Schizophrenia and Psychotic Disorders

Question 1

Describe delusions as positive psychotic symptoms

Answer 1

• firmly held, erroneous beliefs about misinterpretation/experiences
• often believes thoughts are being interfered or planted
• backed up with ‘logic’ and resistant to contradictory evidence
  Delusions of persecution: individual beliefs they are being spied on, in danger
  Delusions of grandiose: individual thinks they are famous/ have great power
  Delusions of control: their thoughts are being controlled externally
  Delusions of reference: independent external events which an individual believes are directly related to them
  Nihilistic delusion: world/selves have stopped existing (invisibility) - some accompanied by hallucination

Question 2

What are hallucinations?

Answer 2

• positive psychotic symptom
• distorted sensory experience

Auditory:

• most common - 70%
• voices, external commands, commentary or conversation
• perceived as distinct from their own thoughts

Visual

• second most common
• defuse form: colours and shapes
• specific: parent/partner present

Other:

• olfactory/taste (smells/ unusual food tasting)
• tactile - skin tingling

Question 3

Describe disorganised symptoms of SZ

Answer 3

Disorganised speech (formal thought disorder):

• derailment/ lose association (swift topic change to unrelated)
• tangentiality: erratic/irrelevant answers to Q
• clanging: thinking driven by word sounds (making rhymes or alliterations ; links that don’t exist)
• neologisms: usually combining several words - made up to communicate
• word salad: disorganised, no link language
• poverty of content: conversation with little substance

Disorders of motor behaviour

Catatonic behaviour:

• decrease in reactivity to the environment (rigidity, avoid movement, negativity)
• lack of purpose, excitement

Grossly disorganised:

• behaviour is childlike or silly
• inappropriate for age or context
• unpredictable and difficult with goal-directed activity
• dishevelled

Question 4

Describe some negative symptoms

Answer 4

• Avolition: lack of motivation for daily goals and activities (much less for self-expression and daily routine goals) - equal motivation for avoiding negative outcomes like criticism tho
• Asociality: poor social skills, difficulty maintaining friendships
• Anhedonia: loss of interest/experience of pleasure (consummatory pleasure; e.g. after eating / anticipatory pleasure: e.g. amount of expected pleasure from future activities) - those with SZ = deficit in anticipatory pleasure mainly (still pleasure after eating good or watching a good movie)
• Blunted affected = affective flattening; limited range/intensity of emotional expression
• alogia = flattening of speech; failure to elaborate or provide additional information - poverty of speech
• these could be on a continuum of normality though (naturally less able/ part of another disorder - careful in diagnoses)

Question 5

Describe the course of schizophrenia (psychotic symptoms)

Answer 5

Prodromal Stage

• first symptoms: late adolescence/early adulthood
• 51% experience between 15-21
• onset is slow deterioration over 5 years (withdrawal from normal life, inappropriate emotions and deterioration in personal/ school performance)
• usually in stress period

Active

• showing unambiguous symptoms of psychosis, delusion and hallucination
• peak

Residual Stage

• recovery is gradual and symptoms may stay (and relapse back to active)
• less positive symptoms
• negative symptoms and more common
• 50% of SZ will alternate between active and residual stages

Notion for DSM - 2 or more symptoms for 1 month period

Question 6

Describe the diathesis-stress perspective of SZ

Answer 6

• combo of genetic diathesis/ predisposition and environmental stress
• may not develop symptoms unless the environmental trigger

Question 7

What is the psychodynamic theory explaining SZ?

Answer 7

Freud = psychosis - is a process of regression to the previous ego state (preoccupation with state)

• primary narcissism (oral stage) - cold/unfulfilling parents, loss of contact with reality
• attempting to establish contact = delusions and hallucinations

Fromm-Reichman (1948)
- SZphrenogenic mother (cold, rejecting, distant) - although little evidence

Question 8

Describe Roger’s person-centred theory of SZ

Answer 8

• Psychosis: person defences overwhelmed
• shattered sense of self and disconnected
• little consistency in behaviour (psychotic break)
• making little sense, inappropriate emotion, can’t differentiate between self and non-self

Question 9

What is the behavioural theory of SZ?

Answer 9

• psychotic behaviours may be rewarded operantly
• extinction to eliminate psychotic
• explains maintenance not acquisition

Question 10

Describe familial factors as an explanation for SZ

Answer 10

Communication Deviance

• difficult and puzzling (abrupt sentences, inconsistent references, using word/phrases incorrecly)
• characteristic of families with offspring who develop psychotic symptoms
• risk factor

Expressed Emotion

• one family member ; extremely critical and blaming sufferer for symtpms
• relapse higher in high EE homes
• interventions moderating EE = beneficial

Question 11

Biological explanation

Answer 11

Notion card

Question 12

Describe biological treatments for Sz (and pros and cons)

Answer 12

Antipsychotics

• Typical: reduces positive symptoms by blocking dopamine and developed in past 50 years
• less typical: specific to symptom
• Atypical: most recent and shown more effective across a broader range of symptoms - less risk of relapse and less risk of involuntary motor side effects

Pros:

• improves major symptoms and reduces relapse
• improvement in treatment-resistant patients

Cons:

• only partial solution
• they do not address social/occupational deficits
• some with improvement still relapse
• adverse LT effects (tardive dyskinesia)
• dependency and harmful perception
• producing extrapyramidal side effects (resembling Parkinson’s side effects)

Question 13

Describe social skills and CBT as treatment

Answer 13

Social Skills

• learning basic skills to cope with everyday interaction (appropriate expression and gestures)
• role modelling, positive reinforcement
• improving skills and independent living

CBT

• for delusions and hallucinations - coping with them
• generating alternative explanations
• challenging interpretations
• reality tests to try them out
• learning to identify relapse and comply with medicine
• deal with dress and inappropriate responses/cognition

Cognitive remediation therapies

• enhancing basic cognitive functions (cognitive training)
• training in attention, memory and problem solving

Question 14

Describe family based programmes in SZ

Answer 14

- supportive management 
Education
- around diagnosis, prevalence and aetiology 
- antipsychotic medication 
- helping comply with medicine
- recognising relapse 

Taught

• social skills for family issues
• shared experiences and avoiding blame
• for highEE - family based and mediciation = effective