Psychotic Disorders (Schizophrenia) ! Flashcards
What is psychosis?
Extreme impairment in several areas of functioning:
- clarity of thought.
- emotional response.
- communication.
- understanding reality.
- behaviour.
Severely interfere with normal life.
Psychotic symptoms are observed in many other conditions:
- schizophrenia, bipolar, depression, substance abuse, withdrawal.
Schizophrenia: DSMV
A. (Characteristic symptoms) Two of more of the following:
- delusions
- hallucinations
- disorganised speech
- grossly disorganised or catatonic behaviour
- negative symptoms
B. For significant proportion of time.. level of functioning markedly below pre-onset functioning.
C. Signs of disturbance must persist for at least 6 months.
D. Schizoaffective disorder and depressive/bipolar disorder with psychotic features has been ruled out.
E. … not attributable to psychological effects of a substance or other medical condition.
Positive symptoms
Delusions: firmly held (erroneous) beliefs: distorted reasoning, misinterpretation or perception.
- delusion of control
- delusion of reference
- erotomania
- grandiose delusion
- persecutory delusion
- religious delusion
Hallucinations: distortions or exaggerations of perception.
- perceiving sensations that aren’t apparent to others.
- can relate to any of the senses.
- but can also relate to other senses.
Auditory hallucinations (most common): hearing voices which may comment on patients behaviour.
Visual hallucinations: seeing things no one else can.
Negative symptoms
Affective flattening- reduction in range and intensity of emotional expression.
Alogia- poverty of speech.
Avolition- reduction or difficult with goal0directed behaviour.
Other social dysfunction impairments- reduced energy, lack of motivation, poor hygiene, problems functioning at school/work/etc, moodiness.
Disorganised symptoms
Patient’s inability to think clearly and respond appropriately.
Most commonly associated with irregular speech:
- talking in sentences that do not make sense.
- rambling loose associations.
- using nonsense words.
- speaking incoherently.
Can also be related to behaviours:
- odd movements.
- disorganised actions.
- catatonia.
Causes of schizophrenia
Several causal explanations have been suggested. Schizophrenia strongly linked to biological causes- but environmental triggers also likely to be needed. Some associated causes: - genetics. - obstetric events. - infections. - brain structure and function. - neurochemistry etc.
Genetic explanations
Schizophrenia tends to run in families- risk of schizophrenia about 10% if parent has the illness.
Gen pop. = 1%.
MZ twins = 11-14% quite low- against 1-4% DZ twins.
But 60% of pts do not have other family member with disorder- genetic predisposition does not always lead to illness.
Probable that inherited genes make a person vulnerable to schizophrenia- but environmental factors act on vulnerability to trigger illness..
Neurochemistry - dopamine
Overabundance of dopamine strongly implicated.
- dopamine aids communication between nerve cells.
- imbalance affects perception of stimuli.
- increases may relate to positive symptoms.
- certain recreational drugs increase levels (eg. cocaine).
- drugs that treat Parkinson’s increase dopamine.
- antipsychotic medications reduce dopamine and reduce positive symptoms.
Social explanations: life experiences
Risk for schiz increases with number of adverse social factors experienced in childhood (Wicks et al, 05). Some key risk factors: - birth events- eg. maternal illness. - physical or sexual abuse. - poverty. - lower social class. - social deprivation. - migration and racial discrimination. - relationships. - urbanicity.
Cognitive causes for schiz
Interaction between neurobiological, environmental, cognitive and behavioural factors (Beck & Rector 05).
- brain structure abnormalities may predispose- and environmental stressors may provide trigger.
- but cognitive interpretations guide maladaptive behaviour.
- delusions could be due to cognitive biases- such as external attributions.
- and inappropriate behaviour- such as jumping to conclusions.
- hallucinations may be result of attention biases.
Impact on psychotic disorders
European study explored personal impact (Thornicroft et al, 04).
- poorer personal outcomes: higher rates of unemployment; more likely to be single; greater use of welfare benefits.
- poorer quality of life: anxiety/depression; alcohol/substance abuse; poor social life; labelling and stigma etc.
Functional impairment
While social deprivation may be potential cause it is also a consequence.
Schizophrenic people often live in poor urban areas- but did this cause illness or did the illness cause the drift to these areas?
- Social causation hypothesis- (Hollingshead & Redlich, 58)- those in lower classes sugger greater stress; more likely to trigger predisposition.
- Social drift hypothese (Wender et al, 73)- those with schiz cannot gain employment; “drift down” to lower class.
Social cognition impairment
Social cues (Verbal and non verbal) involve perception:
- processing others’ emotional facial expression.
- recognition of familiar social situations.
Theory of mind:
- recognition of other’s intentions and thoughts- depends on interpreting non verbal cues.
- schizophrenia pts impaires in ToM (Brune, 05).
Schiz also associated with other cognitive dysfunctions (Rodriguez-Sanchez et al, 08):
- information processing.
- executive functioning.
- speed of processing.
Insight
Considerable problem in schizophrenia (Mintz et al, 03).
50-80% schiz pts do not believe they are ill.
- some may acknowledge experience of symptoms, but say these are due to outside forces.
- only take meds because pressured to.
Burden
Schiz pts represent sig burden to society (Awad & Vorguganti, 08):
- on caregivers.
- economic costs.
- hospitalisation.
- state benefits.
- psychological support etc.
But most research focuses on family burden:
- emotional, psychological, physical and economic impact.
- distress, shame, embarrassment, guilt, self-blame.
