Task 8 - Psychotic disorders

Question 1

What is psychosis?

Answer 1

Inability to tell the difference between what is real and what is unreal, e.g. see things that don’t really exist, believe others already know what the person is thinking

Question 2

What are the features that define psychotic disorders?

Answer 2

1. Delusions
2. Hallucinations
3. Disorganized thinking
4. Grossly disorganized/abnormal motor behavior
5. Negative symptoms (diminihed emotional expression or avolition)

Question 3

Define delusions

Answer 3

Fixed ideas that individuals believe are true but instead are highly unlikely or impossible even if showned with conflicting evidence.

Question 4

Define hallucinations

Answer 4

Perception-like experiences (i.e. vivid and clear, not under voluntary control!) without an external stimulus

Question 5

Explain disorganized thinking

Answer 5

Detected from speech, e.g. derailment/loose associations: unrelated speech/ person says many ideas but they are not coherent/part of a story; In extreme cases, it can resemble aphasia

Question 6

Explain the abnormal motor behavior

Answer 6

Ranges from childlike “silliness” to unpredictable agitation;
–> Catatonic behaviour: decrease in reactivity to environment, e.g. negativism: resistance to instructions, mutism: inappropriate/bizarre posture or excessive motor

Question 7

Define diminished emotional expressions

Answer 7

Reductions in expression of emotions in face, eye contact, intonation of speech, movements of head/face

Question 8

Define avolition

Answer 8

Decrease in motivated self-initiated purposeful activities, e.g. patient sits for long periods of time, shows little interest in participating social events

Question 9

How is the severity of schizophrenia assesed?

Answer 9

delusions, hallucinations, disorganized speech Abnormal behaviour and negative symptoms assessed on 5-point scale (0 = not present, 5 = present and severe)

Question 10

Explain the psychotic disorders along a continuum of severity

Answer 10

SC symptoms appear in mild to moderate forms in many people who do not meet the full criteria for any disorder

Further along continuum: personality disorders (PD), e.g. schizoid PD, paranoid POD, schizotypal PD: moderate symptoms but keep grasp of reality

Further along continuum: loss of touch with reality: individuals hold beliefs contrary to reality but lack other key SC symptoms and usually are not impaired in functioning, e.g. delusional disorder: delusions without hallucinations

Even More dysfunctional: schizophreniform disorder, where symptoms present for more than 1 month but less than 6

Question 11

What are other associated features with SC?

Answer 11

• Inappropriate affect, e.g. laughing for no reason
• Dysphoric mood, e.g. depression, low mood, anger
• Disturbed sleeping pattern
• Lack of interest in eating or food refusal
• Depersonalization and/or derealization
• Anxiety or phobias
• Cognitive problems, e.g. working memory (WM) impairments, reductions in attention, some show lack of theory of mind
• Anosognosia
• Aggression can be shown, more frequently by males

Question 12

What is anosognosia?

Answer 12

Lack of awareness of symptoms of the disorder; high predictor of non-adherence/compliance to treatment and/or relapse, poorer course of illness, increased number of involuntary movements, poorer functioning

Question 13

What is the prevalence of SC?

Answer 13

03.7% to 0.7%; Gender differences: more negative symptoms and longer duration is higher in males

SC emerges between late teens (in men) and late-20s (in women); mos individual show a slow and gradual development

Question 14

Is there a suicidal risk?

Answer 14

Yes,

Approximately 20% attempt suicide, 5-6% of SC patients die by suicide

Question 15

Is there comorbidity with other disorders?

Answer 15

Yee,

Over half have tobacco use disorder also comorbid with anxiety, OCD, panic disorders, Schizotypal or paranoid PD

Question 16

The schizophreniform disorders has 2 different types. What are these?

Answer 16

1. Schizophreniform with good prognostic features: good premorbid social and occupation functioning, absence of blunted affect/emotions
   2: Without good prognostic features: features of good prognostics are absent

Question 17

What is the prevalence of Schizophreniform disorder?

Answer 17

5 times lower than schizophrenia; in developing countries higher rates of good prognostic features

Question 18

What is the genetic contribution to developing a psychotic disorder?

Answer 18

• Strong genetic component in SC

- Finish study estimated SC heritability around 80%! (very high)

Question 19

What are the structural and functional brain abnormalities influencing the development of psychotic disorders?

Answer 19

• Enlarged ventricles, reductions in prefrontal areas and abnormal connections between PFC and amygdala and hippocampus
• Abnormalities in volume, density and metabolic rate in frontal cortex, temporal lobe, basal ganglia, hippo., thalamus, and maygdala
• Abnormalities in PFC –> deficits in cognition, emotion processing and social interactions

Question 20

Do birth complications and prenatal viral exposure affect the developing of a psychotic disorder?

Answer 20

Yes,

• around 30% of SC patients suffered perinatal hypoxia (oxygen deprevation at birth)
• Mothers exposed to viral infections whilst pregnant  higher chances for offspring to develop SC

Question 21

What are the possible explanations (not yet fully understood) for the influence of neurotransmitters?

Answer 21

• Excess dopamine activity in meso-limbic pathway; atypical antipsychotic medication that blocks activation of dopamine - reduced SC symptoms
• Unusually low dopamine in PFC - explains lack of motivation, inability to care for oneself, lack of emotions
• Glutamate abnormalities: glutamate is excitatory, especially in limbic system, thalamus and basal ganglia - explains movement sometimes observed in SC patients

Question 22

What does the Integrative model explain?

Answer 22

Abnormalities in PFC –> working memory deficits (WM) –> difficult to keep away/ignore irrelevant information –> difficulties in reasoning, communication and problem solving, all observed in SC patients

Question 23

What are the psychological perspectives of developing a psychotic disorder?

Answer 23

1. Social drift and urban birth
2. Stress and relapse
3. SC and family: expressed emotion families
4. Cognitive perspectives

Question 24

Explain the social drif and urban brith

Answer 24

o Social drift: SC symptoms interfere with ability to complete education/hold a job - SC patients show history of living in impoverished inner-city neighbourhoods and low-status occupations or unemployment
o Urban birth: SC patients show history of living in big cities; SC more prevalent in higher cities due to higher rates of diseases/viruses that are available

Question 25

What role does stress play in psychotic disorders?

Answer 25

It does not cause someone to develop SC, but has been shown to trigger new episodes in patients with the disorder

Question 26

How does family influence a psychotic disorder?

Answer 26

Families are over-involved with one another, overprotective of the ill family member and voice self-sacrificing attitudes toward family member whilst being critical, hostile and resentful

SC individuals that have such dysfunctional families show higher rates of relapse

Question 27

What are the cognitive perspective?

Answer 27

Attention, inhibition and communication difficulties in SC patients explained by limited cognitive resources, e.g. delusions arise when patient tries to explain strange perceptual experiences
Hallucinations result from hypersensitivity to perceptual input
–> e.g. instead of “I’m hearing things” SC patient thinks “Someone is trying to talk to me”

Question 28

One biological treatment for psychotic disorders is the use of Antipsychotic drugs such as chlorpromazine.

What are the (side) effects of the drugs?

Answer 28

reduces agitation, hallucinations and delusions in SC patients by blocking dopamine receptors to reduce its action in the brain; However, 25% of SC patients show no response to antipsychotic medication

Side effects:

1) Do not reduce negative symptoms
2) If drug is discontinued, 78% show relapse within 1year, 98% relapse within 2 years
3) Dry mouth, blurred vision, sexual dysfunction, weight gain or loss, menstrual disturbances in women
4) Akinesia
5) Tardive dyskinesia

Question 29

What is akinesia?

Answer 29

Slower motor activity, monotonous speech

Question 30

What is tardive dyskinesia?

Answer 30

Bizarre involuntary movements of tongue, face, mouth or jaw

Question 31

There is another biological treatment with the use of atypical antipsychosis drug such as clozapine.

How does it work? What are the side effects?

Answer 31

Binds to D4 dopamine receptor and blocks it - reduces SC symptoms (also negative ones). ; Other antipsychotic drugs stabilizes dopamine levels in the brain

Less side effects than classical antipsychotic drugs, but still can experience dizziness, nausea, seizures, weight gain and Agranulocytosis which is fatal

Question 32

How does Operant conditioning treatment works?

Answer 32

Family members encouraged to ignore bizarre behaviours of the patient and focus on reinforcing socially appropriate behaviour by giving it attention and positive emotional responses; Often use token economies (you get a coin for each good behavior)

Question 33

How does family therapy work?

Answer 33

Since expressed emotion within family can lead to increased risk for relapse  teach family members to cope with patient’s inappropriate behaviours and disorder’s impact on their lives; Families taught about biological causes, symptoms, medications and side effects to reduce self-blame in family members, increase tolerance and help to monitor medication use; Also taught appropriate techniques to facilitate operant conditioning treatment

Question 34

How does assertive community teatment paradigms work?

Answer 34

Medical professionals, social workers and psychologists work together to help the patient, e.g. by providing skills training, social support

Question 35

There different types of dellusions. What are they?

Answer 35

• Erotomanic: belief another person is in love with the individual
• Grandiose: conviction of possessing talent, insight, wealth, fame
• Jealous: beliefs his/her spouse/partner is unfaithful
• Persecutory: belief individual is followed, conspired against, cheated, spied on ir pursuit of long-term goals
• Somatic: believes individual has physical defect/medical problem
• Mixed: no single delusional theme predominates
• Unspecified: difficult to determine dominant delusional beliefs

Question 36

What is a bizzarre delision?

Answer 36

• Clearly implausible, e.g. belief outside force removed organs and replaced them with someone else’s organs without any wounds/scars;
• Component of loss of control over mind
  
  • -> e.g. thought withdrawal: beliefs one’s thoughts have been “removed” by some force
  • -> e.g. thought insertion: beliefs aliens put thoughts into one’s head or delusions of control: believes body actions are manipulated by some outside force

Question 37

What is a non-bizarre delusion?

Answer 37

They are beliefs that lack evidence, e.g. belief police/FBI is watching/tracking the individual