Psychotic Disorders - schizophrenia spectrum

Question 1

Schizophrenia vs psychosis

Answer 1

Psychosis: cluster of symptoms - relating to a range of disorders not specific to a single disorder

Schizophrenia: a specific mental disorder

Question 2

3 symptom clusters of psychotic symptoms:

Answer 2

1. positive - occur in excess of normal
2. negative - absent issue
3. disorganised - disruptions in thought patterns

Question 3

Diagnostic criteria in Schizophrenia DSM-5
(2 or more)

Answer 3

• delusions
• hallucinations
• disorganised speech
• grossly disorganised behaviour
• negative symptoms
• social disfunction
• continuous signs for 6 months
• Catatonia Specifier: rare, immobile state, altered state of consciousness (lasting for mins or even hours)

Question 4

Delusions
(positive symptoms)

Answer 4

A fixed irrational belief a person will hold despite the contrary. Convinced their minds with not be changed = their reality

• persecution
• grandeur
• reference
• erotomania
• somatic
• nihlistic
• bizarre vs non bizarre

Question 5

Hallucinations
(positive symptoms)

Answer 5

sensory experiences that aren’t real

• auditory
• visual (rare)
• olfactory
• gustatory
• tactile

Question 6

Disorganised Speech/ thought
(positive symptoms)

Answer 6

• loose association - disorganised talking
• neologisms - made up words
• clang associations - rhymes
• echolalia - repeating what is being said to them
• echopraxia - mimicking movements/ words

Question 7

negative symptoms

Answer 7

• affective flattening - shallow emotions
• alogia - poverty of speech/ vocab
• thought blocking - forget when talking
• Avolition - lack of motivation
• anhedonia - inability to experience pleasure

Question 8

other important diagnostic criteria

Answer 8

-temporal criteria (differentiate different disorders)
- symptoms for at least 6 months
- impairment in functioning
- downward drift

Question 9

3 phases…

Answer 9

usually we see more negative symptoms first

1. prodromal: negative symptoms appear
2. Active: meets threshold for disorder
3. Residual: can function in society

usually schizophrenia is chronic

Question 10

other psychotic disorders…

Answer 10

1. Schizophreniform disorder: short duration of symptoms
2. Schizoaffective disorder: independent symptoms of SZ and mood disorder
3. Delusional Disorder: delusions 1+ months/ few negative symptoms , rare. with ‘bizarre’ content present

Question 11

Epidemiology of Schizophrenia

Answer 11

• psychotic disorders appear in all societies
• 0.7-1.5% of pop suffers from SZ
• 3/4 cases = 15-45 yr olds
• mens 1st psyc break usually 18-25yrs
• womens 1st psyc break usually 25-35 yrs

Question 12

Etiology of Schizophrenia

Answer 12

schizophrenia is a brain disorder w 80% heritability index

• predisposing causes
• environmental causes
• pregnancy/ brith complications
• maternal drug use

The Neurodegenerative hypothesis

Question 13

The Neurodegenerative Hypothesis

Answer 13

lower brain volumes than people without schizophrenia,

schizophrenia people have a faster degeneration of brain matter

Question 14

the Dopamine Paradox in Schizophrenia

Answer 14

• excessive dopamine in subcortal areas = positive psyhotic symptoms
• excessive dopamine in prefrontal cortex = negative psychotic symptoms

different dopamine pathways

Question 15

Treatment - Biological Perspective

Answer 15

1st Generation Antipsychotics
- reduce only positive symptoms/ side effects

2nd Generation Antipsychotics
- both pos/ neg symptoms reduced

Question 16

Treatment - Cognitive Perspective

Answer 16

research has shown that patient have unusual perceptive processes

Cognitive Rehabilitation:
- modify over/ under attention

Cognitive Restructuring
- challenge delusional beliefs