Psychopathology: Key Concepts in Schizophrenia, Mood Disorders, and Trauma

Alogia

Poverty of speech

Asociality

Lack of interest in social interactions

Apathy

A lack of feeling, emotion, or interest

Avolition

Decreased engagement in purposeful, goal-directed actions

Ex. self care

Anhedonia

Inability to experience pleasure

Somatic symptom disorder (aka somatization disorder)

Physical complaints without physical pathology

Does not involve conscious malingering

Illness anxiety disorder (aka Hypochondriasis)

Preoccupation with fears of having/getting serious, life-threatening disease

High anxiety, without specific focus

Conversion disorder (functional neurological symptom disorder)

Actual physical disability is present "hysteria"

- Sensory, motor or visceral symptoms without organic pathology

- Secondary gain

Factitious Disorder: (Munchausen Syndrome)

Intentional production of symptoms to gain attention from medical providers

Factitious Disorder by Proxy (MSBP)

Intentional production of symptoms in another (generally a child)

Primary Gain:

Internal chief goal (medical attention or sympathy)

- Factitious Disorder

- Munchausen syndrome (imposed on self)

- Munchausen by Proxy - imposed on another, often a child or elderly patient

Secondary Gain:

External chief goal (day off from work, compensation)

- Malingering

Malingering

Knowingly lying about being afflicted with symptoms

- Typically trying to avoid something negative or gain something positive

- Ex. avoid going to jail / be gifted lots of money for condition

Positive (Type 1) signs of psychosis:

Hallucinations, Delusions, Incoherence, Bizarre/disorganized behavior

Negative (Type 2) signs of psychosis:

Alogia (Poverty of speech), Emotional flattening, Asociality, Avolition/Apathy

- poorer prognosis

Types of hallucinations

Auditory (75%)

Visual (15-40%)

Olfactory (1-7%)

Tactile

Gustatory

Schizophrenia:

- symptoms > six months:

hallucinations, delusions, and significant disorganization of speech.

Schizophreniform Disorder:

- (delusions/hallucinations) < six months

- may be an early or less severe form of schizophrenia

Schizoaffective Disorder:

Mania/depression + schizophrenia

- (delusions/hallucinations) > 2 weeks in absence of mood episode, but with depression or mania

- can be bipolar or depressive type

Bipolar I:

Delusions/hallucinations present ONLY during mood episode

Brief Psychotic Disorder

Sudden onset of psychotic behavior for < 1 month

- Complete remission with possible future relapses

Delusional Disorder

Firmly held false beliefs (delusions) for at least 1 month,

- Without other symptoms of psychosis

- No negative symptoms

Schizotypal Personality Disorder

Personality disorders within Cluster A

(disorders marked by odd or eccentric behavior)

- No negative symptoms

Depressive episode:

5 symptoms, for at least 2 weeks

- Episodes are 6-9 months on average

Relapse: return of symptoms within a short period of time

(Often when meds are discontinued)

Manic episode:

Elevated, expansive, irritable mood lasting at least 1 week

- Clinically significant distress, impairment, hospitalization, or psychotic features

Hypomanic episode:

Manic signs for at least 4 days instead of 1 week (manic episode)

- Noticeable, but not severe enough to cause marked impairment in functioning

Persistent depressive disorder:

Symptoms must persist for at least 2 years

- brief normal moods can occur (less than 2 months)

Bipolar 1 vs Bipolar 2

Bipolar 1: one or more Manic Episodes

Bipolar 2: one or more Major Depressive Episodes/Hypomanic Episodes

- No history of Manic Episode

Seasonal affective disorder (SAD)

Commonly begins in late fall

Symptoms: depression & anhedonia, decreased energy, oversleeping, overeating, crave carbohydrates, achy muscles/joints, social withdrawal

- Treatment: Bright light therapy

Endogenous depression:

Not triggered externally

- Melancholia (persistent depression and ill-founded fears)

Exogenous depression:

External trigger

- Predominant sadness

Causes: Marital conflict, parental separation, divorce, illness/death in family, loss of employment

Tripartite Model & Emotion Theory

-shows how depression and anxiety often co-occur and how they can be distinguished

High Negative Affect (NA): Both anxiety and depression

Low Positive Affect (PA): Depression.

Physiological Hyperarousal (PH): Anxiety

Atypical depression

Depression with mood reactivity (mood brightens to actual or potential positive events)

- 2 or more of the following: Significant weight gain/increase in appetite, hypersomnia, leaden paralysis (heavy feelings in arms/legs), rejection sensitivity

- A common type of depression among adults abused as children

Melancholic depression

Severe anhedonia

- Prominent physical symptoms: insomnia, weight loss, psychomotor agitation

- Considered "biologically-based", Less common among females

Post-partum depression

Core symptoms of depression plus:

-Anxiety, worry, panic attacks, Intense irritability/anger, mood swings, Difficulty bonding with baby, Withdrawal from friends, family, Difficulty caring for the baby, Thoughts of harming oneself or baby

- Symptoms begin during pregnancy or first weeks after birth

Psychotic depression

Core symptoms of depression plus:

- Hallucinations or Delusions

- Disordered Thinking

- Paranoia

Psychotherapy:

(CBT) Cognitive behavioral therapy:

Reframing thoughts

- As effective as medications; better at preventing relapses and recurrences

Psychotherapy:

Behavioral activation therapy:

Reducing avoidance

- Construct hierarchy (easy activities to accomplish)

Psychotherapy:

(MBCT) Mindfulness-Based Cognitive Therapy:

Research shows improvement ONLY for those with 3+ episodes

Psychotherapy:

(IPT) Interpersonal therapy:

Identify and change maladaptive interaction patterns with others.

- As effective as medications and CBT

Trauma:

Type 1 trauma:

Acute, unforeseeable, and singular

- Ex. car accident; sexual assault

- Typically, outside the context of an existing relationship

- Typically respond to treatment

Trauma:

Type 2 trauma:

Repeated and prolonged

- Polyvictimization (e.g. CSA and neglect),

- Often ongoing relationship (e.g., caregiver; partner)

- Typically harder to treat; comorbidities

Trauma:

Complex traumas

Chronic, sustained trauma experiences

- Childhood?

- Repetitive trauma in context of significant interpersonal relationships

Selye's General Adaptation Syndrome (GAS)

(GAS): the body responds to prolonged stress through three distinct stages

- Alarm Reaction Stage: Fight or flight is activated

- Resistance stage: Body attempts to cope w/ stress

- Exhaustion stage: Body's resources are depleted

Fight or flight activates the:

Rest and recovery is the:

Sympathetic Nervous system

Parasympathetic nervous system

Acute Stress Disorder (ASD)

Similar to PTSD, More dissociative symptoms*

- critical window for early intervention to prevent PTSD.

- Occurs within 4 weeks of the trauma

- Symptoms last between 2 to 30 days

If symptoms persist > 30 days diagnosis changed to PTSD

Adjustment disorder

similar to PTSD: Less extreme stressors

- Ex. divorce or job loss.

- Symptoms must be disproportionate to the stressor and impair functioning

- Treatment: Psychotherapy, sometimes medications

Brain structures and PTSD:

Amygdala:

Processes fear and emotional memories.

PTSD: Becomes hyperactive, leading to exaggerated fear responses and heightened emotional reactivity.

Brain structures and PTSD

Hippocampus:

Involved in memory formation and distinguishing between past and present experiences.

PTSD: reduced volume and impaired function, contributing to flashbacks and difficulty distinguishing safe from dangerous situations.

Brain structures and PTSD:

Hypothalamus:

Regulates autonomic nervous system, initiates the stress response.

PTSD: Dysregulation can lead to chronic activation of the stress response system.

Brain structures and PTSD:

HPA Axis (Hypothalamic-Pituitary-Adrenal Axis):

Governs the body's hormonal response to stress, including cortisol release.

PTSD: abnormal cortisol levels—either elevated or blunted—disrupting the body's ability to manage stress