception occurs as normal
b) If there is a misalignment between the prediction and the generation of motor function - it may cause hallucinations, the perception of something seemingly external
What are delusions?
“A firmly held false belief based on something incorrect about reality despite what almost everyone else beliefs and despite usually obvious proof or evidence to the contrary”
Bizarre vs. non bizarre delusions?
Bizarre - clearly illogical based on the individuals cultural context
Non-bizarre - not necessarily illogical based on individuals cultural context
Types of delusions?
- Persecutory - paranoid delusions, individual fears harm MOST COMMON
- Referential - ideas of reference taking trivial/unimportant events and frames them of being of personal significance
Grandiose - delusions of power and superiority, wealth, fame, importance
Somatic - delusions that one’s body is grossly abnormal, diseased or infected with something toxic
Religious - religious theme and common in schizophrenia, common with cross over with delusions of grandeur, not socially acceptable
Thought alienation - belief that their thoughts have been inserted into their head (insertion) or taken away (withdrawal)
Broadcasting - belief that one’s thoughts are being broadcasted/transmitted to others
External - belief that someone else is in control of their thinking and behaviour, eg. a radio transmitter tower controlling their thoughts and actions
Misidentification - belief that people around oneself have been replaced by imposters
Schizophrenia prevalence, gender and onset?
“Un umbrella term for complex syndrome with cognitive, perceptual, behavioural, language and emotional dysfunctions”
LP = 1-2% in general population
3:2 male to women, disproportionately affecting men
Onset = Early adulthood
What is criteria A for schizophrenia?
A. Two or more of following symptoms for a significant portion of one month period, at least 1, 2 or 3
1. Delusions
2. Hallucinations
3. Disorganised speech
4. Grossly disorganised / catatonic
5. Negative symptoms (diminished emotional expression or evolution, overlap with depression)
What is criteria B and C?
B. for a significant portion of time since the onset, level of function is markedly below the level achieved prior to the onset
C. Continuous sign of disturbance persisting at least 6 months (can be diagnosed with other psychotic disorders if it hasn’t been 6 months yet)
What if patient has a history of autism in a diagnosis of schizophrenia?
Criteria F. If there is a history of autism or communication disorder of childhood onset, a diagnosis of schizophrenia can only be made if there are prominent delusions or hallucinations, as well as other schizophrenic symptoms, that have lasted at least one month
What other things do you need to rule out for a diagnosis of schizophrenia?
D. Schizoaffective disorder, depressive and bipolar disorder with psychotic features have been ruled out because:
No major depressive or manic episodes have occurred
Mood episodes that have occurred have only been there for a small about of time
E. not attributed to physiological effects of a substance or other medical condition
When do you put specifiers for schizophrenia?
(after diagnosis, beyond the length of a year) - to describe level of severity
What is first vs. multiple episode?
Number of instances of psychotic symptoms experienced
First episode (acute, partial or full remission) OR
Multiple episode (acute, partial or full remission)
What is acute, partial or full remission?
Acute = Any time period in which the symptom criteria are fulfilled
Partial = after episode, when criteria are only partially fulfilled (getting better)
Full = after episode, when criteria are not fulfilled /no symptoms are present (feel completely fine / symptom free)
