Schizophrenia + Psychosis Related Disorders Flashcards
What is psychosis?
Loss Of Contact with reality, disturbances in thinking/perception
Graph: Idea goes on a spectrum
Normative experience - DO not have it but have inklings that seem like hallucinations, low-level
Non-clinical psychosis,
Attenuated psychotic
Clinical Psychotic Symptoms
What are the symptom clusters of Psychosis?
Positive:
Hallucinations
Delusions
Does not suggest it is emotionally happy, rather it means something is added, added experience that should not be there
Hallucination is having an experience and nothing is there
Negative
Reduced motivation
Reduced emotion
Etc
Experiences that should be there are not
Disorganized
Not missing/present – Instead, they are there but abnormal
Speech
Behavior
What are hallucinations?
Sensory experiences Or Perceptions in the absence of a stimulus or sensory input.
- External attribution – experienced as separate from the self
*Can involve one or more sensory domain
A) Visual Hallucination
- Seeing things that are not there
- Funky, hallucinate a person in detail
B) Auditory Hallucation
- Command hallucination
– Voice commanding them what to do
Bronchus area of the brain
C) Olfactory Hallucination
- Less common
- Smell things that aren’t there
-Unpleasant smell
- Sour smell, rotten flesh
D. Gustatory Hallucination
- Less common
- Tasting things despite not eating anything, taste different compared to others
E. Tactile Hallucination
- Less common
- Feels something – A sensation in the skin like bugs crawling on you
- Hallucination sensation coming internally as their organs are burning hot feeling like an electrical shock
Can have multimodal hallucinations at the same time.
What are delusions?
Strong, inaccurate, or unusual thoughts/beliefs that persists despite conflicting evidence
Beliefs are outside the norm of the person’s cluster
Important
Certain beliefs are accepted as common in different cultures
Persecutory delusions
- Common
- Others are trying to watch/harm/set them up in some way
Delusions of reference
-Belief of external signal that have a special meaning/significance just for them specifically
Somatic delusions
-Like a version of being a hypochondriac
-Convinced they have a parasitic disease
-Or convinced one arm is shrinking compared to the other
Religious delusions
- Common
- Believe they are saint/god
- Special pathway talking to the devil
- Think they are demonically possessed
Erotomanic delusions
- Becomes convinced that someone else is in love with them
- Higher status like a celebrity
- Stranger – Facilitate stalking behavior
Grandiose delusions
- The separate idea “I am god”
- Believe they have special powers, skills in some other way
- Ex. Selected to be a spy by the government
- The Idea of spy, CIA, FBI, etc is more common is Western countries
What are the Negative Symptoms?
Negative Symptoms
Things that should be there, but aren’t
5 A’s
- Anhedonia
Lack of pleasure or interest in activities - Alogia
Reduced speech output and expressivity - Asociality
Social withdrawal - Avolition
Lack of motivation
5.. Affective Blunting/Emotional Blunting/Flat Emotion
Reduced range of expression of emotion
Both positive and negative
Feeling happy in a flat way
If they feel angry or scared it is expressed as well in a flat way as well
What is disorganized speech?
Is producing speech, but when they speak they speak in ways that are unusual
Derailment
- Loose association where it is difficult for the person to maintain the topic of conversation
- “I felt breathless, like running a marathon. Marathon, the ancient Greek town…”
- No one thought is completed fully
Incoherence
- Word Salad
- Words and phrases are strung together in a nonsensical way
- Intended sentence: Sometimes it feels like someone has been (touch, taste, smell)
- Spoken sentence: Sometimes it feels and smells like someone has screwed a quarter pounder hamburger into my head and arms and legs, and if you shine a headlight it will drill you.
What is disorganized behavior?
Grossly inappropriate, unproductive, or unusual behavior
- Lack of personal hygiene, wearing clothes that do not match the weather
Withdrawn catatonia:
- Unresponsiveness
- Someone talking to them but do not register
- Blankly staring
- Mutism
- Staring
- Rigid posture, holding strange positions
Excited Catatonia
- Pacing/Walking in circles
- Loud Utterances
- Incongruent affect
- Watching a movie with, very sad scene and they are laughing uncontrollably
Aggression/Agitation
What are the phases of psychotic disorders?
- Prodromal Phase
- Psychotic symptoms beyond a normal experience
- Not yet full-blown - Active Phase
- Clinical levels - Residual Phase
- Happens after one active phase
- Subclinical psychotic symptoms
- Person’s new baseline
- Depending if the person gets treatment that works it can continue to be a cycle going through all three phases again and again
DSM-5 Criteria: Schizophrenia
Persistence:
- 6+ months of 2+ prodromal or residual phase symptoms, with 1+ month of 2+ active-phase symptoms
Symptoms
- At least 1 of the symptoms must be:
- Delusions
- Hallucinations
- Disorganized speech
Plus of the following:
- Grossly disorganized or catatonic behavior
- Negative symptoms
Distress Or Impairment
- The usual
- Know functioning before onset
Has functioning diminished
Rule Outs
- Not attributable to a substance or another medical condition
- No other psychotic disorders or mood disorders with psychotic features
What are other possible diagnoses based on DURATION?
- Schizophrenia: 6+ months of disturbance across phases of illness
- Schizophreniform Disorder: 1-6 months of disturbance across phases of illness
- Brief Psychotic Disorder: 1-30 days of active symptoms, with full return to premorbid level of functioning
What are other possible diagnoses based on CO-OCCURING MOOD EPSIODES?
- Schizophrenia: no co-occurring mood episodes OR present for only a brief period of illness
- Schizoaffective Disorder: Major Depression and/or manic episode(s) co-occur with psychotic symptoms for the majority of illness, AND 2+ weeks of psychotic symptoms in the absence of mood symptoms
- Mood Disorders With Psychotic Features: Psychotic symptoms are limited ONLY to [during] major mood episode(s)
What are cross-cultural Considerations?
- Schizophrenia is found at similar rates across cultures
- Similar symptom profiles, but content varies across cultural and historical contexts
- Across cultures, there are hallucinations, delusions but the content/or type may have more common themes in one culture than in another culture
- More prevalent in developed countries than in developing countries
- Some symptoms are culturally normative, not always pathologized
What are the antipsychotic medications?
Relevant Risk Factors
- Family History - Genetic Or Biological Risk
- Something gene Encoding enzymes that break dopamine
Goal of treatment
- Regulate dopamine and serotonin neurotransmission
- Less clear whether increasing/decreasing
How it works:
- Block dopamine/serotonin receptors in cortical and limbic regions
- More dopamine is available in the synapse
- Build up of serotonin in the synapse
Long-term: help have the right amount of dopamine and serotonin
Cons
- Side effects (e.g. tremors, sexual dysfunction, lethargy
What is Cognitive Behavior Therapy
Relevant Risk Factors:
- Difficulties with reality testing
- Expectations related to recovery and engagement with treatment
Goal Of Treatment
- Cope with psychotic symptoms so they don’t interfere with functioning
- NOT: Convince the individual that their experiences are not real
- Not necessarily get rid of them, but help them cope
How it works
- Psychoeducation on psychosis
- Changing the interpretations and beliefs about the nature and consequences of symptoms
- Behavioral experiments to test hallucinations/delusions
- Hear a voice telling them what to do
- Believe if they do not follow through with the command, something worse will happen
- Make a prediction – (What will they think will happen if they do not follow through)
- Have them not listen to the voice – ignore the command
- Comeback, back and see if their prediction was accurate or not (did anything happen)
What are other targeted treatments?
Relevant Risk Factors
- Domain-specific challenges in functioning
- Family Therapy
- Improve family communication, problem-solving, and coping skills; caretaker support - Social Skills Training
- Teach and role-play appropriate social behaviors to improve interpersonal functioning - Supported Education Or Employment Services
- Training to improve academia or occupational skills and outcomes
