W10: Schizophrenia & Psychotic Disorders Flashcards
What is psychosis?
A ‘break with reality’
It is a symptom, not an illness. Caused by a variety of conditions
What are the five key features of psychosis?
- Hallucinations
- Delusions
- Disorganised thinking (speech)
- Grossly disorganised or abnormal behaviour (catatonia)
- Negative symptoms
What is the most severe of the schizophrenia spectrum and other psychotic disorders listed in the DSM?
Schizophrenia
What is typically diagnosed when someone has psychotic symptoms but not severely enough to be included in this part of the DSM?
Schizotypal Personality Disorder
What is a positive symptom?
Things that are ‘added’ or new things experienced that they didn’t before
What is a negative symptom?
Something ‘subtracted’
A loss or absence of normal traits of abilities
What positive symptoms are involved in schizophrenia and psychotic disorders?
Hallucinations
Delusions
Bizarre behaviour
Positive formal thought behaviour
What negative symptoms are involved in schizophrenia and psychotic disorders? (5)
Alogia Affective flattening Avoilation-apathy Anhedonia-asociality Attentional impairment
Alongside positive and negative symptoms, what is the 3rd grouping of symptoms?
Disorganisation
chaotic speech, thought and behaviour
What does the DSM say about schizophrenia?
Need to have 2 or more of the following - for most of one month - with at least one being one of the top 3 Delusions Halluncinations Disorganised speech Disorganised or atatonic behaviour Negative symptoms
Level of functioning in one or more areas (work, self care) is below the level achieved prior to onset
Persists for at least 6 months (including one month of symptoms that meet the first point)
Schizoaffective disorder and depressive or bipolar disorder have been ruled out (no depressive or manic episodes have occurred)
Not attributable to a substance or another medical condition
What if there is a history of autism or a communication disorder in a schizophrenia diagnosis?
Diagnosis should only be made if prominent delusions or hallucinations in addition to the other required symptoms of schizophrenia are present for at least one month
What are delusions?
Strange beliefs that are maintained despite evidence to the contrary
Can people with schizophrenia rationalise their delusions?
Some people, particularly high functioning people, can rationalise their delusional beliefs
BUT it may be a constant struggle because while they can rationally see that their belief is not supported by evidence, it just doesn’t ‘feel’ right
What are hallucinations?
Perception in the absence of sensory stimulation
May be: Auditory Visual Somatic/tactile Olfactory
Not just like imagining someones voice - like you are hearing actual voices.
What are the different kinds of disorganization symptoms?
Means disturbances in the logical process of thought - apparent in speech and behaviour
Positive thought disorder
Bizzare behaviour
What is positive formal thought disorder?
Derailment Tangentiality (go off on tangents) Incoherence Illogicality Circumstantiality Pressure of speech Distractable speech Clang associations (grouping words together)
What is bizarre behaviour?
Bizarre clothing and appearance
Bizarre social and sexual behaviour
Aggressive and agitated behaviour
Repetitive or stereotyped behaviour
What is affective blunting?
Unchanged facial expression
Decreased spontaneous movements
Poor eye contact
Lack of vocal inflections
What is alogia?
Poverty of speech
Blocking
Increased latency of response
What is avolition-apathy?
Poor grooming and hygiene
Impersistence
Physical anergia
What is anhedonia-asociality?
Decrease in recreational interests and activities
Decrease in sexual interest
Decreased ability to feel intimacy and closeness
Diminished relationship with friends and peers
What factors promote a good prognosis?
Late onset
Obvious precipitating factors (identified trigger = management plan)
Good pre-morbid social, sexual and work history
Acute onset
Married (if male)
Mood disorder symptoms
Good support systems
Fewer psychotic episodes
Continued use of medications
What factors contribute to a poor prognosis?
Young onset
No precipitating factors
Insidious onset
Poor social, sexual and work history
Withdrawn, autistic behaviour
Single, divorced, widowed
Family history of schizophrenia
Poor support systems
Negative symptoms (lead to withdrawal)
Many psychotic episodes
Inconsistent use of medication
Explain the bio-psycho-social model of schizophrenia
Genetic: family history, inheritance of certain gene variants
Neuro-developmental: prenatal, obstetric complications
Environmental/social: childhood trauma, low SES backgrounds (access to timely interventions), substance use
Psychological: information processing biases, maladaptive self and world schemas (core beliefs)
What are some key cognitive processes that are involved in schizophrenia?
Distorted information processing: biased reasoning contributing to symptom formation and maintenance
Jumping to conclusions: hasty decision making, drawing inferences based on limited data
Bias against disconfirmatory evidence: difficulty disengaging from initial faulty interpretation
Impaired TOM and monitoring of own and others mental states and behaviours
What is the most important part of treatment in psychosis?
Medication - pharmacotherapy
What are first generation antipsychotics?
Oral or depot (none of better efficacy)
80% of people respond to them but there are common significant side effects such as:
- restlessness/anxiety
- cramping of face, tongue and neck
- antipsychotic induced Parkinsonism (rigidity and tremor) although reversible
- tardive dyskinesia (sometimes irreversible) which is chronic involuntary movements of the tongue, face and neck, extremities or trunk
- sedation
Explain second generation antipsychotics
They have different receptor profiles with more specific mechanisms of action (blocks D1 not D2 receptors)
What are some second generation antipsychotics?
Amisulpride, aripiprazole, clozapine etc
What makes second generation antipsychotics better than the first generation antipsychotics
There are fewer motor symptoms less Tadive dyskinesia
There is also a positive affect on cognitive symptoms
Are there any side-effects to 2nd generation antipsychotics
Serious weight gain is a significant side-effects
What are third-generation antipsychotics
They are a different mechanism of action with a partial agonist against D2 receptors
What are the advantages of third-generation antipsychotics
Minimal potential weight gain glucose intolerance and anti-cholinergic effect
What mild potential do 3rd generation antipsychotics bring?
Muscle tension type symptoms and tardive dyskinesia
Finding the right medication for a client is…
A process of trial and error
What can psychological interventions such as therapy provide someone with psychosis or schizophrenia with
Coping mechanisms especially those that reduce stress important
Provides a secure base which is important as it becomes a part of the social support network it may help you to catch symptoms earlier to allow intervention
What is the goal of using CBT For schizophrenia
The goal is to live with it not to eliminate
What is the process of CBT for someone with schizophrenia
Motivation building
psycho education - learning about your illness and learning about triggers and relapse symptoms
Life skills development such as managing treatment and medications
Exploring evidence against thoughts and hallucination so you can learn to recognise them and filter them out especially command hallucinations
How can CBT be used for negative symptoms of schizophrenia
Psycho education in normalisation
Re-engaging with meaningful life goals via activity scheduling with pleasure and mastery activities such as goalsetting and graded task assignments in small achievable goals
Explain family intervention For people with schizophrenia
Works on that idea of a social support network
Include psychoeducation so that everyone is on the same page
Emotional processing of grief loss and anger to normalise it and then reframe it
Communication skills training
To reduce expressed emotion reduce criticism hostility and over involvement or anything that is stopping the person with the condition from self managing
Problem solving skills for problems that are existing or may arise, setting realistic goals, self-care family members and carers who are directly involved in providing care for family members with the condition
