psychosis Flashcards
1
Q
prodromal symptoms
A
- emerging symptoms that come before the first psychotic episode
- person might go through some behavioural and cognitive symptoms that then progress into psychotic symptoms
- symptoms: social isolation, lack of motivation, anxiety, irritability, difficulty concentrating, changes to one’s normal routine, sleep problems, neglecting personal hygiene, possible erratic behaviour
- 75% of people with schizophrenia will go through this phase
2
Q
active symptoms
A
- intense delusions, hallucinations, fully disorganized speech, etc.
- florid symptoms
3
Q
residual symptoms
A
- symptoms that remain after a full psychotic episode
- fewer or less severe than active stage
- typically no positive (added) symptoms of schizophrenia
- negative symptoms, like lack of motivation, low energy, depressed mood, social isolation, trouble concentrating, trouble planning/participating in activities
4
Q
positive psychosis symptoms
A
- hallucinations
- delusions
5
Q
hallucinations
A
- experience of sensory events without input from external reality
- auditory: voices, sounds, commands
- visual: shadows or ghost-like images
6
Q
delusions
A
- incredibly strong held beliefs that appear irrational to any reasonable person
- subtypes: grandeur, persecutory, erotomatic, jealous, somatic, capgras syndrome
7
Q
grandeur (delusion subtype)
A
having a great talent or insight, or making some discovery
8
Q
persecutory (delusion subtype)
A
being cheated on, spied on, poisoned, harassed or obstructed
9
Q
jealous (delusion subtype)
A
lover/spouse is unfaithful
10
Q
erotomatic (delusion subtype)
A
- someone else loves you
- ie. a celebrity
11
Q
somatic (delusional subtype)
A
- involving bodily functions/sensations
- ie. that there is something wrong with their body
- you’ll see them going to lots of physicians or getting lots of work done
- can lead to tactile hallucinations
12
Q
capgras syndrome
A
belief that everyone around you has been replaced by an imposter
13
Q
disorganized symptoms of psychosis
A
- disorganized speech
- inappropriate affect
- grossly (largely) disorganized behaviour
- catatonia
14
Q
disorganized speech
A
- when a person jumps from topic to topic
- tangential speech: individual may start to respond to a question and then start going on tangents
- loose associations: some connections a person makes during various statements have some minimal, but logical associations with the topics
15
Q
inappropriate affect
A
- emotions do not match the context
- ie. laughing at inappropriate situations like a funeral
16
Q
grossly (largely) disorganized behaviour
A
- childish/silly behaviour
- unpredictable agitation
- hoarding and collecting odd items
17
Q
catatonia
A
- wavy flexibility: where an individual can contort/be contorted into uncomfortable positions and can stay there for hours
- pacing, stereotyped behaviours: like what you would see in depression; repetitive behaviours
18
Q
negative symptoms (wednesday adams)
A
- avolition: little interest in daily functioning, including hygiene
- alogia: little use of speech, brief speech, little interest in conversations
- anhedonia: little interest in pleasurable activities (ie. eating, social interactions, sex)
- affective flattening: lack of emotional expression, still feels them but to a lesser degree
- asociality: little interest in socializing, poor social skills
19
Q
schizophrenia
A
- criteria A: two or more of the symptoms during a one month period, unless treatment is provided
- symptoms: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behaviour, negative symptoms
- at least one of the first three
20
Q
schizophrenia con’t
A
- deteriorated level of functioning below before onset
- continuous signs of the disorder must be present for at least 6 months either in the prodromal, active or residual states (minimum one month of psychosis included)
- life prevalence: 0.3-0.1%
- rates equal for men and women
20
Q
schizoaffective disorder
A
- active psychosis (criteria A) concurrent with mood episode (mania or MDE)
- hallucinations/delusions must have occurred outside of mood episodes during a 2 week period
- mood episodes occur throughout the majority of the active and residual periods
- lifetime prevalence: 0.3%
- women more likely to be diagnosed because more like to have depression
- with schizoaffective, outside psychosis you will see mood disturbance vs schizophrenia, you will see negative symptoms
21
Q
schizophreniform disorder
A
- active psychosis (criteria A) for at least one month
- deterioration in functioning lasts less than 6 months
- provisional “pre” diagnosis
- 2/3 people will be diagnosed with schizophrenia or schizoaffective
- equal rates in men and women
- lower rates in developed countries compared to developing countries
22
Q
brief psychotic disorder
A
- one or more of the symptoms for at least 1 day, but for less than a month: delusions, hallucinations, disorganized speech
- may also experience catatonia
- diagnosis can only after the symptoms have evaded because it may be an early manifestation of another disorder
- rates twice as common in men and developing countries
- lifetime prevalence: 0.1-0.5%
22
Q
delusional disorder
A
- must experience (one or more) delusions for one month or longer
- apart from the impact of the delusions, functioning is not impaired and behaviour is not odd
- does not meet criteria for schizophrenia, though hallucinations may be present (must fit the theme of the delusion but are not prominent)
22
psychological etiology of psychosis
- stress
- families
22
stress
- stressful events can precede relapse
- psychosis also leads to a slow decline in their socioeconomic status which adds stress
- social support from non-family members improves outcomes
22
families
- may see symptoms as intentional
- families with high levels of expressed emotion (criticism, animosity and intrusiveness) is related to increased relapse rates of schizophrenia
- interaction with culture/ethnicity
- in latin american families, criticism did not seem to affect relapse rates but lack of warmth did
- in african american families, expressed emotion seemed to decrease relapse rates
22
psychological historical treatments of psychosis
- psychoanalytic/psychodynamic
- token economy
23
psychoanalytic/psychodynamic
- have historically been harmful
- schizophrenogenic mothers: individuals with schizophrenia were believed to develop it because they had moms characterized as being cold, overprotective and rejecting
- can produce a lot of guilt
24
token economy
- formerly used in psychiatric hospitals
- individuals given rewards for positive behaviours or removing things as a form of punishment
- ie. giving patients cigarettes for appropriate behaviour
25
psychological modern treatments of psychosis
- community resources
- clinicians
- first episode clinics
26
community resources
- getting people involved with sources like support groups or recreational therapist
27
clinicians
- helps clients detect relapse, manage medications, and deal with stress
- deconstruct complex social skills which are modelled
- a lot of positive effects seem to fade
- earlier intervention can impact the course of the disorder over time
28
first episode clinics
- targets those who have experienced their first active phase episode
- connect with support systems and community resources
- prescribe correct medications, offer therapy
- provide them with psychoeducation of the disorder
29
behavioural family therapy for psychosis
- classroom-type psychoeducation for family members
- may include some training in expressed emotion
- effective in the short-term
- does not appear to work once family members leave the program
30
beck's CBT for psychosis
- targets negative symptoms along the same lines as CBT for depression
- targets positive symptoms with very gentle questioning of beliefs with evidence
- provides a sense of self-control
- can lead to significant improvements that appear to last
31
onset of psychosis
- late teens to late twenties
- early 20s for men and late 20s for women
- 20% of people diagnosed tend to do okay
- men tend to have worst outcomes
- no prevalence cross culturally but members of minority groups tend to be forced into hospitalization and injected against their own will
32
a neurodegenerative disorder theory of psychosis
- not supported by research
- most have moderate to severe levels of impairment throughout their life
33
genetic contribution of psychosis (family studies)
- ie. if a parent has a severe form of schizophrenia, then the child is predisposed to developing psychosis disorders generally
34
genetic contribution of psychosis (twin studies)
- twins are at highest risk (identical)
- fraternal twins compared to siblings have an increased risk because of in-utero shared environment
35
genetic contribution to psychosis (adoption studies
- if an individual had biological parents with schizophrenia but are adopted into a healthy environment, it may delay the onset and severity of the disorder but does not prevent it
36
genetic contribution to psychosis (genes and cannabis)
- use of marijuana during teen years can increase the chances of onset within a specific group of individuals with specific genetic profiles
37
biological model of psychosis (dopamine)
- age-related decreases in positive symptoms = age-related increases in dopamine
- excess stimulation of D2 receptor sites are located in the basal ganglia (overstimulation) is related to both the positive and disorganized symptoms of schizophrenia
- understimulation of the D1 receptor sites in the limbic system (responsible for emotional regulation) associated with negative symptoms of schizophrenia
38
biological model of psychosis (glutamate)
- under stimulation of NMDA receptor sites
- possibly related to both positive and negative symptoms of schizophrenia
- PCP and ketamine are considered NMDA antagonists so they block glutamate = experiencing brief psychosis
39
biological model of psychosis (brain structure)
- enlarged ventricles (found in the brain of schizophrenic individuals)
- decreased frontal lobe activity, especially with negative symptoms (50% of schizophrenic individuals)
- 22q deletion syndrome
40
biological model of psychosis (viral infection)
- 2nd trimester of prenatal influenza
41
biological treatment of psychosis (conventional antipsychotics)
- works for 60%-70% of clients
- can cause severe side effects: extra-pyramidal symptoms: tardive dyskinesia (involuntary movements), grogginess, weight gain, sexual issues, blurred vision
42
biological treatment of psychosis (newer antipsychotics)
- clozapine and risperidone now common
- fewer side effects, work well, if not better
- may work on both positive AND negative symptoms
