psychosis Flashcards
psychosis definition
any mental disorder characterised by delusions &/or hallucinations, w/ or w/o insight into their pathological nature
schizophrenia lifetime prevalence & onset
around 1% of the population; onset between 20-24 years but women tend to have 2nd peak around 40 years
schizophrenia in men vs women
clinical symptoms of schizophrenia tend to be more severe in men, w/ women having better long term outcomes
DSM-5 psychotic disorders
schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional disorder, schizotypal (personality) disorder, brief psychotic disorder, other (substance/medication induced psychotic disorder, psychotic disorder due to another medical condition, catatonia/catatonia associated w/ another mental disorder & catatonia due to another medical condition, unspecified catatonia, etc.)
negative symptoms of schizophrenia
negative symptoms reflect an absence / deficit of normally present behaviours
flat affect, blunted emotional expressiveness, alogia (decrease in thought & speech productivity), avolition (decrease in goal-directed behaviour, motivation/will)
positive symptoms of schizophrenia
reflect an excess or distortion in normal repertoire of behaviour & experiences
delusions, hallucinations
DSM-5 diagnostic criterion A - symptoms of schizophrenia spectrum disorders
(1) delusions
(2) hallucination
(3) disorganised thought & speech, incl. cognitive derailment, loosening of associations in which ideas slide from one track to a new unrelated one
(4) grossly disorganised/abnormal behaviour, incl.
(4. i) childlike silliness to unpredictable agitation
(4. ii) problems in goal-oriented behaviour that compromise daily activities
(4. iii) catatonic behaviour (marked decrease in reactivity to environment), incl. negativism (saying ‘no’ to everything), bizarre postures, mutism, stupor, catatonic excitement (excess motor behaviour that can sometimes be harmful), echoing speech
(5) negative symptoms incl.
(5. i) alogia
(5. ii) anhedonia (decrease in ability to experience pleasure)
(5. iii) asociality (apparent lack of interest in engaging in social interaction)
(5. iv) blunted affect
DSM-5 schizophrenia diagnostic criteria
(1) 2 or more symptoms of delusions, hallucinations, disorganised thought/speech
(2) symptoms lasting at least 1 month, w/ continuous signs of disturbance for at least 6 months
(3) symptoms not caused by substance misuse or medical condition
schizophrenia vs MDD or bipolar disorder - differential diagnosis
if psychotic symptoms (delusions & hallucinations) are present w/ MDD or bipolar disorder, they occur during depressive or manic episodes
schizophrenia vs delusional disorder - differential diagnosis
besides delusions, there are no other symptoms of schizophrenia present
schizophrenia vs OCD - differential diagnosis
OCD characterised by prominent obsessions & compulsions
schizophrenia vs PTSD - differential diagnosis
w/ PTSD, traumatic event in past is relived or reacted to
DSM-5 diagnostic criterion B
social & occupational dysfunction: for a significant portion of time since onset of disturbance, level of functioning in 1 or more areas (work, interpersonal relations, self-care) is markedly below level achieved prior to onset OR, if in children/adolescents, failure to achieve expected level of functioning
DSM-5 delusional disorder diagnostic criteria
(1) presence of 1 or more delusions (subtypes: erotomania, grandiose, jealous, persecutory, somatic, mixed) lasting 1 month or longer
(2) criterion A for schizophrenia has never been met
typical pattern of schizophrenia course
prodromal period, acute episode, resolution
prodromal period
1st phase of common schizophrenia course involving transient &/or attenuated psychotic symptoms, memory & concentration problems, unusual behaviour & ideas, disturbed communication & affect, social withdrawal, apathy, reduced interest / pleasure in daily activities
acute episode
2nd phase of common schizophrenia course involving hallucinations, delusions, behavioural disturbances, agitation, & distress
resolution (schizophrenia)
final phase of common schizophrenia course in which symptoms diminish & often disappear; negative symptoms sometimes remain; may later be interrupted by more acute episodes
greatest risk factor for developing schizophrenia
family history; associated w/ more severe clinical expression of positive & negative symptoms
prenatal causal factors that, when present in early neurodevelopment, increase risk of later schizophrenia development
malnutrition, stress in mother during foetal development, premature birth, nicotine use in mother, prenatal exposure to viral infections
stress-vulnerability model in relation to schizophrenia
SVM emphasises interaction between vulnerabilities (genetics, birth complications, environmental factors) & stress (drugs, major life events)
stress may be a vulnerability factor: psychotic patients react more intensely to daily stress
onset & relapse in schizophrenia associated w/ significant life events
cognitive model of positive symptoms of schizophrenia
suggests that basic cognitive dysfunctions are appraised as external, leading to development / maintenance of positive symptoms
psychological factors associated w/ schizophrenia
cognitive deficits, dysfunctional beliefs & attributions, difficulty conveying & recognising emotions, impaired theory of mind
psychodynamic perspective of schizophrenia development
intrapsychic conflicts between ego & reality cause a split & hyperactive id
social-environmental risk factors for developing schizophrenia
(1) living in dense, urban neighbourhoods (2) inequality - poor people living in wealthier neighbourhoods tend to do worse than those living in neighbourhoods where most people have a similar income (3) people from migrant groups (esp. of African & African-Caribbean descent) living in the UK = much more likely than white British population to be diagnosed w/ schizophrenia
