PSYB32: unit 8 schizophrenia and psychotic disorders

what is psychosis?

a syndrome, or a collection of symptoms occurring together

NOT a diagnosis

a SPECTRUM of absence of experience to psychosis

hallucination

perceptual abnormalities that can occur in any sense

persecutory delusion

they are target of harm

referential delusion

tendency to attribute ambiguous stimuli to special meaning for the self (ex. numbers, codes patterns)

grandiose delusion

inflated sense of self-worth, ability, power, or importance (ex. special mission)

control delusion

something external is controlling aspects of their will

religious delusion

religious interpretation of events that is not shared (ex. you are second coming of christ)

somatic delusion

belief that something is seriously wrong with their health without medical evidence (can often FEEL things wrong in body)

erotomaniac delusion

belief they have relationship with someone famous

jealousy delusion

belief of infidelity in face of evidence

guilt delusion

belief they are to blame for something ridiculous and should be severely punished

disorganization

• change from baseline

• thoughts and speech no longer organized or goal-directed

positive symptoms of schizophrenia

• hallucinations

• delusions

• disorganized thought/speech

• disorganized behavior

negative symptoms of schizophrenia

• avolition (lack of motivation)

• anhedonia (lack of enjoyment or pleasure)

• asociality (lack of wanting social interaction)

• affective flattening (monotone voice)

• alogia (no speech)

schizophrenia spectrum disorders

• group of disorders requiring psychosis as primary criterion

• 2+ symptoms (one MUST be positive)

• brief psychotic disorder (positive symptoms for one month or less)

• schizophreniform disorder (above for 1<x<6 months)

• schizophrenia (>6 months)

• schizoaffective disorder (above + significant mood symptoms)

mood vs. psychotic disorders

• schizophrenia: no mood symptoms, just psychotic episode

• schizoaffective: has psychotic episodes DURING and AWAY from mood episodes

• bipolar I: only has psychotic episodes DURING mood episodes

if mood present >50% of time, mood disorder

if psychotic stage present >50% of time, psychotic disorder

delusional disorder

non bizarre and less impairing delusions

NOS psychotic disorder

clear positive symptoms, but presentation does not meet full criteria for any other diagnosis

another medical condition/substance-induced psychosis

• irregular showing of positive symptoms that need treatment

• removing substance should remove positive symptoms

• substance happens —> psychosis (temporal relationship)

dopamine hypothesis

• mesolimbic pathway: inhibition of D2 receptors leads to more dopamine and more positive symptoms

  • treatment: must slowdown dopamine neurotransmission

• mesocortical pathway: hypoactive D1 receptors lead to less dopamine which creates negative symptoms

  • treatment: increase dopamine neurotransmission

phases of schizophrenia

• premorbid phase: childhood, cognitive, motor, or social deficits

• prodromal phase: adolescence, brief positive symptoms and/or functional decline (some subclinical symptoms)

• psychotic phase: young adult, full positive symptoms

• stable phase: negative symptoms, cognitive/social deficits, functional decline

duration of untreated psychosis (DUP)

shorter DUP leads to more effective treatment

CBT for psychosis

understand situation

thoughts—>emotions—>behavior