Psychotic disorders 2/6

what is psychosis

Psychosis = a condition where a person loses contact with reality.

• Affects:

  • Perception (what you see/hear)

  • Thinking

  • Emotions

• People may not realize their experiences aren’t real

• Psychosis is a symptom, not a disorder itself

Schizophrenia positive symptoms:

Positive symptoms (added experiences)

• delusions: beliefs that are misinterpretations of reality (bizare and non-bizarre)

• hallucinations: sensory experiences without external stimulus

  • auditory: most common

  • visual: second most common

  • tactile (touch)

  • somatic (mind)

  • ofactory (smell)

Schizophrenia negative symptoms:

○ Absence or insufficiency of typical behaviour

• Avolition - initiate/persist at basic activities

• Alogia - amount of speech

• Anhedonia - pleasure/interest

• Affective flattening - emotional expression

• Asociality - social relationships/skills

Schizophrenia: disorganized thinking (speech)

• Erratic speech, motor behaviour, and emotions

• Inappropriate affect

• Disorganized behaviour - acting in usual ways, unusual dress

• Catatonia - motor dysfunctions that range from agitation to immobility

  • Waxy flexibility

• Disorganized speech - tangentiaty, loose associations, derailment

Types of Delusions

1. Of guilt or sin (usually bizarre)

2. Somatic (bizarre or non)

3. Of reference (usually bizarre)

4. Grandiose (bizarre or non)

5. Of being controlled (usually bizarre)

Schizophrenia DSM-5 Criteria

A. 2 or more of the following, each present for a significant portion of time during a 1-month period

1. Delusions

2. Hallucinations

3. Disorganized speech

4. Disorganized or catatonic behaviour

5. Negative symptoms

MUST INCLUDE 1,2 OR 3

B. Impaired functioning

C. Continuous disturbance for 6 months (prodromal symptoms)

schizophrenia key features

• Usually begins:

  • Late teens → early adulthood

• Affects:

  • Thinking

  • Emotions

  • Behaviour

Schizophrenia: who is most likely to develop it in families

1. monozygotic twins (from same egg)

2. offspring of 2 parents w/ schizophrenia

3. dizygotic twins (split egg)

Schizophrenia biological influences:

genetics:

• inherit a TENDENCY for psychosis

• Close genetic relatives of people with schizophrenic disorders are at increased risk for schizophrenia

• risk for monozygotic twins is half, dizygotic is around 1/5

viral infection:

• Prenatal exposure increases risk

• Maternal flu infection in the second trimester can triple risk

• Other infections (e.g., rubella, toxoplasmosis, and cytomegalovirus) have also been implicated

• Immune system activation and neuroinflammation affecting fetal brain development

Genain quadruplets:

• Identical quadruplets all developed schizophrenia - strong genetic component of the disorder

• Variation

• youngest had most severe, unremitting symptoms; the third-born has mildest, later in remission

• Grandmother had schizophrenia; father was "disturbed" and possibly abusive (stress)

• Child treated best had most mild symptoms

• Testing over decades showed stable or improved cognition, challenging the idea of progressive decline

Schizophrenia psychological influence:

• stress: can activate underlying vulnerability

• Family interactions - "expressed emotion" associated with relapse

• Social drift - people in urban areas have higher rates of schizophrenia

The sociogenic hypothesis and The social-selection theory

The sociogenic hypothesis - stressors having low income contribute to onset of schizophrenia

The social-selection theory - those with the disorder move to impoverished areas of city due to lack of resources or access to social services

schizophrenia environmental factors:

• Drug use (especially cannabis, stimulants)

• Urban living

• Social isolation

• Prenatal complications

Diathesis-Stress Model

• Biological vulnerability + stress = disorder

Biological treatments: Medication

Medication:

• antipsychotics, drugs used to treat psychosis

  • blocks dopamine receptors, reducing reward need (ultimately reducing psychotic symptoms)

  • most effective for: positive symptoms (hallucinations and delusions)

  • least effective for: negative symptoms (motivation, emotion, social withdrawl)

  • can also increase negative symptoms, making patients feel numb

  • Compliance issues: many people stop taking medication due to increased negative symptoms

• Tardive dyskinedia: side effect of long-term anti psychotic use

  • includes involuntary movements (lip smacking, tongue movements, facial twitching)

  • can be permanent

  • more common in older (typical) antipsychotics

Biological treatments: Transcranial magnetic stimulation

• Exposure to magnetic fields that up and down regulate brain regions (uses magnetic pulses on the brain)

• increases activity in frontal lobe (more motivation)

• reduces activity in temporal lobes (reducing hallucinations)

Psychosocial Treatments

• Early intervention programs

  • Coping skills, stress management, medication compliance, psychoeducation

• social skills training

  • Social judgments, taking turns talking, role plays

• Community care and vocational programs

• Cognitive-behavioural therapy - reality testing, behaviour activation, recognizing triggers

Prognosis and Outcomes

• 50-80% of people who have one episode will have another

• 38% recovery rate - significantly reduced symptoms and restoration of function, linked with early intervention and social support

• Life expectancy shortened 10 years - social determinants of health

• Smoking/substance use ○ Less access to healthcare

• Unemployment

• Social isolation

• Lack of housing

• Need for reduced stigma and comprehensive care for people with schizophrenia to improve outcomes