Types of Psychotic Disorders
PSYCHOTIC SYMPTOMS
positive symptoms
-hallucinations
-delusions
-disorganized behaviour
-disorganized speech
PSYCHOTIC SYMPTOMS
negative symptoms
-affective flattening
-anhedonia
-alogia
-avoliition
-asociality
schizophrenia -neurobiology
-genes
-psychosocial adversity in childhood
-ongoing or recent psychological stress
-dopamine
-serotonin
hallucinations
Perceptual Disturbances- anything that alters the 5 senses
delusions
○ A false, fixed belief, based on an incorrect inference about reality, not shared by others,
inconsistent with the individual’s intelligence or cultural background and which cannot be corrected by reasoning
Persecutory/Paranoid
delusions
Think being watched, ridiculed, harmed or plotted against ● Someone spying on me..they will hurt me
magical thinking delusions
If I do ___, there will be an earthquake
grandiose delusions
exceptional powers, wealth, skill, influence or destiny
● I am prime minister, I am(/will be) famous
Somatic delusions
Think they have abnormality in body or medical problem
● My hand doesn’t belong to me,
● infested w/ parasites
Affective Flattening or blunting:
restriction or flattening in the
range and intensity of emotion, (little or no emotion shown- they understand the emotion, they cannot express it
Alogia:
Reduced fluency and productivity of thought and speech
■ reduction in quantity of words spoken
poverty of speech- difficulty getting words out
Anhedonia
inability to experience pleasure.
Avolition
withdrawal and inability to initiate and persist in goal-directed activity (may not do ADLs..ex:dressing)
■ decreased motivation
-loss of ability to do anything
Asociality
no desire to be social or to be around people
difference between amotivation and avolition
-amotivation- loss of motivation towards anything, can be social, work, etc.
-avolition is loss of motivation towards a goal oriented activity- ex. work, school
Neurotransmitter Influence on Psychotic Symptoms-
dopamine
-influences decision making –> disorganized behaviour –> disorganized thinking
-influence motivation –> amotivation- avolition
-influence arousal- asociality
-signals pleasure and reward -anhedonia
Neurotransmitter Influence on Psychotic Symptoms
-seratonin
-feeling –> affective flattening -mood
-energy level–> avolition
-social behaviour –> ascoiality -anhedonia
-sexual desires –> amotivation- anhedonia
-perception -hallucinations -delusions
-Sensorium & cognitive functions –> memory -attention
-somatic functions –> appetite -sleep
Schizophrenia: Diagnostic Criteria (DSM-5, 2013)
Diagnostic Criteria: Schizophrenia
Two or more of the following symptoms each present for a significant length of time over 1 month
-Delusions
-Hallucinations
-Disorganized speech
-Grossly disorganized or catatonic behavior
-Negative symptoms -avolition, anhedonia, affective flatting, asociality, amotivation
-Social or occupational dysfunction
- Symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning
- Episode not attributable to physiological effects of a substance or another medical condition
- Episode not better explained by schizoaffective disorder, schizophreniform disorder, delusional disorder, or other psychotic disorder
Schizoaffective Disorder: Diagnostic Criteria (DSM-5, 2013)
Diagnostic Criteria: Schizoaffective Disorder
At least 2 symptoms of a psychotic disorder for 2 or more weeks
-Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganized or catatonic behavior
- Negative symptoms-flat affect, anhedonia, avolition, amotivation, asociality
+
-A major mood episode that lasts for an uninterrupted period of time
- Mood symptoms present for the majority of the illness
Psychotic Disorders: Pharmacotherapeutic Interventions: Antipsychotics
-First generation or atypical antipsychotics increase dopamine in the brain to help reduce or relieve the symptoms of schizophrenia
-Second generation or atypical antipsychotics increase both dopamine and serotonin
-Antipsychotics are always offered with adjunctive non-pharmacological interventions to improve clinical outcomes
Psychotic Disorders: Pharmacological Interventions: Antipsychotics
FIRST GENERATION
“TYPICAL”
Haloperidol (Haldol) - commonly used in the ED but should not be repeated doses
Thorazine (Chlorpromazine)
Fluphenazine (Moditen, Modecate)
Trilafon (Perphenazine) Loxapine (Loxitane)
Thioridazine (Mellaril)
Psychotic Disorders: Pharmacological Interventions: Antipsychotics
SECOND GENERATION “ATYPICAL”
Olanzapine (Zyprexa) - causes the MOST weight gain, also the most common drug and can be used orally or a long-acting injection
Quetiapine (Seroquel) Ziprasidone (Zeldox) Paliperadone (Invega) Aripripazolole (Abilify) Risperidone (Risperdal) - oral and long-acting injection
Clozapine (Clozaril)-lowers WBC count = risk of infection so constantly needs blood work, stop taking if reaction occurs but there are less side effects and a better response
Possible Side Effects of Antipsychotic Medications
Anticcholinergic effects
Dry mouth (can use a life saver or butter scotch candy to counter this), constipation, urinary retention, bowel obstruction, dilated pupils, blurred vision, increased heart rate, decreased sweating