Psychotic Disorders

What is schizophrenia?

Characterized by a broad spectrum of cognitive, behavioral, and emotional dysfunctions that include delusions, disorganized speech and behavior, and inappropriate emotions

What does the term schizophrenia mean?

It means 'split mind,' relating to a split from reality rather than an actual split in the mind

What percentage of the global population suffers from schizophrenia?

Approximately 1%

What are positive symptoms of schizophrenia?

Refers to active manifestations of abnormal behavior or an excess of distortion of normal behavior — delusions, hallucinations, disorganized thinking/speech, grossly disorganized or abnormal motor behavior

What are negative symptoms of schizophrenia?

Refer to the absence of insufficiency of ‘normal’ behavior and include emotional and social withdrawal — avolition or apathy, alogia, anhedonia, affective flattening

What is the typical age range for the onset of schizophrenia according to DSM-V?

Between 18-35 years, younger in men than women

What are common biological treatments for schizophrenia?

Drug therapy, including typical and atypical antipsychotics

What psychological treatments are used for schizophrenia?

Behavioral approaches, behavioral family therapy, and vocational and social skills training

Schizoaffective disorder?

When the individual suffers from symptoms of schizophrenia AND a mood disorder (manic or depressive) — hallucinations and/or delusions must be present for at least 2 weeks when the symptoms of a mood disorder are not active

What are the clinical characteristics of schizophrenia?

They include both positive and negative symptoms as outlined in diagnostic manuals — individual must exhibit symptoms for at least 6 months, including at least one month of active-phase symptoms (or less if succesfully treated) and their level of functioning is markedly below the level prior to onset in one or more areas (work, interpersonal relations, self-care)

Types of delusions

Delusions of persecution, grandiose delusions, referential delusions, delusions of being controlled

Grossly disorganized or abnormal motor behavior

Includes acting in unusual ways, marked agitation, dressing unusually or appearing markedly disheveled, and catatonia (motor dysfunctions that range from complete immobility to wild agitation)

Hallucinations

Experiencing a sensory event without any actual input from the environment (can include any of the senses, most common are auditory)

Disorganized thinking/speech

Includes cognitive slippage (illogical and incoherent speech), tangentiality, loose associations, word salad

Avolition or apathy

The inability to initiate and engage in activities, even basic ones like personal hygiene

Alogia

Relative absence of speech (could manifest as brief replies, slowed responses, or delayed comments)

Anhedonia

A lack of pleasure or indifference to activities that are considered pleasurable

Affective flattening

An absence of normally expected emotional responses (difficulty in expressing emotion — not an inability to feel emotion)

Psychotic

Generally refers to the presence of delusions, hallucinations, disorganized thinking, or disorganized or abnormal motor behavior

Schizophrenia derived from Greek words…

“split mind”

Between acute episodes of schizophrenia

May still be unable to think clearly, may speak in a flat tone, may have difficulty perceiving emotions in other people’s facial expressions, and may show little if any facial expressions of emotions themselves

Prodromal Phase

Early symptoms and signs of an illness that come before the characteristic symptoms appear

Prodromal Phase in Schizophrenia

People tend to isolate themselves, school and work performance suffers, lose interest in activities, and may show inappropriate or blunted emotions

Residual Phase in Schizophrenia

Final stage of schizophrenia — features very similar to the prodromal stage

Symptoms in Residual Phase

May experience some negative symptoms such as lack of emotional expression or low energy… Do not have delusions or hallucinations, may continue to experience strange beliefs

Schizophrenia in Forensic Populations

Current literature reveals that individuals diagnosed with schizophrenia have been involved in crime and arrested more frequently than the general population, they are overrepresented in correctional settings, and they represent the majority of those found not guilty by reason of insanity

Unclear Link Between Schizo. in For. Pop.

Is it related directly to the mental illness, or to other risk factors like poverty, being unskilled, uneducated, and unmarried (all which are strong predictors of antisocial/violent behavior in the mentally ill)

Schizophreniform Disorder

Involves the same symptoms present in schizophrenia but the time frame is different (at least one month but no more than 6 months) and impaired functioning is not required for the diagnosis

Number of ppl w/ Schizophreniform Disorder who eventually get Diagnosed with Schizophrenia

2/3

Delusional Disorder

Display persistent beliefs (bizarre or nonbizarre) that is contrary to reality in the absence of most other psychotic symptoms… must not exhibit prominent symptoms of schizophrenia and functioning is not markedly impaired

Types of Delusions in Delusional Disorder

Erotomanic, grandiose, jealous, persecutory, and somatic type

Brief Psychotic Disorder

Experience one or more positive symptoms of schizophrenia within one month — often precipitated by an extremely stressful situation/commonly dissipated on own

Psychotic Disorders Length/Symptoms

Schizophrenia = 6+ months

Schizophreniform = 1–6 months

Brief Psychotic = less than 1 month

Schizoaffective = psychosis + mood disorder

Delusional Disorder = delusions without most other psychotic symptoms