Chapter 11 Abnormal Psych

Anhedonia

inability to experience pleasure

Catatonia and motor disturbances

characterized by significant motor disturbances, ranging from complete immobility and rigidity to excessive or bizarre movements, and can also include mutism and impaired volition. 

Psychosis

a psychological disorder in which a person loses contact with reality, experiencing irrational ideas and distorted perceptions

Delusions and types

Fixed beliefs that are not amenable to change considering conflicting evidence

Of grandeur (delusion type)

belief that they have exceptional abilities, wealth, or fame; belief they are God or another religious savior

Of control (delusion type)

belief that their thoughts/feelings/actions are controlled by others

Of thought broadcasting (delusion type)

belief that one's thoughts are transparent, and everyone knows what they are thinking

Of persecution (delusion type)

belief they are going to be harmed, harassed, plotted or discriminated against by either an individual or an institution ***most common

Of reference (delusion type)

belief that specific gestures, comments, or even larger environmental cues are directed directly to them

Of thought withdrawal (delusion type)

belief that one's thoughts have been removed by another source

Hallucinations

false sensory experiences, such as seeing something in the absence of an external visual stimulus

Schizophrenia criteria

A. Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3):

1. Delusions.

   2. Hallucinations.

   3. Disorganized speech (e.g., frequent derailment or incoherence).

  4.Grossly disorganized or catatonic behavior.

  5. Negative symptoms (i.e., diminished emotional expression or avolition).

B. For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or

self-care, is markedly below the level achieved prior to the onset (or when the

onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning)

C. Continuous signs of the disturbance persist for at least 6 months. This 6-month

period must include at least 1 month of symptoms (or less if successfully treated)

that meet Criterion A (i.e., active-phase symptoms) and may include periods of

prodromal or residual symptoms. During these prodromal or residual periods, the

signs of the disturbance may be manifested by only negative symptoms or by

two or more symptoms listed in Criterion A present in an attenuated form (e.g.,

odd beliefs, unusual perceptual experiences).

D. Schizoaffective disorder and depressive

or bipolar disorder with psychotic features have been ruled out because either 1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or 2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.

E. The disturbance is not attributable to the physiological effects of a substance  (e.g., a drug of abuse, a medication) or another medical condition.

F. If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of

schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1 month (or less if successfully treated

Schizophrenia positive symptoms and example

Hallucinations, Delusions, Disorganized thoughts and speech, Grossly disorganized behavior, Inappropriate affect, Catatonic excitement

Schizophrenia negative symptoms and example

Asociality and Social withdrawal, Flat affect and anhedonia ( lack of pleasure in everyday life), Avolition (a lack of motivation) and apathy, Alogia (a poverty of speech), Lack of goal-oriented activity, Catatonic stupor, Poor hygiene and grooming and Distorted sense of time

Negative symptoms are defined as the inability or decreased ability to initiate actions, speech, expressed emotion, or to feel pleasure.

Cognitive symptoms

Poor executive control, Trouble focusing, Working memory problems, Poor problem-solving abilities, Slow processing speed

Disorganized thinking, communication and speech types

Thoughts and speech patterns may appear to be circumstantial or tangential (e.g., they give unnecessary details, or they may never reach the point)

Retardation

another cognitive symptom where the individual may take a long period of time before answering a question

Derailment

the illogical connection in a chain of thoughts

Illogicality

the tendency to provide bizarre explanations for things

Word Salad

confused and unintelligible speech with mixture of seemingly random words and phrases

Behavioral Disturbances

Disorders of behavior may involve deterioration of social functioning, such as social withdrawal, self-neglect, or neglect of environment. Behavioral disorders may also involve behaviors that are considered socially inappropriate,such as talking to oneself in public, obscene language, or inappropriate exposure. Substance abuse is another disorder of behavior; patients may abuse cigarettes, alcohol, or other substances. Substance abuse is associated with poor treatment compliance and may be a form of self-medication

Mood disturbances

Disorders of mood and affect include affective flattening, which is a reduced intensity of emotional expression and responsiveness that leaves patients indifferent and apathetic. Typically, one sees unchanging facial expression, decreased spontaneous movements, a lack of expressive gestures, poor eye contact, lack of vocal inflections, and slowed speech. Anhedonia, or the inability to experience pleasure, is also common, as is emotional emptiness. Patients may also exhibit inappropriate affect, such as laughing at a funeral

General causes neurotransmitters and specific parts of the brain

stem from a complex interplay of genetic, environmental, and neurobiological factors, particularly involving neurotransmitter imbalances (like dopamine and glutamate) and specific brain regions, including the striatum, prefrontal cortex, and temporal areas

Avolition

a severe lack of motivation, can manifest as a persistent inability to initiate or sustain purposeful activities, leading to neglect of self-care, social withdrawal, and difficulty in daily tasks

Diathesis Stress Theory

psychological framework that explains how certain mental health disorders develop as a result of the interaction between a predisposition (diathesis) and environmental stressors

Eight Areas of rehabilitation treatment and treatment in general (biopsychosocial)

Psychiatric (symptom reduction and management)

Health and Medical (maintaining consistency of care)

Housing (safe environments)

Basic living skills (hygiene, meals [including increasing healthy food intake and reducing processed food intake], safety, planning and chores)

Social (relationships, family boundaries, communication and integration of client into the community)

Education and vocation (coping skills, motivation and suitable goals chosen by client)

Finance (personal budget)

Community and legal (resources)

Psychopharmacological treatment and other treatment modalities

•Conventional antipsychotics (e.g., Thorazine, Chlorpromazine) - successfully calm agitated patients by acting on dopamine receptors, but come with awful side effects (e.g., muscle tremors; involuntary movements; muscle rigidity; and tardive dyskinesia which includes involuntary movements of the tongue, mouth, and face) which increase the longer an individual takes the medication

•Second generation/Atypical antipsychotics (e.g., Clozapine, Risperidone, Aripiprazole) - acts on dopamine and serotonin receptors and manages both positive and negative symptoms; side effects are less likely but still possible

•Patients often discontinue medications, which makes it important to incorporate psychological treatment and additional support

Extrapyramidal symptoms (EPS)

movement disorders, which include acute and long term symptoms from antipsychotic medications.

tardive dyskinesia

irregular, jerky movements

dystonia

continuous spasms and muscle contractions

akathisia

may manifest as motor restlessness

parkinsonism

characteristic symptoms such as rigidity

bradykinesia

slowness of movement

tremors

Continuous quivering or shaking.

Family Interventions

•Goal is to reduce the stress on the individual that is likely to elicit onset of symptoms

•Majority of programs focus on psychoeducation, problem-solving skills, and CBT

•Social skills training

•Poor interpersonal skills not only predate the onset of the disorder, but also remain significant even with management of symptoms via antipsychotic medications

•So, patients learn how to interact with others (e.g., establish eye contact, engage in reciprocal conversation, etc.) through group therapy and role play

•Inpatient hospitalization - helpful during stabilization of patients

•Can be short-term (a few weeks), long-term (months, years), or partial (during the day)

•So, patients learn how to interact with others (e.g., establish eye contact, engage in reciprocal conversation, etc.) through group therapy and role play

•Inpatient hospitalization - helpful during stabilization of patients

•Can be short-term (a few weeks), long-term (months, years), or partial (during the day)

Brief Psychotic Disorder

•A. Presence of one (or more) of the following symptoms. At least one of these must be (1), (2), or (3):

•1. Delusions.

•2. Hallucinations.

•3. Disorganized speech (e.g., frequent derailment or incoherence).

•4. Grossly disorganized or catatonic behavior.

•Note: Do not include a symptom if it is a culturally sanctioned response.

•B. Duration of an episode of the disturbance is at least 1 day but less than 1 month, with eventual full return to premorbid level of functioning.

•(Specifiers)

Schizophreniform Disorder

•A. Two (or more) of the following, each present for a significant portion of time

•during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3):

•1. Delusions.

•2. Hallucinations.

•3. Disorganized speech (e.g., frequent derailment or incoherence).

•4. Grossly disorganized or catatonic behavior.

•5. Negative symptoms (i.e., diminished emotional expression or avolition [lack of motivation or inability to engage in goal directed behaviors]).

•B. An episode of the disorder lasts at least 1 month but less than 6 months. When the diagnosis must be made without waiting for recovery, it should be qualified as "provisional."

•C. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either

•1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or

•2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.

•(Specifiers)

Schizoaffective Disorder

•A. An uninterrupted period of illness during which there is a major mood episode

(major depressive or manic) concurrent with Criterion A of schizophrenia.

Note: The major depressive episode must include Criterion A1: Depressed mood.

•B. Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode (depressive or manic) during the lifetime duration 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.

•Depressed type and bipolar type

•D. The disturbance is not attributable to the effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

Delusional Disorder and subtypes

•Requires the presence of at least one delusion that lasts for at least one month in duration and that individuals must not have experienced hallucinations, disorganized speech, disorganized or catatonic behavior, or negative symptoms to be diagnosed with delusional disorder

• Daily functioning is not overly impacted due to the delusions and any mood disorder symptoms are typically brief

Erotomanic delusion

occurs when an individual reports a delusion of another person being in love with them (usually a person of higher status)

Grandiose delusion

involves the conviction of having a great talent or insight; these may take on a religious affiliation

Jealous delusion

revolve around the conviction that one's spouse or partner is/has been unfaithful; this is much more extensive than common questions of infidelity and is generally based on incorrect inferences

Persecutory delusion

involves the individual believing that they are being conspired against, spied on, followed, poisoned or drugged, maliciously managed, harassed, or obstructed in pursuit of their long-term goals; individuals with these delusions are most at risk to become aggressive or hostile

Somatic delusion

involves delusions regarding bodily functions or sensations (e.g that they emit a foul odor or that there are insects in/on them)

Mixed

more than one delusion theme predominates

Unspecified

the dominant delusional belief cannot be clearly determined or is not described by the subtypes above