Psychotic Disorders

Question 1

Psychosis Definition

Answer 1

gross departure from reality that may include:
1. Hallucinations: sensory experiences in the absence of sensory input (ex hearing voices)
2. Delusions: strong, inaccurate beliefs that persist in the face of evidence to the contrary

Question 2

Schizophrenia Definition

Answer 2

a pervasive type of psychosis characterized by disturbed thought, emotion, behavior

Question 3

History on Psychosis & Schizophrenia

Answer 3

*Emil Kraepelin - used the term dementia praecox to describe schizophrenic syndrome (early subtypes = catatonia, hebephrenia, paranoia)
*Eugen Bleuler - introduced the term ‘schizophrenia’ (means splitting of the mind)

Question 4

Symptoms of Schizophrenia

Answer 4

“Positive” symptoms:
-Active manifestations of abnormal behavior
-Distortions or exaggerations of normal behavior
“Negative” symptoms:
-Absence of normal behavior
“Disorganized” symptoms:
-Erratic speech, emotions and behavior

Question 5

What are the positive symptoms?

Answer 5

-Delusions
-Disorganized Speech
-Disorganized and bizarre behavior
-Hallucinations
-Unusual motor behavior

Question 6

What are the negative symptoms?

Answer 6

-Flat affect
-Loss of energy
-Loss of motivation
-Loss of feelings of pleasure

Question 7

What are the disorganized symptoms?

Answer 7

-Confused or abnormal speech, behavior, and emotion such as:
1. Cognitive slippage – illogical and incoherent speech
2. Tangentiality – “going off on a tangent”
3. Loose associations – conversation in unrelated directions
-Nature of disorganized affect: inappropriate emotional behavior
-nature of disorganized behavior: unusual behavior

Question 8

Old subtypes of schizophrenia

Answer 8

-divided by psychosis into paranoid, catatonic, residual (minor symptoms persist after past episode), disorganized (many disorganized symptoms) and undifferentiated

Question 9

DSM-5 Criteria of Schizophrenia

Answer 9

A. Two or more of the following present for a time of 1 month period
1.delusions
2.hallucinations
3.disorganized speech
4.grossly disorganized
5.negative symptoms
B. For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas such as work, interpersonal relations or self care is below the level achieved prior to onset
C. Continuous signs of the disturbance persist for at least 6 months (must be at least 1 month of symptoms - prodromal or residual periods)
D. Schizoaffective disorder, depressive or bipolar disorder with psychotic features have been ruled out because there was no maniac episodes, mood episodes happen
E. The disturbance is not attributed to physiological effects of a substance or another medical condition
F. If there is a history of autistic spectrum disorder or a communication disorder of childhood onset, the diagnosis of schizophrenia is made only if prominent delusions or hallucinations

Question 10

Incidence of Schizophrenia

Answer 10

rate is 1%

Question 11

Schizophrenia risk ____ with genetic closeness to relatives with schizophrenia

Answer 11

increases

Question 12

Schizophrenia Stats

Answer 12

-affects males and females equally
-found in similar rates in all cultures

Question 13

Course of Schizophrenia

Answer 13

1. Prodromal Phase
   -85% experience
   -1 to 2 years before serious symptoms (ideas of reference, magical thinking, illusions, isolation, marked impairment in functioning, lack of initiative, interests or energy)

Question 14

Schizophreniform Disorder

Answer 14

-psychotic symptoms lasting between 1 to 6 months
-associated with good functioning
-most patients resume normal life
-lifetime prevalence at 0.2%

Question 15

DSM-5 of Schizophreniform Disorder

Answer 15

A. Two or more of the following present in 1 month: delusions, hallucinations, disorganized speech, grossly disorganized, negative symptoms
B. An episode of the disorder lasts at least 1 month but less than 6 months
C. Schizoaffective disorder, depressive or bipolar with psychotic features have been ruled out
D. The disturbance is not attributed to the [physiological effects of a substance

Question 16

Schizoaffective Disorder

Answer 16

-symptoms of schizophrenia and additional experience of a major mood episode
-psychotic symptoms must also occur outside the mood disturbance
-prognosis is similar for people with schizophrenia
-medicine is main treatment with psychotherapy

Question 17

DSM-5 of Schizoaffective Disorder

Answer 17

A. An uninterrupted period of illness during which there is a major mood episode concurrent with A of schizophrenia (**depressed mood)
B. Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode during the lifetime duration of the illness
C. Symptoms that meet criteria for a major mood episode are present for the majority of the total durance of the active and residual portions of the illness
D. The disturbance is not attributed to the effects of a substance

Question 18

Delusional Disorder

Answer 18

**delusions that are contrary to reality
-lack other positive and negative symptoms
-types of delusions: erotomanic, grandiose, jealous, persecutory, somatic
-better prognosis than schizophrenia
-very rare (affects 26-60 per 100,000)
-later age of onset (35-55)
-more common in females

Question 19

DSM-5 of Delusional Disorder

Answer 19

A. Presence of one or more delusions with a duration of 1 month or longer
B. Criterion A for schizophrenia has never been met
C. Apart from the impact of the delusions, functioning is not impaired and behavior is not odd
D. If maniac or major depressive episodes have occurred, these have been brief relative to the duration of delusional periods
E. The disturbance is not attributed to the physiological effects of a substance or another medical condition

Question 20

Delusional Disorder Types

Answer 20

-Erotomanic: delusion that another person is in love with the individual
-Grandiose: delusion of having some great talent or having made some important discovery
-Jealous: delusion that the individual’s spouse or lover is unfaithful
-Persecutory: delusions that the individual is being conspired against, cheated, followed or obstructed in the pursuit of long term goals
-Somatic: delusions that involve bodily functions or sensations
-Mixed: no delusional theme predominates
-Unspecified: delusional belief can’t be clearly determined or is not described in the specific types

Question 21

Catatonia

Answer 21

-Unusual motor responses, particularly immobility or agitation, and odd mannerisms
-Tends to be severe and quite rare
-May be present in psychotic disorders or diagnosed alone, and may include:
-Stupor, mutism, maintaining the same pose for hours
-Opposition or lack of response to instructions
-Repetitive, meaningless motor behaviors
-Mimicking others’ speech or movement

Question 22

Why might psychosis occur?

Answer 22

result of substance use, medication and medical conditions
*knowing the cause is important for treatment

Question 23

DSM-5 of Substance/Medication-Induced Psychotic Disorder

Answer 23

A. Presence of one or both: delusions, hallucinations
B. There is evidence from history, physical exams, or lab of: symptoms developed during or after intoxication or withdrawal or after exposure to medication, the involved substance/medication is capable of producing symptoms
C. The disturbance is not better explained by a psychotic disorder that is not substance/medication induced. Must persist for about 1 month
D. The disturbance does not occur exclusively during the course of a delirium
E. The disturbance causes clinically significant distress or impairment in social or other important areas of functioning

Question 24

DSM-5 of Psychotic Disorder Associated with another Medical Condition

Answer 24

A. Prominent hallucinations or delusions
B. There is evidence from history, physical exams, or lab that it is a direct pathophysiological consequence of another medical condition
C. Not better explained by another mental disorder
D. Does not occur exclusively during the course of a delirium

Question 25

Brief Psychotic Disorder

Answer 25

-positive or disorganized symptoms of schizophrenia
-lasts less than a month
-typically precipitated by trauma or stress

Question 26

DSM-5 of Brief Psychotic Disorder

Answer 26

A. Presence of one or more: delusions, hallucinations, disorganized speech, grossly disorganized
B. Duration of an episode is at least 1 day but less than 1 month with full return to normal level of functioning
C. Not better explained by major depressive or bipolar disorder

Question 27

NOT TRUE Etiology of Schizophrenia

Answer 27

NEPF

-Neofreudians
-Existential Theory
-Psychoanalytic Theory
-Family Theories

Question 28

Etiology of Schizophrenia - Biology

Answer 28

genetic predisposition, higher risk in monozygotic twins than dizygotic, 3 genes are directly related (chromosome 6, 8, 22*), 22 breaks down dopamine, abnormalities in prefrontal cortex & hippocampus, weed increases risk

Question 29

Medications for Schizophrenia

Answer 29

1. Antipsychotics (neuroleptics)
   -theorazine
   -haldol, navane
   *lots of side effects
2. Atypical antipsychotics
   -cozaril, risperidal, seroqual, zyprexa, geodon, abilify, latuda, rexulti
   *acts on different dopamine receptor sites & less side effects

Question 30

What are the integrative treatment for schizophrenia?

Answer 30

medication, psychosocial rehab, psychosocial support