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Psychosis Flashcards

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1
Q

Define psychosis

A

a state in which thought and emotions are so impaired that contact is lost with external reality.

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2
Q

What did the DSM five change in the diagnosis psychosis.

A
  • Moved away from the single overriding diagnostic category (e.g. schizophrenia) split into a number of subtypes (paranoid, disorganised, catatonic, undifferentiated)
  • Now list a number of separate psychotic disorders that range across the spectrum depending on severity, duration and complexity symptoms
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3
Q

What is the main diagnostic categories in the DSM five?

A
  1. Schizophrenia
  2. Schizotypal personality disorder
  3. Delusional disorder
  4. Brief psychotic disorder
  5. Schizoaffective disorder
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4
Q

What are the positive symptoms of psychosis (define what they refer to)

A
  • Reflect an excess or distortions of normal functions
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5
Q

What are the main types of positive symptoms in psychosis?

A
  1. Delusions
  2. Hallucinations
  3. Disorganised thinking (speech)
  4. Grossly disorganised or abnormal motor behaviour
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6
Q

What do negative symptoms refer to in psychosis?

A

Negative symptoms reflect diminution loss or loss of normal functions

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7
Q

What negative symptoms associated with psychosis?

A
  1. Diminished emotional expression -reduction in facial expressions, lack of eye movement, poor voice information, lack of head movement
  2. Avolition - and inability to carry out normal day-to-day goal orientated activities
  3. Alogia - lack of verbal fluency in which individual give brief empty replies
  4. Anhendonia - inability to react to enjoyable or pleasurable events
  5. Asociality - lack of interest in social interaction
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8
Q

What are delusions?

A
  • Firmly held but erronous beliefs
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9
Q

Name six types of delusions?

A
  1. Persecutory delusions(Paranoia)-belief is being spied on
  2. Grandiose delusions- Believe they have fame or power
  3. Delusions of control - believes thoughts, feelings or actions are controlled by external forces
  4. Delusions of reference - Believe the independent external events are making specific reference to them
  5. Nihilistic delusions -Believe some aspect is either the world on himself has ceased to exist
  6. estromanicc delusions - believes that another person is in love with him or her
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10
Q

What are hallucinations?

A

A sensory experience in which someone can sense something that isn’t there!

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11
Q

What are the common features of disorganised thinking?

A
  • derailment - individuals may drift from topic to topic
  • tangential answers - rather than relevant
  • clanging - speech pattern where speech is driven by word sound
  • neologisms
  • poverty of content
  • word salads

this suggests that psychotic people have difficulty with:

  • inhibiting associations between thoughts and tone
  • difficulty understanding the full content of conversations
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12
Q

What does the disorganized speech suggest about people with schizophrenia?

A

they have difficulty inhibiting associations between thoughts and have difficulty understanding the full context of conversations

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13
Q

Describe the grossly disorganized behaviors in schizophrenia.

A
  • Childlike -silly or inappropriate
  • Unpredictable or agitated
  • Difficulty completing goal-directed activities
  • Catatonia ( decrease in reactivity to environment)
    • catatonic rigidity = maintaining rigid or immobile postures
    • catatonic negativism = resisting attempts to be moved
    • catatonic excitement = purposeless and excessive motor activity consisting of stereotyped movements
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14
Q

what are the diagnostic criteria for delusional disorder.

A
  1. One or more delusions lasting at least one month
  2. Apart from the impact of delusions, normal functioning is not impaired and behavior is not bizarre
  3. Any manic episodes have been brief in relation to the delusional episode
  4. The disorder is not attributable to substance use, medication or another mental disorder
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15
Q

What is the diagnostic criteria for brief psychotic disorder?

A
  • Presence of at least one of the following:
  1. delusions
  2. hallucinations
  3. disorganised speech
  4. highly disorganised or catatonic behaviour
  • the distubances last between one day and one month with eventual return of normal function
  • continuous signs of disturbances that last for at least 6 months
  • the disorder is not attrubutable to substances or by other. medical conditions
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16
Q

what is the diagostic criteria for schizophrenia?

A
  • At least 2 of the following must be present for longer than one month
    • delusions
    • hallucinations
    • disorganised speech
    • highly disorganised catatonic behaviours
  • diminished ability to function in one or more areas such as work, self-care, interpersonal relationships
  • disorder not better attributed to other medical conditions or substances use.
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17
Q

what is the diagnostic critera for schizo-affective disorder?

A
  • A continuous period of illness during which there is a major mood episode (depressive or manic)
  • Delusions or hallucinations for more than 2 weeks without the occurrence of a major mood episode.
  • symptoms for major mood episode are present for the majority of the duration of the illness
  • the disorder is not attributable to the use of a substance or medication and is not better explained by other mental disorders
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18
Q

what is the diagnostic criteria for bipolar disorder?

A

There are two types of bipolar disorder ( Bipolar 1 and bipolar 2)

bipolar 1 - characterised by

  • Prevalence or history of at least one manic episode - The manic episodes have been preceded by and may be followed by hypomanic or major depressive episodes
  • symptoms are not better accounted for by schizoaffective disorder or other disorders.

bipolar 2

  • presence or history of at least one major depressive episode
  • presence or history of at least one hypomanic episode
  • symptoms are not better accounted for by schizoaffective disorder
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19
Q

what are the problems with the diagnoses of psychotic disorders?

A
  • They are not reliable or valid
    • There is disagreement between clinicians
    • Symptoms don’t always cluster together
    • Does not predict the course or prognosis
    • Does not predict the response to particular treatments
  • Tells us nothing about the cause or nature of the problem

But some people find they’re helpful to simplify communication and others find them reassuring.

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20
Q

what is the alternative to diagnosis?

A

The individual symptom-focused approach (Bentall)

He argues that we cannot define madness as an illness to be cured like any other; that labels such as schizophrenia are meaningless; based on old classifications; and that the experiences such as delusions and madness are foibles to which we are all vulnerable.

Bentall argues for a radically new way of thinking about psychiatric problems. One that does not reduce madness to brain chemicals but to human nature.
He thinks “We should abandon psychiatric diagnoses altogether and instead try to explain and understand the actual experiences and behaviours of psychotic people.

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21
Q

what is the prevalence of psychotic disorders?

A
  • Lifetime prevalence for schizophrenia = 0.3-0.7%
  • mostly aged 15-35
  • mortality rate is 50% higher than normal
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22
Q

describe the stages involved in schizophrenia.

A
  1. Prodromal stage - onset of schizophrenia
  2. Active stage - characterized by the unambiguous symptoms of schizophrenia
  3. Residual stage - gradual recovery but still have symptoms for a long time
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23
Q

What is the dithesis-stress model relating to psychotic disorders?

A
  • Psychosis is thought to be caused by a combination of genetically inherited biological diathesis and environmental stress.

Stress may include early rearing factors (Schiffman et al 2001), dysfunctional relationships with family (Bateson 1978) an inability to cope with stresses of normal adolescent development (harrop & trower 2001) or educational or word demands.

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24
Q

What are the biological causes of psychosis?

A
  • genetic factors
  • molecular genetic factors
  • brain neuro transmitters
  • brain size and abnormalities
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25
Q

what are persecutory delusions?

A

(or paranoia) is the belief that the person is being spied on

26
Q

What are grandiose delusions?

A

belief that they have fame or power

27
Q

what are delusions of control?

A

belief that their thoughts, feelings or actions are controlled by an external force

28
Q

what are delusions of reference?

A

the belief that independent external events are making reference to them

29
Q

What are nihilistic delusions?

A

belief that some aspect of their world or themselves ceases to exist

30
Q

What are estomanic delusions

A

The belief that someone is in love with them.

31
Q

Describe the prodromal stage of schizophrenia

A
  • slow deterioration from normal functioning
  • this deterioration lasts on average 5 years
  • Exhibited as:
    • withdrawal from normal functioning and social interaction
    • shallow or inappropriate emotions
    • deterioration in physical care
    • deterioration in educational performance
32
Q

describe the active stage of schizophrenia.

A

Individual shows unambiguous symptoms of psychosis which may manifest as delusions, hallucinations, disordered speech and communication and a range of full-blown symptoms

33
Q

Describe the residual stage of schizophrenia

A

Recovery= gradual but many still retain symptomatology over the longer term

Stage reached when the individual ceases to show prominent signs of positive symptoms (such as delusions, hallucinations, disordered speech) but may still exhibit negative symptoms (e.g blunted affect, social withdrawal)

28% of sufferers will remit after one or more active stage, 22% will continue to show positive symptoms over the longer term , 50% will alternate between active and residual stages (Wiersma et al 1998)

Relapse can be traced to either…

Stressful life event or return to stressful family environment

Non-adherence to medication (40-50% fail to adhere to meds - Lacro et al 2002)

34
Q

Describe the evidence for the genetic componet of schizophrenia

A

Concordance studies (Gottesman et al 1987) found 44% MZ twins Dz twins only 12%- makes schizophrenia one of the most heritable of psychiatric disorders

First degree relative 10X more likely to develop psychotic symptoms than someone who has without. (Schneider & Deldin 2001)

Adoption studies = Heston (1966) compared 47 adaopted children who were reared apart from their schizophrenia biological mothers- symptoms of psychosis in 16.6% of the children found.

Genetic overlaps between schizophrenia and other psychiatric disorders such as bipolar and autism found- suggesting variation in a specific gene or set of genes may affect the development of these different diagnosis (Gejman et al 2011)

Also provide support for diathesis stress model.

35
Q

Describe the evidence for biochemical theory of schizophrenia

A
  • dopamine hypothesis- argues that symptoms of schizophrenia are importantly related to excess activity of the neurotransmitter dopamine.
  • Anti-psychotic drugs= alleviated positive symptoms by reducing dopamine activity but lead to muscle tremors.
  • Excessive dopamine= leads to many of the symptoms of psychosis. (when parkinsons patients given L-dopa to raise dopamine levels- experienced psychosis.
  • Amphetamines = produce disturbed behaviour by increasing dopamine levels
  • Brain imaging studies show that individuals diaognosed with schizophrenia show excessive levels of dopamine released from areas of the brain such as the basal ganglia. (Carlsson 2001)
  • Post-mortom- found increased levels of dopamine and more dopamine receptors in schizophrenic brains-especially in the limbic area.
  • Excess of dopamine receptors only seems to be related to the positive symptoms associated with schizophrenia- consistent with the fact that anti-psychotic drugs only appear to attenuate positive symptoms and have little or no effect on negative symptoms. Affect localized in the mesolimbic dopamine pathway
  • Mesocortical pathway may be linked to the negative symptoms- dopamine neurons I nthe prefrontal cortex may be underactive.
36
Q

Describe the evidence for brain abnormalities in schizophrenia

A

Number of structural differences that appear to continue to develop throughout the lifetime of the individual suggesting a causal role in symptoms rather than simply a consequence.

  • Brain appear to be smaller- schizophrenia associated with enlarged ventricles (areas in the brian containing cerebrospinal fluid) – found in patients with first psychotic episode – cause not consequence?
  • Reduced volume of grey matter in the prefrontal cortex (Buchanan et al 1998) – area that plays important role in cognitive processes (e.g executive functioning, speech and working memory) impact on negative symptoms
  • Brain-imaging studies have shown abnormalities in the temporal cortex, including limbic structures, the basal ganglia and the cerebellum (shenton et al 2000) – relate more strongly to positive symptoms such as hallucinations. (McCarley et al 2002)Auditory hallucinations have been shown to be associated with neural activation in the temporal lobes – limbic system (Shergill et al 2000)
  • Deficits also related with reduced volume in the temporal cortex & hippocampus in individuals with a diagnosis of schizophrenia (Steen et al 2006)
  • Impaired hippocampus affects memory for events and facts and pattern completion which are disrupted in schizophrenia (Tamminga et al 2010)

^^^^^^Findings suggest that abnormalities in different areas of the brain may each be associated with different symptoms of psychosis.

Other factors:

  • Individuals diagnosed with schizophrenia do not show the normal hemispheric asymmetry in brain development that occurs during the second trimester of pregnancy (4-6 months) – gives rise to the deficits in those areas of the brain concerned with language and associative learning (Sommer et al 2001)

Birth complications (reduced supply of oxygen) seen to be linked.

maternal infections- probability of offspring developing schizophrenia much higher in mothers who have suffered an infection during pregnancy (Brown & Derkits 2010) e.g influenza.

Reason for symptoms developing in adolescence: pre-frontal lobe seen to be strongly linked, however this area does not fully mature until adolescence so any developing deficits in that brain region are only likely to manifest in obvious ways at maturation (Giedd 2004)

Also adolescence = very stressful time- stress activated cortisol which in turn activates brain dopamine activity in at-risk individuals which is likely to trigger the onset of psychotic symptoms (Walker et al 2008)

37
Q

What are the three main theories that relate to the social epidemiology of psychosis

A
  1. sociogenic hypothesis
  2. social selection theory
  3. social labelling
38
Q

What is the sociogenic hypothesis? and what is the evaluation of this hypothesis?

A
39
Q

what is the social selection theory?

A
40
Q

what is the social labelling theory?

A
41
Q

what are the familial factors that are thought to be associated with psychotic symptoms?

A
42
Q

What are the psychodynamic theories of psychosis?

A
43
Q

What are the critisisms related to the psychodynamic theories of psychosis?

A
44
Q

What are the behavioural theories relating to psychosis?

A
45
Q

What are the cognitive theories relating to psychosis?

A
46
Q

what are the cognitive deficits relating to psychosis?

A
47
Q

describe the cognitive bias in people with psychosis?

A
48
Q

What are attenuational biases in psychosis ?

A
49
Q

what are attributional biaes in psychosis?

A
50
Q

what are the attributional biases in psychosis?

A
51
Q

What are the reasoning biases in people with psychosis?

A
52
Q

What are the interpretational biases for poeople with psychosis?

A
53
Q

what is the complaint oriented approach (bentall, 2006)

A

Study of causes has focused on explaining specific features of psychosis rather than attempting to elaborate an all-inclusive explanation.

Argues that there is a need to study individual symptoms , but also that individual symptoms may have their origin in psychological mechanisms that underlie normal experience (Bentall 2004)

54
Q

What are the problems with twin studies?

A
  • MZ twin’s always the same sex but DZ may not be
  • MZ twins usually physically identical leading to family treating them more similar
  • MZ tiwns likely to have shared same placenta whilst DZ have not- (Interuterine abnormalities more likely to affect MZ)
55
Q

what critisisms are there for the biochemical theories of psychosis?

A
56
Q

why is the diagnosis for schizophrenia unreliable?

A
  • recent study found no statistically significant relationship between clinical diagnoses of schizophrenia and diagnoses based on researchers (whaley, 2001)
  • Massive difference between cultures. When 69% of psychatrissts diagnosed a perosn with schiziophrenia in the USA, only 2% of people in england gave the same diagnoses (copeland et al 1971)
  • lack of reliability renders the word useless for clinnical communication!!
57
Q

How is the schozophrenia invalid?

A

Bentall(2003), lacks validity in:

  • symptomology and outcomes
  • aetiology
  • response treatment
  • extent to which symptoms cluster together

this is also the case for people with bipolar and psychotic depression.

58
Q

explain the cultural differences in hallucinations

A
  • visual hallucinations more common in developing countries
  • some cultures hallucinations are positively valued and so encouraged
59
Q

how do psychologists model paychosis?

A
  • Psychologists use formulations or explanatory models instead of diagnostic categories
  • Provide a theoretical and conceptual framework for understanding individual cases
  • Offer a basis for informing intervention strategies
  • Enable communication of an understanding of the problem and possible intervention plan with the person and their family

These can be:

  • Aetiological models - formative effects:Causes of experience and prevalence rate
  • Relapse models - precipitant effects: Factors that predict relapse/reoccurence of previous condition
  • Phenomenological - single symptom models:Accounts and explanations of individual experiencesand behaviours
60
Q

what is the continuum model?

A
  • Population surveys suggest that psychotic experiences are more common than psychiatric admission data would suggest..
    • Hallucinations: 10-15% (Tein 1991)
    • Delusions: 12% (van Os et al 2000)
    • Paranoia: 12.6% (Poulton et al 2000)
    • Bipolar spectrum: 6.4% (Judd & Akiskal 2003)
  • No clear boundary between ‘normal’ and ‘psychotic’ – shades of grey
  • Cultural diversity of experience and meaning
61
Q

what is the stress-vulnerability model

A
  • Theory about how biological and environmental factors might interact (Zubin, Stuart & Condray 1992)
  • Underlying vulnerability may be biological or psychological
  • Environmental stress combines with vulnerability to produce problem/distress
  • Non medical, normalising, continuum model with emphasis on coping and adaptation and clear options for intervention
  • Accounts for relapse after period of wellness
  • Not clear how to measure/define vulnerability
  • Not easy to test: need longitudinal research

Clinical psychology (8 decks)

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