Schizophrenia and other psychotic disorders

Question 1

Psychosis
What is it?

Answer 1

1. Break from reality
2. Impaired reality testing

Symptom cluster rather than a disorder
Present in a range of disorders: Schizophrenia, depression, Bipolar
Other causes are drug use, head injury, stress

Question 2

Symptoms of Psychosis

Answer 2

1. Hallucinations: Perception like experiences that occur without external stimulus
2. Delusions: Fixed beliefs that don’t change when faced with conflicting evidence
   - Must be invonsistent with (sub)cultural norms.
   - Not always bizzarre
   - Not always easy to identify
   e.g., sister implanted microchip in brain, Carl Jung wants me to dechiper his work
   harder to tell: neighbours are out to get them
3. Disorganised thinking/speech
   - Rapidly switching topics (loose dissociations)
   - Tangential changing of topics
   - Rare cases
4. Negative symptoms: Reduced social interaction, anhedonia, avolition, alogia, reduced emotional expression
5. Grossly disorganised/abnormal motor behaviour
   - Problems with routine tasks (dressing, bathing, brushing teeth)
   - Catatonia: marked psychomotor disturbance

Cognitive symptoms
- Language
- Memory
- Processing speed
- Attention
- Exeutive functioning
- Social cognition

Question 3

Psychotic disorders

Answer 3

Schizophrenia
A. Two or more of the following, each present for a significant portion of the time during a 1 month period
ATLEAST ONE OF THREE BELOW
1. Delusions
2. Hallucinations
3. Disorganised speech
AND/OR
4. Grossly disorganised and catatonic behaviour
5. Negative symptoms

B. Clinically significant impact to social/occupational functioning

C. Continous disturbance for 6 months

D/F: Not better accounted for by another diagnosis: schizoaffective, substance, autism

Other types:
- Schizotypal (personality) disorder
- Schizophreniform disorder
- Schizoaffective disorder
- Delusional disorder
- Brief psychotic disorder
- Psychotic disorder due to a medical condition
- Substance/medication induced psychotic disorder
- Other specified schizophrenia spectrum ad other psychotic disorder
- Unspecified schizophrenia spectrum and other psychotic disorder

Question 4

Aetiology of Psychotic disorders

Answer 4

Genetics
- Twin studies 73-90% heritability
- <1/3 people with schizophrenia have a family history
Environment
Brain
- Increased pre-synaptic dopamine release
- Glutamate
- Brain structure

First episode psychosis
- Many people who have a first episode recover or go into remission (rate of remission is 58%)
- Rate of recovery 38% (no longer functionally impaired for at least 2 years)

Remission/recovery rates decrease for multiple episodes
Services focus on early intervention during prodromal phase/after first episode

Question 5

Transdiagnostic Clinical Staging Model of Mental Health Problems

Answer 5

Treatment at earlier ages results in a less likelihood of developing schizophrenia

Stages of Schizophrenia development
1. Premorbid: before any functional impairment/symptoms begin

2. Prodromal: a sustained and clinically significant deviation from premorbid level of experience and behaviour
   - Don’t generally administer psychotic medication
   - Psychoeducation
   - CBT (reality testing, enhancing coping strategies)
3. Acute phase
   - Multi-disciplinary approach
   - Treatment duration 2-5 years (“critical period”)
   - Pharmacological treatment/non pharmacological treatment
   - First generational antipsychotics for positive symptoms such as hallucination and delusions
   - Second generation antipsychotics effective for positive AND negative symptoms (less side effects)
4. Late phase interventions:
   - Continue with pharmacological treatment/Non-pharmacological treatment
   - Psychological intervention for relapse prevention
5. Chronic phase interventions
   Pharmacological treatment

Non-pharmacological treatment
- Clinical psychologist to address comorbidites, practical aspects, social aspects

Cultural perspectives
- Visits from spirits or psychosis?