Psychotic Disorders Flashcards
Psychosis
Inability to differentiate between what is real and what is unreal
Negative symptoms
Loss of normal function. Can include symptoms such as lack of pleasure (anhedonia), lack of emotion, lack of motivations, etc.
Positive symptoms
Excesses or distortions, such as delusions, hallucinations and disorganized speech.
Schizophrenia
Chronic and severe psychotic disorder
Active phase of schizophrenia
Basically psychosis. Involves disturbance of thoughts, behaviours and emotions.
Why is schizophrenia known as a heterogeneous disorder?
There are a number of symptoms that aren’t shared among all the individuals with the disorder; so not very easy to point to one thing that characterizes it (e.g. depression -> sadness, panic disorder -> panic attacks) - so two individuals with the disorder may not look anything alike
DSM-5 criteria for schizophrenia
2 or more active phase* symptoms for > 1 month
- *Delusions
- *Hallucinations
- *Disorganized Speech
- Disorganized or catatonic behavior
- Negative Symptoms
Continuous signs > 6 months (basically chronic)
Symptom presentation of schizophrenia
- Acute
- Prodromal
- Residual
Acute symptoms
Significant symptoms are present and cause marked
impairment in functioning
Prodromal symptoms
Milder symptoms present for at least 1-2 years before first acute episode
Residual symptoms
Milder symptoms between acute episodes
Types of hallucination
- Auditory: Hearing voices; most common (e.g. might speak in 3rd person, might command individual to do things, might be running commentaries)
- Visual: e.g Seeing a figure
- Olfactory: e.g. Smelling burning
- Tactile: e.g. Bugs crawling on skin
- Somatic: e.g. Stomach rotting
Wernicke and Broca’s areas during hallucinations
Broca’s area (language production), but not Wernicke’s (language comprehension), was activated during hallucinations, which suggests that auditory hallucinations have more to do with generating words than listening to them - brain can’t recognize difference between thoughts and speech.
Types of delusions related to thought
- Broadcasting
- Insertion
- Withdrawal
Thought broadcasting
Delusion that others can hear or are aware of an individual’s thoughts
Thought insertion
Thoughts are put into mind by external source (e.g. evil thoughts transmitted into head through modem/router)
Thought withdrawal
Thoughts are being removed (e.g. your roommate is stealing your thoughts while you sleep)
Delusions of….
- Grandeur
- Persecution
- Reference
- Being controlled
Delusions of grandeur
A false impression of one’s own importance (e.g. setting out to save the world)
Delusions of persecution
Most common; belief that one is being plotted against/threatened
Delusions of reference
A neutral event is believed to have a special and personal meaning (e.g. people on TV are making fun of you, broadcasting coded info about you)
Delusions of being controlled
Actions, thoughts, etc. are controlled by someone/something else (e.g. demons)
Capgras syndrome
People who experience this syndrome will have an irrational belief that someone they know or recognize has been replaced by an imposter.
Types of disorganized speech
- Loosening of association
- Word salad
- Neologisms
- Clanging
Loosening of association
Derailment, speech is very tangential, topic to topic
Word salad
More extreme, speech is illogical and makes no sense
Neologisms
Makes up words that have no meaning to the person being spoken to
Clanging
Stringing together words that rhyme
Types of disorganized symptoms
- Disorganized speech (formal thought disorder)
- Disorganized affect: Inappropriate emotional behaviour (inappropriate to situation)
- Disorganized behaviour (Unusual behaviours) and catatonia
Types of catatonia
- Catatonic immobility
- Catatonic excitement
- Catatonic posturing
- Waxy flexibility
Catatonic immobility
Lack of behavior
Catatonic excitement
Uncontrolled excitation
Catatonic posturing
Person assumes a bizarre or inappropriate posture and maintains it over a long period of time
Waxy flexibility
The limb or other body part of a catatonic person can be moved into another position that is then maintained
Types of negative symptoms (5 A’s)
- Affective flattening
- Alogia
- Avolition (apathy)
- Anhedonia: Lack of pleasure; indifference
- Asociality: Severe relationship impairment
Affective flattening
Little expressed emotion (nothing to do with feeling emotions)
Alogia
Reduction in speech amount/content (e.g. delayed comment, brief comments - thought disorder, not inadequate communication skills)
Avolition (apathy)
Lack of initiation/persistence - don’t do even the most basic things (e.g. basic hygiene)
Cognitive deficits in schizophrenia
- NOT criteria for diagnosis; simply correlated with schizophrenia
- Deficits in attention (focusing and maintaining attention) and working memory (hold and manipulate info actively in mind)
- May be present before development of full blown disorder - might be an early marker for the disorder
Consequences of cognitive deficits
- Information and stimulation flood awareness and individual can’t figure out the source or differentiate between what’s real/not real
- Delusions/hallucinations might develop as a way to make sense of the information bombarding them
Genain quadruplets
- Identical quadruplets
- All of them developed schizophrenia by age 24
VERY VERY rare - Symptom presentation + course of disorder = very different for each sister
Development of schizophrenia in the Genain quadruplets
- Genetic risk from grandmother
- Concordance is only about 40-50% though
- Toxic family environment
- Birth complications -> lack of oxygen (even for short period of time) + family history -> increased risk
- Myra was the least impaired since she didn’t experience birth complications nor abuse; Hester was the most impaired because she experienced both
Excess dopamine affects the _____ and leads to ____
mesolimbic pathway, positive symptoms
Dopamine deficit affects the _____ and leads to _____
prefrontal cortex, negative symptoms
Brain abnormalities in schizophrenia
- Enlarged ventricles (due to atrophy or improper development of surrounding regions that gave them room to enlarge)
- Smaller PFC (language, emotional expression, planning); less activation
- Smaller hippocampus, abnormal activation
- Only affected twins show these differences (implication that they’re environmental)
Damage to developing brain
- Birth complications (30% with perinatal hypoxia - inadequate oxygen)
- Maternal viral infections
- Maternal nutritional deficiencies
- Maternal herpes simplex viral infection
- Most vulnerable during 2nd trimester (when extreme development occurs), and simply increases the risk (but not by a lot)
Schizophrenia and low SES
- Low SES might be a risk factor (low SEs -> schizophrenia)
- Social drift - those with disorder are more likely to “drift” down into lower SES (schizophrenia -> low SES)
Influence of urban settings on schizophrenia
Higher likelihood of viral infections (i.e. could lead to brain damage in developing fetuses)
Effects of stress
- Increases risk for relapse
- May precede first onset of acute symptoms
Types of stress
- Family environment
- Stressful life events
- Immigration
Role of culture
- Symptom expression: Content of delusions and hallucinations can differ
- Prognosis: Better prognosis in developing countries
- Risks: Sensitivity to family functioning
Expressed emotion
The critical, hostile, and emotionally over-involved attitude that relatives have toward a family member with a disorder. Can lead to more symptoms, and more symptoms can lead to more expressed emotion. Culture can influence whether it’s well meaning or an act of control.
Study by Rosenbarb
- Participants: Patients with schizophrenia
- Independent variables: Relative’s criticism/intrusiveness, patient’s odd thinking and race
- Dependent variable: Amount of time before patient NEEDED to take medication (e.g. showed signs of relapse, couldn’t cope with family therapy alone)
- Method: Recorded families problem solving, coded intrusiveness and criticism
- Results: High in expressed emotion + high odd thinking -> medication more needed
Treatment options
- Neuroleptics (first discovered)
- Atypical antipsychotics (newer)
Neuroleptics
- Block receptors for dopamine
- Treat positive symptoms not negative symptoms
- 25% don’t respond
- 98% of patients have relapse within 2 years if they go off
- Serious side effects
Atypical antipsychotics
- Affect dopamine in various ways
- Treat positive well and negative to some degree
- Better side effect profile but still not great
Individual therapy
- Cognitive: focus on changing attitudes about
treatment and seeking help - Behavioral: reinforcing appropriate social interaction
- Social support: increase contact with others and
learn problem solving skills
Family therapy
- Educate families about disorder
- Improve communication skills
- Improve problem solving
- Healthier family relationship and reduces stress on patient; reduces criticism towards patient
Assertive community teamwork
- Team of social workers, medical professionals, and psychologists
- 24-hour assistance
- Services provided in home and community
Outcomes of assertive community teamwork
- Reduces hospitalizations
- Increases likelihood of employment
- Reduced symptoms
- BUT gains decline if treatment stopped
Acceptance and commitment therapy
- Views avoidance/control as the problem
- Focus on accepting, not avoiding, inner experiences
Outcomes of acceptance and commitment therapy
- Reduces hospitalizations
- Reduces believability of hallucinations
- Increases reported delusions/hallucinations
Poor prognosis of schizophrenia
- 40-60% don’t receive treatment in a given year
- Re-hospitalization 50-80%
- 10-15% suicide
- BUT most stabilize after 5-10 years
Poor prognostic indicators of schizophrenia
- Males earlier onset/more severe
- Worse functioning in younger patients
- Less social support
- More criticism
Schizoaffective disorder
Mix of schizophrenia and a mood disorder
Schizophreniform disorder
Symptoms of schizophrenia present for less than 6 months
Brief psychotic disorder
Sudden onset of delusions, hallucinations, disorganized
speech, and/or disorganized behavior lasting for up to a month
Delusional disorder
Delusions lasting at least 1 month regarding situations
that occur in real life
Schizotypal personality disorder
Lifelong pattern of significant oddities with respect to
self-concept, ways of relating to others, thinking and
behavior
Criteria for involuntary commitment
- Incapacity: Incapacitation to the point of an inability to care for basic needs
- Dangerousness to self: Imminently suicidal
- Dangerousness to others: Must be imminent
Process of involuntary commitment
- Review process - doctor determines if patient should be kept within facility
- Anyone detained involuntarily have the right to a hearing
- Two opinions are needed to maintain admission - have to be in agreement
- Being homeless with a mental illness isn’t sufficient
Right to treatment
- Provided humane psychological and physical environment
- Given by qualified staff
- Individualized treatment plan
- Minimum restrictions of freedoms
Right to refuse treatment
- Must have informed consent to treatment (patient understands and agrees to treatment)
- In some jurisdictions this can be overruled
