Psychotic disorders Flashcards
Psychosis
- Psychosis is a condition of the mind broadly defined as a loss of contact with reality.
- The cardinal features of psychotic disorders is the presence of psychotic symptoms: hallucinations and or delusions as well as thought disorders.
- Due to impairment in thoughts, perception, and judgement, an individual has difficulty in differentiating real-world experiences from those that are not based on fact.
- They are therefore regarded as more ‘serious’ and require immediate attention
Causes of Psychosis
- Schizophrenia
- Schizophreniform disorder
- Schizoaffective disorder
- Delusional disorders
- Brief psychotic disorder
- Bipolar disorder
- MDD with psychotic features
- Delusional disorders
- Substance-induced psychosis
Psychotic disorders
1. Primary psychotic disorders → Schizophrenia disorder →Schizoaffective disorder →Delusional disorders → Brief psychotic disorder
- Substance-induced psychosis
- Psychoses associated with medical or neurological conditions
What are delusions…..?
- Delusions are unshakeable false beliefs held by an individual despite being presented with rational and logical arguments and evidence to support the contrary
- These beliefs are not shared by the people of the same cultural and religious background and cannot be accounted for by the individual’s level of intelligence
Types of Delusions
- Persecutory delusions
- Grandiose delusions
- Erotomania delusions
- Somatic delusions
- Delusions of reference
- Delusions of control
- Delusions of guilt
Persecutory delusions
The most common type of delusion.
The individual believes that he/she is going to be harmed by a living or non-living thing, another person, group, organization or some force of power despite there being no evidence to support such beliefs
Example: “My classmates are all ganging up on me because I have different opinions, They want to hurt me”
Note: Delusions of persecution are seem in Schizophrenia
Grandiose delusions
The individual believes that he or she is very famous, rich, talented (e.g. performing artist, scientist, inventor), is related to prominent people.
Note: Grandiose delusions are seen in Mania and Schizophrenia
Delusions of guilt
The individual believes the he/she is a bad person and has done something terribly wrong for which he deserves to be punished for. These delusions usually start off by the individual being overly critical of him/herself and by feelings of self-reproach. The patient feels unworthy of himself.
Note: Usually seen in depressed patients and can lead to suicide or homicide.
Delusions of reference
The individual misrepresents harmless, non-suspicious events or mere coincidences as being strongly applicable to him.
Example: An individual believes that the news being read out on TV is directly referencing him, music being played for him; and car number plates have a coded message for him.
Somatic delusions
Patient is preoccupied with his body and health and makes false perception of his body.
Example: His nose is large; his teeth are misshapen, etc. even though they are fine
Religious delusions
The individual believes that he is God, a saint, an angel or has spiritual powers or that he is born for a divine purpose
Erotomania or Delusions of love
Patient believes that the other person is in love with him/her. These delusions may lead to stalking behavior disturbing another person
Hallucinations…..?
Deceptions in perceptions that occur in the absence of an external stimulus. This perception cannot be experienced by other people.
They have the quality of normal perception and the individual perceives them vividly and clearly. They cannot be controlled voluntarily.
Types of Hallucinations
- Auditory
- Visual,
- Tactile,
- Olfactory
- Gustatory
Auditory hallucinations
The voices heard can be complementary, critical, or neutral and can be displayed in the patient’s actions and behaviors.
Auditory hallucinations can be subclassified as:
•Elementary/rudimentary auditory hallucinations: includes sounds like banging, tapping, musical sounds, pre-verbal whispers, muttering, etc.
Individual words cannot be deciphered, though the patient may still imagine content for these sounds.
- Single hallucination: only one voice is heard, these can occur sporadically
- Mass hallucinations: several voices can be heard, all talking at the same time
Visual hallucinations
- Can be of formed objects (faces, people, crosses, tridents, crosses, angels, devils, parts of bodies, etc.) or formless (lights, shadows, shapeless images, etc.)
- Hallucinations, where the individuals experience visions of complete scenes, are called scenic or panoramic hallucinations (e.g. war scenes, mob fighting scenes)
- Visual hallucinations are usually seen in organic states like Lewy body dementia, drug intoxication, delirium; they are less commonly seen in Schizophrenia
Olfactory hallucinations
Olfactory Hallucinations are also called phantosmia. They are usually unpleasant smells, which the individual perceives and which are not normally present in the surrounding environment. Olfactory Hallucinations are seen in aura with epilepsy and aura with migraine.
Gustatory hallucinations
Gustatory hallucinations are quite rare. The individual has an abnormal perception of taste. For example, the individual complains of a persistent metallic taste or bitter taste. They coexist along with olfactory hallucinations as flavor hallucinations.
Haptic/Tactile hallucinations
- The individual has an abnormal perception of touch, it may also be painful.
- Example: A dead animal’s limb is touching his face, a knife is stabbing him.
- Special type of tactile hallucination is that of insects or ants crawling on the skin or just underneath the surface, called formication
Note: Seen in cocaine withdrawal or alcohol withdrawal
Definition of Illusions
Illusions are deceptions in perceptions that occur in the presence of an external stimulus, these perceptions are distorted by the individual’s ideas. This differs from hallucinations where the external stimulus is absent. They are not symptoms of psychosis. They can occur even in normal individuals.
Schizophrenia
The term Schizophrenia
From the Greek roots:
→ Schizo: split
→ Phrenia: mind
• Shows the fragmented thinking of people with the disorder
Now classify as a spectrum rather than a single disease entity
What is Schizophrenia?
It is a chronic mental health disorder characterized by loss of contact with reality and manifested by two main symptoms: delusions and hallucinations
Causes of schizophrenia
• Genetic factors: close relative
• Structural abnormalities of the brain:
→ Enlargement of the
lateral ventricles in
schizophrenic patients.
→ And decreased brain
tissue evidenced by
widened cortical sulci
and decreased volumes
of grey and white
matter.
• Biological (Chemical factors):
→ Dopamine hypothesis – Schizophrenic symptoms may result from increased limbic dopamine activity (positive symptoms) and decreased frontal dopamine activity (negative symptoms).
• Psychosocial factors: - Traumatic life time experiences may precipitate the occurrence of schizophrenia.
Pathogenesis of Schizophrenia
..
Warning signs for SZ
- Irrational, bizarre or odd statements or beliefs.
- Increased paranoia or questioning other’s motives.
- Hostility or suspiciousness
- Increasing reliance on drugs or alcohol.
- Speaking in a strange manner unlike themselves.
- Insomnia or oversleeping.
- Deterioration in their personal appearance and hygiene
Cardinal Symptoms of schizophrenia
• Positive symptoms:
Exaggerations or distortions of normal thoughts, emotions, and behavior
•Negative symptoms:
Symptoms that involve functioning below the level of normal behavior
Positive symptoms
- Delusions
- Hallucinations
- Illusions
- Behavioral dyscontrol
•Disorganization symptoms: →Uncoordinated speech, →Loosely associated ideas (disorganized thinking), →Inappropriate behavior, and → Inappropriate emotions.
Negative symptoms
- Potentially difficult to recognize because of similarities to depression.
- Flat affect (diminished emotional expression).
- Avolition (lack of initiative)
- Alogia (poverty of speech)
- Poor attention
- Anhedonia
Cognitive symptoms
- Usually nonspecific; related to the impact on patient’s quality of life.
- Poor executive functioning, represented by disorganized speech and/or thought that results in impaired communication.
- Inattention
- Impaired memory
- Difficulty concentrating
MNEMONIC To recall the negative symptoms of schizophrenia, remember the 5 As
• Anhedonia • Affect (flat) • Alogia (poverty of speech) • Avolition (apathy) •Attention (poor)
DSM-V Diagnostic Criteria for SZ
A. Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3):
- Delusions
- Hallucinations
- Disorganized speech (incoherence, derailment)
- Grossly disorganized or catatonic behavior
- Negative symptoms
B. Impairment in level of functioning in work, interpersonal relationship, or self-care which is markedly below the level achieved before onset.
C. Continuous signs of disturbance persist for 6 months. This must include at least 1 month of symptoms that meet criterion A (active phase) and periods residual symptoms (only negative symptoms).
D. Disorder is not due to physiological effects of substance
Effects of schizophrenia to the individual, family & community
- Problems at school - drop out of school.
- Problems at work - deterioration in performance at work.
- Problems with social contact.
- Decline in activities of daily living (ADL).
Differential Diagnosis for schizophrenia
• Brief psychotic disorder • Schizophreniform disorder • Schizoaffective disorder • Delusional disorder • Substance-induced psychotic disorder
- Psychotic disorder due to a general medical condition
- Mood disorders with psychotic features
