Module 10 – Psychotic Disorders

Psychosis

Inability to distinguish between what’s real and what’s not.

Psychotic Disorder

A disorder in which psychotic symptoms cause distress or impairment.

Schizophrenia

The most common psychotic disorder; involves positive, negative, and disorganized symptoms.

Psychotic Spectrum

Ranges from mild deficits (e.g., schizotypal personality disorder) to severe impairment (e.g., schizophrenia).

Positive Symptoms

Excess or distortion of normal functions (e.g., delusions, hallucinations, disorganized speech or behavior).

Negative Symptoms

Loss or reduction of normal functioning (e.g., flat affect, alogia, avolition).

Delusions

Fixed, false beliefs that are resistant to contradictory evidence.

Persecutory Delusion

Belief that one is being spied on, conspired against, or harmed.

Delusion of Reference

Belief that random events or comments are directed personally toward oneself.

Grandiose Delusion

Belief of having great power, talent, or importance.

Somatic Delusion

Belief that one’s body or part of it is diseased or altered.

Delusion of Control

Belief that thoughts or actions are controlled by external forces.

Difference Between Delusions and Self-Deception

Delusions are implausible, cause preoccupation, and resist contrary evidence.

Hallucination

Unreal sensory experience not based in external stimuli.

Types of Hallucinations

Auditory (most common), visual, tactile, olfactory, or gustatory.

Example – Hearing voices that insult or give commands.

Auditory Hallucination

Disorganized Speech

Incoherent or illogical thought patterns revealed through speech (e.g., word salad, loose associations).

Neologism

Creating new words or phrases with idiosyncratic meanings.

Clanging

Speaking in rhymes or sounds rather than logical sentences.

Echolalia

Repeating words or phrases spoken by others.

Disorganized Behavior

Unpredictable or inappropriate actions such as shouting, pacing, or poor hygiene.

Catatonia

Extreme lack of responsiveness; may include rigid posture or wild agitation.

Catatonic Excitement

Periods of excessive motor activity that are purposeless and repetitive.

Affective Flattening

Reduced emotional expression; flat tone and facial affect.

Alogia

Poverty of speech or decreased fluency and productivity of language.

Avolition

Lack of motivation to initiate or persist in goal-directed activity.

Phases of Schizophrenia

Prodromal (onset of subtle symptoms), Acute (active psychosis), Residual (recovery with residual symptoms).

Course of Schizophrenia

Chronic with high relapse rates and functional impairment.

Prevalence of Schizophrenia

About 1% of the population; more common in men.

Gender Differences in Schizophrenia

Men have earlier onset (~21 yrs); women have later onset (late 20s–30s) and better prognosis.

Factors Predicting Better Prognosis

Later onset, acute onset, good premorbid functioning, adherence to medication, supportive environment.

Genetic Risk of Scizophrenia

About 50% concordance in identical twins; strong familial component.

Diathesis-Stress Model

Genetic vulnerability combined with environmental stressors increases risk for schizophrenia.

Prenatal Risk Factors

Maternal flu, infections, birth complications, hypoxia, and Rh incompatibility increase risk.

Developmental Markers of Risk

Delayed milestones, poor motor coordination, and reduced positive affect in childhood.

Structural Brain Abnormalities

Enlarged ventricles, reduced cortical thickness, and abnormal white matter connectivity.

Functional Brain Abnormalities

Overactivation of Broca’s area during hallucinations (produces speech rather than comprehending it).

Dopamine Hypothesis

Excess dopamine activity leads to positive symptoms (hallucinations, delusions).

Glutamate Hypothesis

Low glutamate activity may contribute to negative and cognitive symptoms.

Sensory Processing Deficits

Problems with smooth eye tracking and sensory gating (difficulty filtering repetitive stimuli).

Expressed Emotion

High levels of criticism, hostility, or overinvolvement in families predict relapse.

Environmental Risk Factors

Urban upbringing and minority immigrant status increase risk.

Cannabis Use and Psychosis

Early and high-potency cannabis use linked to earlier onset and higher risk of psychosis.

Brief Psychotic Disorder

Psychotic symptoms lasting 1 day to 1 month, often following stress.

Schizophreniform Disorder

Symptoms identical to schizophrenia but duration less than 6 months.

Schizoaffective Disorder

Schizophrenia symptoms plus a mood disorder; psychotic symptoms persist outside mood episodes.

Schizotypal Personality Disorder

Subthreshold psychotic-like features, odd beliefs, and social deficits.

Typical (First-Generation) Antipsychotics

Dopamine antagonists that reduce positive symptoms but have major side effects.

Common Side Effects of Typical Antipsychotics

Sedation, weight gain, tremors, and tardive dyskinesia (involuntary movements).

Atypical (Second-Generation) Antipsychotics

Affect dopamine and serotonin; fewer motor side effects but risk of metabolic issues.

Advantages of Atypical Antipsychotics

Fewer extrapyramidal side effects; can improve some cognitive symptoms.

Disadvantages of Atypical Antipsychotics

Risk of weight gain, diabetes, and irregular heartbeat.

Psychological Treatments for Schizophrenia

Cognitive remediation, social skills training, family therapy, and case management.

Assertive Community Treatment

Comprehensive, multidisciplinary care that provides support in the community (“hospital without walls”).

Cognitive Remediation

Exercises to improve working memory, attention, and executive functioning.

Behavioral Interventions

Social skills and problem-solving training to reduce functional impairment.

Family Therapy for Schizophrenia

Educates family, reduces expressed emotion, and improves medication adherence.

Prognosis and Treatment Outcomes

Early intervention improves outcomes; relapse rates reduced by combining medication and CBT.

Example Scenario – A man believes the government is monitoring his thoughts through his TV.

Delusion.

Example Scenario –A woman hears voices commenting on her behavior when no one is present.

Auditory Hallucination.

Example Scenario – A person remains in one posture for hours and resists attempts to move.

Catatonic Behavior.

Example Scenario – A person experiences hallucinations even after their depressive episode ends.

Schizoaffective Disorder.

Example Scenario – A patient develops involuntary facial movements after long-term antipsychotic use.

Tardive Dyskinesia.

Example Scenario-what therpy? – Therapist helps client challenge delusional beliefs while developing coping skills.

Cognitive-Behavioral Therapy.