Schizophrenia and Other Psychotic Disorders Flashcards
Psychosis
A broader term, reflected in the diagnostic category. In general, “psychosis” refers to a disconnection from reality (Used to often by general population as a broad term)
Schizophrenia
A specific diagnosis (in the psychosis category) that is often severe and involves a wide variety of symptoms. There used to be “subtypes” for schizophrenia, but now it’s one unified diagnosis in DSM-5;
The severity of Schizophrenia is increased by…
A variety of symptoms, the frequency, and the intensity of each
Those with Psychosis don’t differentiate well between…
Fact and Fiction
Schizophrenia is NOT…
MULTIPLE PERSONALITIES! People often confuse this diagnosis with DID; Schizophrenia involves detachment from reality, cognitive impairment, and problems with mood and socializing, rather than alter personalities…
Schizophrenia: The Core Symptoms
- Positive Symptoms
- Cognitive Symptoms
- Disorganized or Abnormal Motor Behavior (Rare)
- Negative Symptoms
What is the difference between Positive and Negative Symptoms?
Positive: Extra experiences that don’t happen to normally functioning individuals
Negative: Less experiences, Don’t function as a normal person would because they are missing
Positive symptoms are:
Active manifestations of abnormal behavior; Experiences that most “normal” people would never report or exhibit
Positive Symptoms
Delusions and Hallucinations
Delusions
False and sometimes bizarre beliefs that are held firmly and consistently; Often include themes of grandeur or persecution, among other themes (Beliefs that are simply not true)
Hallucinations
Experience of sensory events without environmental input; Can affect all 5 senses, but auditory are most common
Individuals experiencing Delusions usually become distressed when…
They are told they are wrong or beliefs become upsetting
Types of Delusions
Bizarre (Aliens), Non-bizarre (Cheating)
Hallucinations are…
Sensory events; Can become distressing because nobody else notices it
Cognitive Symptoms
Problems with thinking, speech, and communication (Disorganized Speech); Often see problems with attention and memory as well
Disorganized speech can include: (Cognitive Symptoms)
“Word Salad” or Loose associations/tangential speech
“Word Salad” (Cognitive Symptoms)
Trying to communicate but words are jumbled up (medication can help)
Loose Associations/Tangential Speech (Cognitive Symptoms)
Speech is jumbled but more coherent, can follow flow of words but they make no sense (“Tornados are bad like elevators that malfunction, power tools malfunction, have you ever used a saw before?”)
Disorganized or Abnormal Motor Behavior
These are RARE symptoms, but experienced by some patients… The most common motor disturbance in SZ is catatonia, which can present in different ways
Types of Catatonia
- Excited Catatonia
- Withdrawn Catatonia
- Peculiar Postures (e.g., waxy flexibility)
Excited Catatonia
All over the place
Withdrawn Catatonia
Immobility while sitting or standing
Peculiar Postures
Waxy flexibility: Usually seen in state of withdrawn catatonia, weird or abnormal posture (rare)
Negative Symptoms =
Absence or insufficiency of normal behavior
Examples of Negative Symptoms:
- Avolition (or apathy)
- Alogia
- Asociality
- Abnormal Affect
Avolition (or apathy)
Failure to initiate activity
Alogia
Relative absence of speech (usually during catatonia)
Asociality
Lack of interest in socializing
Abnormal Affect
Often flattened or atypical (how someone displays there emotions) Usually makes them hard to read
To be diagnosed with Schizophrenia Two or more of the following for at least one month:
a) hallucinations, b) delusions, c) catatonia, d) disorganized speech, or e) negative symptoms
(and one must be a, b, or c)
-Major impairment in functioning since the onset of the symptoms (i.e., obvious “decompensation” over time)
-Ongoing disturbance for at least 6 months total (with at least one continuous month of features seen in #1)
Schizophrenia: Prevalence and Onset
About 1% of the population worldwide; Equally affects males and females, but females recover more easily; Often develops in early adulthood, but can emerge at any time; Males usually show symptoms EARLIER (early 20’s is typical for males, later 20’s for females)
Schizophrenia: Course and Prognosis
Schizophrenia is chronic, and most suffer with moderate to severe lifetime impairment ; The course can be highly variable, but usually includes 3 phases: prodromal, active, residual; Life expectancy is slightly less than average; Treatment sometimes results in full “recovery,” but more often, involves teaching the person how to function as best as possible despite the diagnosis
Three phases seen in the course of Schizophrenia:
Prodromal, Active, Residual
Prodromal
Lead up to symptoms that show what they may be
Active
Symptoms are occurring
Residual
Returning to normal state of functioning (Not quite there yet)
Residual
Returning to normal state of functioning but are not quite there yet
Are those with Schizophrenia dangerous?
No, normally confused rather than dangerous; Accidental injuries usually occur due to auditory command hallucinations
Other Psychotic Disorders
-Brief Psychotic and Schizophreniform Disorders
-Delusional Disorder
-Schizoaffective Disorder
(These are all thought to have similar causes as SZ, and would involve the same medication/therapies for tx)
Brief Psychotic and Schizophreniform Disorders
Time-limited expressions of SZ symptoms; Brief Psychotic: = 1 month, Likely to only involve positive symptoms), Schizophreniform: 1-6 months
Delusional Disorder
Delusions in the absence of other psychotic symptoms
6 subtypes: 5 specific themes + “mixed” (Some say 1 in 100,000 ppl, others say 1 in 5 but you would never know)
Schizoaffective Disorder
SZ Symptoms and Depressive/Manic Symptoms (Hard to differentiate from bipolar)
6 Subtypes of Delusional Disorder
- Grandiose
- Persecutory
- Erotomanic
- Jealous
- Somatic
- “Mixed”
Grandiose
“I am Rich/Famous”
Persecutory
“Someone is out to get me”
Erotomanic
“Love is mutual but secret”
Jealous
“He is cheating on me”
Somatic
Internal body functioning, think something is bizarre “I have gas in my veins instead of blood”
“Mixed”
MULTIPLE
Biological Dimension of Schizophrenia
- Genes and Endophenotypes
- Neurotransmitter Dysregulation
- Structural Abnormalities in Brain
- Prenatal or Birth Complications
Psychological Dimension of Schizophrenia
- Childhood Trauma
- Depression and Low Self-Esteem
- Unusual Thoughts
- Limited Empathy
- Lacking theory of mind
- Early cognitive difficulties
Social Dimension of Schizophrenia
- Exposure to abuse
- Dysfunctional Family Interactions
- Expressed Emotions
Sociocultural Dimension of Schizophrenia
- Gender
- Low Socioeconomic Status, Poverty
- Social Adversities
- Migration
Treatment of Schizophrenia (or other psychosis)
Has a history of being crude and ineffective; Prefrontal lobotomies and Commitment to asylums with adverse conditions
Treatment of Schizophrenia (or other psychosis) Is much more sophisticated nowadays and usually combines
Medication with psychological treatment; Again, rarely anticipates full recovery, but rather optimizing functioning for the individual (Renaissance)
Prefrontal Lobotomies (Treatment of Schizophrenia or other psychosis)
A form of psychosurgery, a neurosurgical treatment of a mental disorder that involves severing connections in the brain’s prefrontal cortex. Most of the connections to and from the prefrontal cortex, the anterior part of the frontal lobes of the brain, are severed.(May turn individual into a zombie)
Commitment to asylums with adverse conditions (Treatment of Schizophrenia or other psychosis)
Not the ideal place to be because cruel methods are used to control behaviors
Medical Treatment of Schizophrenia/Other Psychosis
Antipsychotic (neuroleptic) Medications; Compliance with medication can be a problem
Antipsychotic (neuroleptic) Medications
Began in the 1950’s; Often a first line treatment for schizophrenia; Most reduce or eliminate positive symptoms; Acute and permanent side effects can occur
Acute and permanent side effects of Antipsychotic (neuroleptic) Medications
Extrapyramidal side effects and Tardive dyskinesia
Extrapyramidal Side Effects of Antipsychotic (neuroleptic) Medications
Physical symptoms, including tremor, slurred speech, akathesia, dystonia, anxiety, distress, paranoia, and bradyphrenia; Parkinson’s disease like effects (twitching hands)
Tardive Dyskinesia (Side Effects of Antipsychotic (neuroleptic) Medications)
Causes repetitive, involuntary movements, such as grimacing, eye blinking, involuntary movements, lip smacking, or repetitive movements
Psychosocial Treatment of Schizophrenia/Other Psychosis
Psychoeducation groups or group therapy for social and daily living skills; Behavioral therapy (i.e., token economies) in inpatient settings is often used; CBT can be used, but requires higher cognitive ability (steps of CBT are listed in text); Might involve vocational rehabilitation; Helpful to address family communication and education
Behavioral Therapy (Psychosocial Treatment of Schizophrenia/Other Psychosis )
(i.e., token economies) in inpatient settings is often used; “Tokens” to reinforce appropriate behaviors, they ultimately have no value but build to a prize or reward for the patient
Vocational Rehabilitation (Psychosocial Treatment of Schizophrenia/Other Psychosis )
Actions towards living normal life (getting a job)
