CHAPTER 25 - PSYCHOTIC DISORDERS

what four factors does a person with psychosis experience

1) delusions
2) hallucinations
3) disorganized thinking, speaking and acting
4) cogntive symptoms, negative symptoms, affective symptoms

Kraeplin was the first to describe symptoms of schizophrenia. He distinguished two types of psychosis:

1. dementia praecox; poor prognosis, cogntive disturbances, delusions, apathy and sterotypical behaviour

2. manic depression; better prognosis, more episodic, no permanent cogntive impairment

In 1911, Bleuler modified dementai praecox into schizophrenia

it is a biological disease, and the symptoms were imagined as a continuum. The alteration of associations as a main symptom

Kraeplin and Bleuler both highlighted negative symptoms. From the 1960s, the focus shifted to postivie symptoms. What are the DSM-5 criteria

two of the following (one of the first three)

-Hallucinations
-Delusions
-Disorganized speech
-Disorganized chaotic behaviour
-Negative symptoms

have to impair functioning and be present for at least 6 months

psychotic symptoms can also occur in bipolar disorder and depression. Explain what episodes occur in bipolar disorder

bipolar disorder
→ hypomanic episodes: euphoric mood, self-confidence, racing thoughts, anger

Give some facts on bipolar disorder
- age of onset (also of psychotic depression)
- what does it have impact on
- what is the recovery after 2 and 13 years
- prevalence and incidence (also of psychotic depression)
- women or men, where also more?

• usually early adulthood (15-30 years) - that of psychotic depression is early 20s

• major impact in their social, academic and work lives

• 13% after 2 years, and 38% after 13 years

• prevalence; 3 in 1000 (1-2.4%) and incidence; 15 in 100000 - prevalence of psychotic depression is 0.35 - 0.6%

  • more common in men, peole in cities or high-income countries, migrants, and in people born in winter and spring

How do you call it when psychotic disorder manifests later in life

late-onset psychosis

the earlier the psychopathology reveals itself in primary psychotic disorders, the … (more/less) favourable the course

less

Van der Gaag summarized the development of psychosis in a four-factor model;

1) dysregulation of the dopaminergic system → dopamine increases of random times -. enhanced perception of stimuli → stimuli get personal salience

2) top-down processes (cognitive evaluation) give meaning to stimuli
3) cognitive tendencies: excessive attention to danger, negatively misinterpreting stimuli, etc.
4) consolidation: mechanism that reinforces self-created delusional ideas and distorted perceptions (unable to control their thoughts)

The cognitive impairments of bipolar disorder aren’t included in the DSM-5 criteria. Name them

fluid and crystallized intelligence, attention, executive functioing, memory and information-processing speed, impairments in social cogntion

talk about the neurological differences that peopel with schizophrenia and BP have and normal people don’t
-cortex
-grey matter
-white matter
-cognitive tasks and social cognition
-ToM

-thinner cortex in both hemispheres
-different density and structure of grey matter in frontal, temporal and parietal areas
-less maturation of white matter and faster atrophy of grey matter, especially in temporal and frontal cingulate and parietal cortices
-different patterns ofa ctivation while performing cognitive tasks, and social cognition

→ more activation in amygdala on non-emotional sitmuli, and reduced functional connectivity in insula, striatum, thalamus and lateral postcentral cortex
→ ToM; reduced activation in dmPFC, vmPFC, and the OFC, while showing more activation in the bilateral parietal cortex

treatment of schizophrenia

1) medication

2) cognitive rehabilitation

explain the medication used for schizophrenia

first-generation antipsychotics: block dopamine receptor D2, but doesn’t improve negative symptoms and cognitive functioning

atypical antipsychotics: targts more serotonin and glutamate receptors
→ side effects; weight gain, metabolic syndrome

third-generation antipsychotics: partial dopamine antagonists

explain cognitive rehabilitation for treating schizophrenia

drill and practice training: therapist-supported training, cogntive training exercises, procedures to develop problem-solving strategies, transfer to everyday life

some cognitive impairments are a transdiagnostic domain (C-factor)
- RDOC (on neural and behavioural level) has 6 domains to investigate psychiatric disorders:
1)negative valence

2) positive valence

3) cognitive systems

4) social process systems

5) arousal systems

6) sensorimotor systems