Schizophrenia and other psychotic disorders Flashcards
Schizophrenia: The “Positive” Symptom Cluster
The positive symptoms
–Active manifestations of abnormal behavior –Distortions or exaggerations of normal behavior
•Delusions: The basic feature of madness
–Gross misrepresentations of reality –Most common:
•Delusions of grandeur •Delusions of persecution
Hallucinations
–Experience of sensory events without environmental input
–Can involve all senses (e.g., tasting something when not eating, having skin sensations when not being touched)
–Most common: Auditory
–Findings from SPECT studies
•Neuroimaging: Part of the brain most active during auditory hallucinations = Broca’s area, involved in
speech production (not comprehension)
Schizophrenia: The “Negative” Symptom Cluster
•The negative symptoms –Absence or insufficiency of normal behavior •Spectrum of negative symptoms –Avolition (or apathy) – lack of initiation and persistence –Alogia – relative absence of speech –Anhedonia – lack of pleasure, or indifference –Affective flattening – little expressed emotion
Schizophrenia: The “Disorganized” Symptom Cluster
The disorganized symptoms –Confused or abnormal speech, behavior, and emotion •Nature of disorganized speech –Cognitive slippage – illogical and incoherent speech –Tangentiality – “going off on a tangent” –Loose associations – conversation in unrelated directions •Nature of disorganized affect –Inappropriate emotional behavior •Nature of disorganized behavior –Includes a variety of unusual behaviors –Catatonia •May be considered a psychotic spectrum disorder in its own right or, when occurring in the presence of schizophrenia, a symptom of schizophrenia
Catatonia
–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
–May include:
•Stupor, mutism or maintaining the same pose for hours
•Opposition or lack of response to instructions •Repetitive, meaningless motor behaviors
•Mimicking others’ speech or movement
Brief psychotic disorder
Psychotic symptoms lasting less than a month
Schizophreniform disorder
Psychotic symptoms lasting between 1-6 months (>6 months = schizophrenia)
Schizoaffective disorder
Schizoaffective disorder
–Symptoms of schizophrenia + additional experience of a major mood episode (depressive or manic)
–Psychotic symptoms must also occur outside the mood disturbance
–Prognosis is similar for people with schizophrenia
–Such persons do not tend to get better on their own
Delusional Disorder
Key feature: Delusions that are contrary to reality
–Lack other positive and negative symptoms
–Types of delusions include
•Erotomanic
•Grandiose
•Jealous
•Persecutory
•Somatic
–Extremely rare –Better prognosis than schizophrenia
Causes of Schizophrenia: Psychological and Social Influences
•The role of stress –May activate underlying vulnerability –May also increase risk of relapse •Family interactions –Unsupported theories •Schizophrenogenic mother •Double bind communication –High expressed emotion (EE) – associated with relapse
Medical treatment of schizophrenia
•Historical precursors
•Development of antipsychotic (neuroleptic) medications
–Often the first line treatment for schizophrenia
–Began in the 1950s
–Most reduce or eliminate positive symptoms
–Acute and permanent side effects are common
•Parkinson’s-like side effects •Tardive dyskinesia •Compliance with medication is often a problem
–Noncompliance with medication
Psychosocial Treatment of Schizophrenia
Historical precursors •Psychosocial approaches
–Behavioral (i.e., token economies) on inpatient units: reward adaptive behavior
–Community care programs
–Social and living skills training
–Behavioral family therapy
–Vocational rehabilitation
–Illness management and recovery: Engages patient as an active participant in his/her care, focusing on goal setting and dealing with functional impairment
–Cultural considerations: important to take into account cultural factors that influence individuals’ understanding of their own illness
–Prevention: identify at-risk children and intervene (e.g., with supportive, nurturing environments, social skills training, etc.)
DSM-5 Criteria: Substance/Medication-Induced Psychotic Disorder
A. Presence of one or both of the following symptoms:
1. Delusions;
2. Hallucinations
B. There is evidence from the history, physical examination, or laboratory findings of both (1) and (2):
1. The symptoms in Criterion
A developed during, or soon after substance intoxication or withdrawal or after exposure to a medication,
2. The involved substance/medication is capable of producing the symptoms in Criterion A
C. The disturbance is not better explained by a psychotic disorder that is not substance/medication-induced. Such evidence of an independent psychotic disorder could include the following:
1. The symptoms preceded the onset of the substance/medication use; the symptoms persist for a substantial
period of time (e.g., about 1 month) after the cessation of acute withdrawal or severe intoxication; or there is other evidence of an independent non-substance/medication induced psychotic disorder (e.g., a history of recurrent non-substance/medication-related episodes).
D. The disturbance does not occur exclusively during the course of a delirium.
E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
DSM-5 Criteria: Delusional Disorder
A. The 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 delusion(s) or its ramifications, functioning is not markedly impaired, and
behavior is not obviously bizarre or odd.
D. If manic or major depressive episodes have occurred, these have been brief relative to the duration of the delusional periods.
E. The disturbance is not attributable to the physiological effects of a substance or another medical condition and is not better explained by another mental disorder.
Specify whether: Erotomanic type: delusion that another person is in love with the individual Grandiose type: delusion of having some great (but unrecognized) talent or insight or having made some
important discovery Jealous type: delusion that the individual’s spouse or lover is unfaithful Persecutory type: delusions that the individual is being conspired against, cheated, spied on, followed,
poisoned or drugged, maliciously maligned, harassed, or obstructed in the pursuit of long-term goals Somatic type: delusions that involve bodily functions or sensations Mixed type: no delusional theme predominates Unspecified type: delusional belief cannot be clearly determined or is not described in the specific types (e.g.,
referential delusions without a prominent persecutory or grandiose component
