Schizophrenia, Psychotic, and Delusional Disorders Flashcards
Psychosis
Mental state characterized by profound disturbances in thought - “losing touch with reality”
Ex. Schizophrenia, MD with psychotic features, certain types of BD, schizoaffective disorder, delusional disorder, etc
Schizophrenia
A disease of the brain which involves a loss of contact with reality, making it hard to distinguish between what is real and what is not
A severe mental disorder, characterized by profound disruptions in thinking, affecting language, perception and sense of self
Symptoms of schizophrenia
Divided into positive (acute) and negative (chronic)
Significant misdiagnosis with bipolar disorder in adults and autism in children
Positive symptoms
Hallucinations and delusions
Hallucinations
Positive symptoms - hallucinations
- False sensory experiences
- Most commonly auditory (commentary, instructions, 2 frightening, degradation)
- Often frightening, but not always
Hearing voices
- Globally more than 5% of the population hears voices
- Hearing voices network (1989) challenges the biomedical interpretation
- Not necessarily a symptom of an illness, but projections of unconscious mind or variation of “normal” internal monologue
- Stress the many positive aspects of hearing voices - creativity, encouragement
- Encourages alternatives to tranquillizers
Delusions
Positive symptoms - delusions
- Beliefs despite improbable (impossible) nature, maintained even when demonstrated to be false
- Control (ex. thoughts/body), grandiosity, paranoia, reference, etc.
- Previously defined as “fixed false beliefs,” but sometimes false beliefs are not delusional, some fixed beliefs are not provable, not all problematic beliefs are false
Negative symptoms
Chronic affective and emotional disturbances
- Blunted affect
- Anhedonia (may extend to physical: taste, touch)
- Asociality
- Avolition
- Alogia (severely reduced speech, poverty of content)
Cognitive/disorganized symptoms
Cognitive disturbances (ex. memory, attention)
Disorganized speech
- Derailment (shifting topics abruptly) - Tangentiality (responding with irrelevant response) - Perseveration (using same word repeatedly) - "Word salads" - Neologisms
Bizarre behaviour
- Sometimes motor behaviour - Inappropriate affect
Classification of schizophrenia
How long has it existed?
- Hippocrates described a girl who “in some cases said dreadful things - the visions ordered her to jump up and throw herself into wells and drown, as if this were good for her and served a useful purpose.”
- Hare: recency hypothesis: explains 19th century epidemic and rarity of previous descriptions. Also explains persistence despite low fertility.
Kraepelin
Various symptoms that had been distinct disorders should be grouped together. Schizophrenia is a brain disorder
Europeans stayed closer to this view.
Bleuler
Didn’t always start in adolescence nor result in dementia. Considered negative symptoms far more important than positive symptoms
Bleuler stayed closer to this view.
Schizophrenia epidemiology
Schizophrenia symptoms found in all cultures across the world
Refrigerator mothers
- Popularized by some psychoanalysts, 1940s-1960s
- Some parents felt blamed for what was increasingly conceived as a brain disease
- Built alliances with biological psychiatry and formed the National Alliance on Mental Illness (NAMI) to publicize illness, push for more treatment, research
Genetic causes
Figures for average risk of developing schizophrenia:–(General pop: 1%–Spouses of people w/ schizophrenia: 2%–Children of one parent w/ schizophrenia: 7-15%–Offspring of two parents w/ schizophrenia: 27-46%–Monozygotic twins: 7-50%)
- Some combinations of genes suspected but research is unclear, inconsistent. Unable to genetically predict schizophrenia
- High genetic overlap between schizophrenia and several other disorders
