PSYC 372 Unit #10

Psychosis

• a significant loss of contact with reality
• a hallmark of the schizophrenic-spectrum disorders

Schizophrenia

• a mental health problem affecting all walks of life
• characterized by a diverse array of symptoms
• a syndrome which typically begins around late adolescence or early adulthood

NOT related to schizophrenia

• Psychopath/Sociopath:
  • The terms are mostly synonymous and largely
  overlapping with Antisocial Personality Disorder
  • Lack in empathy, manipulative, charming

• “Multiple-Personalities”:
  • Outdated term for Dissociative Identity Disorder
  • Common misconception that this is the same as Schizophrenia

• Antisocial:
  • See psychopath above
  • Acting out in ways which go against social norms

Schizophrenia-Relevant

• Psychosis (i.e., Psychotic):
  • Significant disconnect from reality
  • Can include delusions/hallucinations

• Delusion:
  • Disturbance in content of thought
  • Erroneous belief
  • Fixed and firmly held despite clear contradictory evidence

• Hallucination:
  • Disturbance in sensation of environment
  • Seems real but occurs absent of any external stimulus
  • Can occur in any sensory modality

• Asocial:
  • Withdrawn, reserved from socializing

Delusions

• Erroneous belief, firmly held despite clear contradictory evidence,
  disturbing the content of thought

• Common Examples:
  • Made Feelings: “they’re controlling my body”
  • Thought Broadcasting: “they’re sending my thoughts over radio”
  • Thought Insertion: “the police are planting thoughts in my head”
  • Delusions of Reference: “that song on the radio was written for me,
  she’s secretly trying to communicate with me”
  • Delusions of Persecution: “the government is out to get me so I need
  to stay in hiding”
  • Delusions of Grandeur: “I am Buddha and Jesus put together

Hallucinations

• Sensory experience which seems real but occurs in absence of any external perceptual stimulus, and can occur in any sensory modality. Hallucinations can often become interwoven into the delusions.

• Examples:
  • Auditory Hallucinations (by far most common, seen in 75% of schizophrenia patients): hearing voices
  • Visual Hallucinations (second most common): seeing images of the deceased
  • Olfactory / Tactile / Gustatory (least common): feeling an unexplained itchiness, crawling skin

Disorganization

• Failure to make sense despite conforming to semantic and syntactic rules of speech, thus a disturbance in form (not content) of thought

• Examples:
  • Disorganized Speech:
  - Cognitive slippage, loosening of associations, or complete incoherence
  - Use of words such as “detone” or “conframble” which may resemble real words but have no meaning
  - Word pairs and phrases which are comprised of real pieces of language, but together lack sense and meaning
  • Disorganized Behavior:
  • Poor dress, living situation, and daily functionality
  • Catatonia

Symptom Clusters

• “Positive” Symptoms (addition, excess)
  • Hallucinations
  • Delusions

• “Negative” Symptoms (subtraction, deficiency)
  • Affect Flattening
  • Asociality
  • Apathy
  • Anhedonia
  • Alogia

• Disorganized Symptoms
  • Bizarre Behavior
  • Disorganized Speech

Schizophrenia

A) Presence of two or more of the following (at least one must be #1, #2, or #3):
1) Delusions
2) Hallucinations
3) Disorganized Speech
4) Grossly Disorganized or Catatonic Behavior
5) Negative Symptoms
B) Functioning markedly low across areas, for a significant time, since disturbance began
C) Lasts at least 6 months and Criterion A is active at least 1 month total (may fade in/out)
D) Other related disorders ruled out
E) Not attributable to substance use or medical condition
F) If autistic or communication disordered, positive symptoms necessary

Delusional Disorder

A) Presence of one or more delusions, with a duration of 1 month or longer
B) Criterion A of Schizophrenia is not met
C) Apart from the impact of the delusions or its ramifications, functioning is not markedly
impaired, and behavior is not obviously bizarre or odd
D) Symptoms are not better explained by a mood disorder such as bipolar
E) Symptoms are not attributable to substance or medical condition or other disorder

• Specify type of delusions: (Erotomatic, Grandiose, Jealous, Persecutory, Somatic, Mixed, Unspecified)

• Specify if: with bizarre content

• Specify: first/multiple episodes

• Specify severity

Brief Psychotic Disorder

A) Presence of one or more of the following (at least one must be #1, #2, or #3):
1) Delusions
2) Hallucinations
3) Disorganized Speech
4) Grossly Disorganized or Catatonic Behavior
B) Duration is at least 1 day but less than 1 month, with return to premorbid functioning after
C) Disturbance not better explained by another disorder or medical condition or substances
Specify: with marked stressors; without marked stressors; with postpartum onset; with catatonia
Specify severity

Schizophreniform Disorder

A) Presence of two or more of the following (at least one must be #1, #2, or #3):
1) Delusions
2) Hallucinations
3) Disorganized Speech
4) Grossly Disorganized or Catatonic Behavior
5) Negative Symptoms
B) Duration is at least 1 month but less than 6 months
C) Rule-out other mood/psychotic disorders
D) Disturbance is not attributable to the effects of a substance or another medical condition
Specify: with good prognostic features; without good prognostic features; with catatonia
Specify severity

Schizoaffective Disorder

• A) Uninterrupted period during which there is a major mood episode (i.e., major depressive or manic) concurrent with Criterion A of Schizophrenia
• B) Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode during the lifetime of the illness
• C) Symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the active and residual portions of the illness
• D) The disturbance is not attributable to the effects of a substance or another medical condition
• Specify whether: Bipolar Type; Depressive Type; with Catatonia; First/Multiple Episodes
• Specify Severity

Schizophrenia Epidemiology

• Overall lifetime Prevalence = 0.7%
• If age of father is over 45 at birth, risk is doubled
• Onset age typically young adulthood
• Gender: usually more common and severe in men

Summary & Prevalence Rates

• Delusional Disorder
  • Like Schizophrenia, but only delusions, and lasts at least 1 month
  • Lifetime prevalence approximately 0.2%, persecutory type most common

• Brief Psychotic Disorder
  • Like Schizophrenia, but only requires 1 hallmark psychotic symptom, and lasts 1 to 31 days
  • Lifetime prevalence uncertain; makes up 9% of first-onset psychosis

• Schizophreniform Disorder
  • Like Schizophrenia, with same symptoms, but lasts 1 to 6 months
  • Lifetime prevalence estimated between 0.15% and 0.2%

• Schizophrenia
  • Is Schizophrenia, and lasts at least 6 months
  • Lifetime prevalence estimated between 0.7% and 1.0%

• Schizoaffective Disorder
  • Is Schizophrenia plus mood disorder symptoms while psychosis is active
  • Lifetime prevalence estimated at approximately 0.3%

Risk Factors

• Genetic Links
• Prenatal Exposure/Stressors
• Neurodevelopmental Theories
• Brain/Biological Factors
• Psychosocial/Cultural Risks

Genetic Schizophrenia Vulnerability

• Prenatal infection

• Rhesus incompatibility

• Early nutritional deficiencies and maternal stress

• Pregnancy and birth complications

Other Brain/Biological Factors

• Enlarged ventricles
• Decreased brain volume
• Frontal lobe dysfunction
• Reduced volume of the thalamus
• Abnormalities in temporal lobe areas
• Dysfunctions in eye-tracking capabilities
• Deficits in working memory, attention, and executive functioning

Psychosocial and Cultural Factors

• Family Context
  • distressed families linked to higher relapse rates

• Socio-Economic Status
  • while Schizophrenia affects all groups, lower SES has a clearly higher risk

• Immigration
  • major stressors such as cross-cultural adjustments linked to psychotic symptoms

• Cannabis Abuse
  • people diagnosed with Schizophrenia are twice as likely than the general population to have
  had a history of frequent/chronic marijuana use, particularly in adolescence