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Psychopathology > Schizophrenia Spectrum & Other Psychotic Disorders > Flashcards

Schizophrenia Spectrum & Other Psychotic Disorders Flashcards

1
Q

DSM-5 Schizophrenia Spectrum and Other Psychotic Disorders

A
  • Schizotypal Personality Disorder
  • Delusional Disorder
  • Brief Psychotic Disorder
  • Schizophreniform Disorder
  • Schizophrenia
  • Schizoaffective Disorder
  • Substance/Medication-Induced Psychotic Disorder
  • Psychotic Disorder Due to Another Medical Condition
  • Catatonia
  • Catatonia Associated with Another Mental Disorder (specifier)
  • Catatonia Disorder Due to Another Medical Condition
  • Unspecified Catatonia
  • Other Specified Schizophrenia Spectrum/Other Psychotic Disorder
  • Unspecified Schizophrenia Spectrum/Other Psychotic Disorder
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2
Q

Historical Explanations of Psychosis

A
  • Psychoses have been around since ancient times; demonic possession
  • Mid to late 19th century: psychosis due to syphilis
  • Kraeplin: described schizophrenia as dementia praecox (premature or precocious madness); interested in a cluster of symptoms and deterioration over time
  • Term Schizophrenia coined by Eugen Bleuler in early 20th century
  • —means splitting of the mind
  • —fundamental symptoms: disturbances in affect, ambivalence, autism, lack of motivation, dementia
  • —accessory symptoms: delusions, hallucinations, movement disturbance, somatic symptoms, manic/melancholic states
  • Competing definitions (Kraeplin vs Bleuler): Differences in criteria were not good for research process mid 20th century
  • Criteria were united in ’70s: Feighner or St. Louis criteria and Research Diagnositc Criteria by Spitzer et al.
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3
Q

Schizophrenia DSM-5 Diagnostic Criteria

A

Two or more present for 1-month period (on must be 1, 2, or 3)…
1) Delusions
2) Hallucinations
3) Disorganized speech
4) Grossly disorganized or catatonic behavior
5) Negative symptoms (absence of behaviors that should be there; e.g., diminished emotional expression, avolition)
Functioning level must drop
Continuous signs of disturbance for at least 6 months

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4
Q

Word Salad

A

several loose associations

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5
Q

People with ___ symptoms tend to have a better prognosis according to research.

A

Positive

- Note: women also more likely to have this presentation

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6
Q

Degenerative nature of Schizophrenia

A

Positive symptoms tend to progress into negative symptoms

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7
Q

Psychosis

A

Loss of touch with reality

- may be due to a variety of things, not just Schizophrenia

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8
Q

Schizophrenia: Ruling out schizoaffective d/o and depressive/bipolar with psychotic features

A

Either 1) no major depressive/manic episodes have occurred concurrently with active-phase symptoms or 2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total active & residual periods of the illness

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9
Q

Schizophrenia Specifiers

A
  • With catatonia
  • Severity: each symptoms may be rated for its current severity on a 5-point scale ranging from 0 (not present) to 4 (present and severe)
    After 1-year duration of illness…
  • First episode, currently in acute episode
  • First episode, currently in partial remission (improvement maintained, partial criteria)
  • First episode, currently in full remission
  • Multiple episodes, currently in acute episode
  • Multiple episodes, currently in partial remission
  • Multiple episodes, currently in full remission
  • Continuous
  • Unspecified
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10
Q

Schizoaffective Disorder DSM-5 Diagnostic Criteria

A
  • Criterion A of schizophrenia with concurrent major mood episode
  • Delusions or hallucinations for 2 or more weeks in absence of mood problems (differentiates this from mood disorder with psychotic features)
  • Mood problems are present for majority of duration of illness
  • Same specifiers as schizophrenia, plus specifier for Bipolar type/Depressive type
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11
Q

Delusional Disorder DSM-5 Diagnostic Criteria

A
  • One or more delusions with duration of 1 month or longer
  • Criterion A of schizophrenia has never been met (hallucinations not prominent and related to delusional theme)
  • Functioning not markedly impaired; behavior no “obviously bizarre or odd”
  • No prolonged mood disturbance relative to delusional periods
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12
Q

Delusional Disorder Specifiers

A
  • Erotomanic type: delusion that another person in love with them
  • Grandiose type
  • Jealous type
  • Persecutory type
  • Somatic type
  • Mixed type (multiple themes)
  • Unspecified type
  • With bizarre content: if delusions implausible or not derived from ordinary life experiences
  • Other specifiers from Schizophrenia also apply
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13
Q

Delusional Disorder: Changes in DSM-5

A
  • Removed word “nonbizarre” from Criterion A
  • “With bizarre content” specifier added
  • “Some physical defect” removed from somatic subtype (to differentiate from body dysmorphic disorder)
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14
Q

Delusional Disorder Differential

A
  • Individuals have persistent delusions with relatively normal psychosocial functioning (but can function abnormally in context of delusions)
  • Often prolonged course to recovery, but little mental deterioration
  • No hallucinations (unless related to delusion), disorganized speech/behavior, catatonia
  • Ego-sytonic: little insight
  • Concurrent mood pxs must be brief, though MDD or Bipolar can be diagnosed if symptoms arise following delusions
  • Delusions cannot be secondary to GMC, substance, neurocog d/o
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15
Q

Brief Psychotic Disorder DSM-5 Diagnostic Criteria

A
  • Criterion A of schizophrenia for at least 1 day but less than one month
  • Eventual full return to premorbid level of functioning
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16
Q

Brief Psychotic Disorder Specifiers

A
  • With marked stressor
  • Without marked stressor
  • With postpartum onset
  • With catatonia
17
Q

Brief Psychotic Disorder Differential

A
  • Short in duration (less than one month)
  • Sometimes occurs following marked stressors, acute mood changes, and/or childbirth
  • Negative symptoms not present
  • Rule-out GMCs, substance, neurocog
18
Q

Schizophreniform Disorder DSM-5 Diagnostic Criteria

A
  • Criterion A of schizophrenia that lasts between 1 and 6 months (if continue beyond 6 months, diagnosis changed to schizophrenia)
19
Q

Schizophreniform Disorder Specifiers

A
  • With good prognostic features
  • Without good prognostic features
  • With catatonia
  • Severity specifiers
20
Q

Catatonia Specifier

A

3 or more odd/unusual psychomotor activities, behaviors, movements:
- Stupor (no psychomotor activity), catalepsy (passive induction of posture held against gravity), waxy flexibility (resistance to positioning by examiner), mutism, negativism (opposition to instructions), posturing (active maintenance of posture against gravity), mannerism (odd caricature of normal actions), stereotypy (repetitive movements), agitation, grimacing, echolalia (mimicking speech), echopraxia (mimicking movements)

21
Q

Schizotypal PD DSM-5 Diagnostic Criteria

A

Pervasive pattern of social and interpersonal deficits marked by acute discomfort with close relationships & cognitive or perceptual distortions or eccentricities of behavior
- Beginning by early adulthood and present in variety of contexts
5 or more of following…
1) Ideas of reference: false belief that irrelevant occurrences or details in the world relate directly to oneself/one’s destiny
2) Odd beliefs or magical thinking that influences behavior/is inconsistent with subcultural
3) Unusual perceptual experiences
4) Odd thinking and speech
5) Suspiciousness or paranoid ideation
6) Inappropriate or constricted affect
7) Behavior/appearance that is odd or eccentric
8) Lack of close friends or confidants other than first-degree relatives
9) Excessive social anxiety; tends to be associated with paranoid fears

22
Q

Bleuler’s four As

A

1) Association: loosening of thought associations
2) Affect: inappropriate/flattened affect
3) Ambivalence: holding of conflicting attitudes and emotions towards others and self; lack of motivation and depersonalization
4) Autism: social withdrawal
- reflected in DSM negative symptoms

23
Q

Schneiderian First Rank System

A
  • Reflected in DSM positive symptoms

- Auditory hallucinations, thought broadcast, thought insertion, thought withdrawal, and delusional perception

24
Q

Positive Symptoms

A
  • Hallucinations, delusions, thought disorder
  • Associated with acute and later onset, episodic course, and better prognosis
  • May begin to look like negative symptoms over time
25
Q

Negative Symptoms

A
  • Alogia (barely speaking), avolition (lack of motivation), flat affect, anhedonia, asociality (lack of motivation to engage in social interactions)
  • Associated with insidious, early onset, gradually worsening course, poorer prognosis
  • Poorer premorbid functioning
26
Q

Epidemiology

A
  • Psychotic disorders ~1%
  • Much more prevalent in adults (onset: late teens to age 30)
  • Gender differences: none for Delusional Disorder, Brief Psychotic Disorder 2x more common in females, negative symptoms and chronic presentation of Schizophrenia more common in males (mood symptoms/brief presentation equivalent across sexes)
27
Q

Associated Features of Schizophrenia

A
  • Inappropriate affect
  • Dysphoric mood
  • Sleep disturbance
  • Lack of interest in eating
  • Depersonalization/derealization
  • Anxiety and phobias
  • Vocational and functional impairment (poor self-care)
  • Social withdrawal
  • Cognitive and EF dysfunction
  • Anosognosia (lack of insight)
  • Poor treatment adherence
  • Hostility and aggression
  • Impulsivity
  • Substance abuse (a lot of tobacco)
  • Impairment in motor coordination
28
Q

Schizophrenia: Comorbidity

A
  • Substance-related disorders
  • Anxiety disorders (OCD, Panic Disorder)
  • Schiotypal or Paranoid PD beforehand
  • Medical: weight gain, diabetes, metabolic syndromes, cardiovascular and pulmonary disease, poor adherence to health maintenance, reduced life expectancy
29
Q

Etiology: Neuropsychological

A
  • Pxs with visual processing and scanning efficiency, sensory habituation, sustained attention and EF, emotional expression and understanding, verbal and spatial memory
  • Lower IQ and faster decline in IQ
  • Saccadic eye movement abnormalities
  • Possible frontal lobe abnormalities: abnormal migration and/or prolonged apoptosis - some suggest started in infancy and second round in adolescence
30
Q

Etiology: Brain Abnormalities

A
  • Enlarged ventricles
  • Lower overall brain volume
  • Lower volume in frontal and temporal lobes
  • Smaller thalamus and hippocampus
  • Lower/abnormal activity with fMRI and EEG
  • Possible damage to axons and/or demyelination
  • Note: No evidence of specific abnormalities and not all dx with schiz show abnormalities
31
Q

Etiology: Neurotransmitters

A
  • Dopamine: too much in frontal lobes and limbic systems (DA agonists like cocaine can produce schizophrenia like symptoms)
  • Glutamate (excitatory): deficient or aberrant functioning (Glutamate antagonists like PCP can produce psychotic symptoms)
  • GABA (inhibitory): too much (possibly involved in dopamine regulation)
  • Serotonin may be involved
32
Q

Etiology: Genetics

A
  • Familial aggregation: risk and closeness of relation positively correlated
  • Twin studies: 30-50% of MZ twins
  • Adoption studies: support for genetic theories, but family dysfunction may moderate
  • High rate of genetic mutations
  • Not everyone with family history develops Schizophrenia & can emerge in families with no history
33
Q

Etiology: Environmental Factors

A
  • Early prenatal nutritional deficiencies
  • Maternal viruses in second trimester
  • Obstetric complications (stressful events during pregnancy)
  • Premorbid observations of abnormal motor/social development in childhood; unusual characteristics in home movies
  • No support for schizophrenogenic mother
  • No support for “double blind” (mixed signals from parent)
  • Family climate (high expressed emotions) possibly contributes to onset
  • Increased stressors
34
Q

Barch et al. article

A
  • Schizophrenia can have a lot of different symptoms/ levels of severity depending on the person
  • Importance of using dimensional approach when assessing symptoms in psychosis
  • DSM-5 includes dimensional assessments of 8 domains of psychopathology (hallucinations, delusions, disorganized speech, abnormal psychomotor behavior, negative symptoms, impaired cognition, depression, mania)
  • Rate from 0 (not present) to 4 (present and severe)
  • Hallucinations and delusions - one dimension or two? (good to keep separate bc some disorders only show one or the other, etc.)
  • Negative symptoms: 1) restricted emotional expression, 2) avolition (should these be broken down or stay combined? factor analysis says separate, but high correlation between the two)
  • Cognitive function: large percentage of individuals with psychotic disorders suffer from cognitive impairments, but this is not a differential diagnosis marker for schizophrenia
  • Depression and mania: growing evidence that schizoaffective disorder does not represent a distinct nosological category separate from schizophrenia
  • Similar but not completely aligned with RDoC
35
Q

Gonthier and Lyon article

A
  • Childhood-onset schizophrenia (COS), especially prior to age 13, is extremely rare and severe
  • Most cases of COS are attributable to some form of brain disease with genetic roots
  • As COS is very rare, many in the educational arena have not received training in how to assist children with the disorder.
  • Symptomatology: delays language/social/motor, loose associations/illogical thinking, abnormal peer relationships, negative symptoms, some brain abnormalities found
  • Course of disorder: 1) prodromal (some deterioration prior to psychotic symptoms), 2) acute (positive symptoms), 3) recovery (negative symptoms), 4) residual (symptoms decrease)
  • Same diagnostic criteria as adults
  • Some schizophrenia symptom checklists have been adapted for use with children; Must differentiate from imaginative child and child with hallucinations
  • Treatment has five foci: (a) pharmacological therapy, (b) cognitive strategies, (c) family interventions, (d) educational interventions, and (e) environmental manipulations
  • Children with COS often qualify for services under the seriously emotionally disturbed category
36
Q

Heckers et al. article

A
  • Five domains of psychopathology: hallucinations, delusions, disorganized thought (speech), disorganized or abnormal motor behavior (including catatonia), and negative symptoms
  • The signs and symptoms of psychosis are on a continuum with normal mental states
  • The severity of a psychotic disorder can be defined by the level, number, and duration of psychotic signs and symptoms
  • Eight dimensions of psychosis: the five domains that define schizophrenia spectrum disorder as well as cognition, depression, and mania
37
Q

Malaspina et al article

A
  • Effort to improve reliability of Schizoaffective diagnosis in DSM-5.
  • Concept of Schizoaffective Disorder shifts from an episode diagnosis in DSM-IV to a life-course of the illness in DSM-5
  • When psychotic symptoms occur exclusively during a Mood Episode, DSM-5 indicates that it is the Mood Disorder with Psychotic Features.
  • Psychotic condition with two-week period and no prominent mood symptoms: may be Schizoaffective or Schizophrenia
  • DSM-5: diagnosis of Schizoaffective Disorder can only be made if full Mood Disorder episodes have been present for the majority of the total active and residual course of illness, from onset of psychotic symptoms up to the current diagnosis.

Psychopathology (16 decks)

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