Week 9 + 10: Psychotic Disorders

What are 3 psychotic disorders symptom categories?

-Positive

-Negative

-Disorganized

What are positive symptoms?

symptoms normally absent in individuals but are present in individuals experiencing psychosis

What are negative symptoms?

aspects of behavior that are normally present but are absent in individuals experiencing psychosis

What are the two positive symptoms?

hallucinations and delusions

What are the negative symptoms?

-Anhedonia

-Blunted/flat affect

-Alogia

-Avolition

-Asociality

What are the disorganized symptoms?

-Disorganized speech

-Disorganized behavior

-Catatonic behavior

What is anhedonia?

the inability to experience joy or pleasure from life’s experiences

What are delusions?

false, firmly held beliefs that are not amenable to change despite conflicting evidence

Delusions fall into which two categories?

bizarre or non-bizarre

What are the various types of delusions?

-Persecutory

-Referential

-Grandiose

-Guilt

-Erotomaniac

-Nihilistic

-Somatic

-Religious

-Being controlled

-Thought insertion

-Thought withdrawal

-Thought broadcasting

What are persecutory delusions?

the delusions that one is being harassed, attacked, cheated on, etc. by an outside force despite no evidence

What are referential delusions?

the belief that gestures or actions are directed towards you and might have a particular significance

What are grandiose delusions?

the belief that one has exceptional powers or has a special relationship with a powerful being

What is guilt delusion?

an unnecessary feeling of guilt and taking responsibility for things that were not their fault

What is an erotomaniac delusion?

the belief a person of (typically higher status) is in love with themselves

What is a nihilistic delusion?

the belief that the world/you don’t exist or something is going to happen

What are somatic delusions?

believing there is something wrong with your body

What are religious delusions?

fixed beliefs involving religious themes that are not amenable to change in light of conlficting evidence

What are thought insertion delusions?

believing that someone is adding thoughts into your head and that your thoughts are not your own

What are thought withdrawal delusions?

believing that another person is removing thoughts from your mind

What are thought broadcasting delusions?

believing that other people can hear your thoughts

What is a hallucination?

perception-like experiences that occur without an external stimulus

What type of hallucinations are there?

-Visual

-Auditory

-Olfactory

-Gustatory

-Tactile/somatic

What are the 5 negative symptoms?

-Avolition

-Blunted/flat affect

-Anhedonia

-Alogia

-Asocialty

What is avolition?

a decrease in motivated, purposeful activities

What is blunted/flat affect?

a reduction in expression of emotions

What is alogia?

diminished speech output

What is asociality?

a lack of interest in social interactions

What are 4 types of disorganized speech symptoms?

-Derailment/loose associations

-Tangentiality

-Circumstantiality

-Word salad

What is derailment/loose associations speech?

switching from one topic to another

What is tangentiality?

when the answers are either vaguely related or completely unrelated; answers are not directly stated

What is circumstantiality?

when there is a flow, but there are so many irrelevant details added that it is very difficult to follow

What is word salad?

when the speech is incomprehensible

What is the most rare disorganized speech pattern?

word salad

True or False: In Thacker (1994), it was revealed that there were similar deficits in sign language as in spoken language in individuals with schizophrenia.

true

What are the disorganized behavior symptoms?

-Ranging from childlike “silliness” to unpredictable agitation

-Behavior is inappropriate to the context

-Can include catatonia

-Stupor

-Mutism

-Catatonic excitement

What is catatonia?

a decrease in reactivity to the environment

What is stupor?

no motor responses

What is mutism?

a complete lack of verbal speech

What is catatonic excitement?

physically moving around often and speaking quickly

What are 4 sections on the psychosis continuum?

-Within cultural norms

-Attenuated/subthreshold psychosis part I

-Attenuated/subthreshold psychosis part II

-Fully psychotic

What occurs during the “within cultural norms” section?

-No distress

-No effect on behavior/functioning

-Consistent with cultural beliefs

What occurs during the “attenuated/subthreshold psychosis part I” section?

-Increasing frequency (weekly)

-Some distress that bothers them

-Able to question reality

-Little effect on behavior

What occurs during the “attenuated/subthreshold psychosis part II” section?

-Increasing frequency (daily)

-Increasing distress

-Seems real but individual is not convinced

-Starting to affect behavior/impact functioning

What occurs during the “fully psychotic” section?

-Significant distress

-Frequent

-Convinced it is real

-Behavior changes

-Impairs functioning

What are the diagnostic criteria for schizophrenia?

• 2+ of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one must be delusions, hallucinations, or disorganized speech.

  • -Delusions

  • -Hallucinations

  • -Disorganized speech

  • -Grossly disorganized or catatonic behavior

  • -Negative symptoms

• Level of functioning in +1 major domains (e.g., work, relationships, or self-care) is markedly impaired

• Duration of entire disorder: at least 6 months

What occurs during the prodromal stage of schizophrenia?

Sub-threshold symptoms

What is important to know about the active stage of schizophrenia?

-Occurs for at least 1 month

-Must have impairment in functioning and 2 or more of the previous symptoms

True or False: During the prodromal and residual phases, individuals may have only negative symptoms, or other symptoms in less severity (e.g., odd beliefs instead of delusions).

true

What is a differential diagnosis?

ruling out disorders with similar symptoms

What are the differential diagnoses for schizophrenia?

-Brief Psychotic Disorder

-Schizophreniform Disorder

-Schizoaffective Disorder

-Mood Disorders with Psychotic Features

What are diagnostic criteria for brief psychotic disorder?

• +1 symptoms, must include at least delusions, hallucinations, and disorganized speech

  • Delusions

  • Hallucinations

  • Disorganized speech

  • Grossly disorganized or catatonic behavior

• Duration: lasts between 1 day - 1 month

What are other important things to know about brief psychotic disorder?

-No negative symptoms

-Full recovery

-Intense emotional disturbance

-Can occur in individuals under lots of stress

-Possible for multiple brief psychotic episodes

What are the diagnostic criteria for schizophreniform disorder?

• 2+ of the following, at least one must be delusions, hallucinations, and disorganized speech

  • Delusions

  • Hallucinations

  • Disorganized speech

  • Grossly disorganized or catatonic behavior

  • Negative symptoms

• Duration: must occur for 1-6 months

What is the diagnostic criteria for schizoaffective disorder?

• Presence of a major mood episode (manic or depressive) - bipolar type or depressive type

• 2+ schizophrenia symptoms for at least 1 month, must include at least delusions, hallucinations, and disorganized speech

  • Delusions 

  • Hallucinations

  • Disorganized speech

  • Grossly disorganized or catatonic behavior

  • Negative symptoms

• At least 2 weeks of positive psychotic symptoms without mood symptoms

What are the diagnostic criteria for mood disorder with psychotic features?

• Presence of a major mood episode (manic or depressive) - bipolar type or depressive type

• Psychotic symptoms only occur during mood episodes

  • Usually during mania, but possible during depression too

  • Can be mood-congruent or mood-incongruent

True or False: Mood-incongruency has a poor prognosis than mood-congruency.

true

What is the etiology for psychotic disorders?

-Genetics

-Maternal exposure to a virus (flu virus)

-Complications during delivery

-Brain abnormalities

-Socioeconomic status (SES)

-Family factors

What do adoption and twin studies demonstrate?

that the risk for developing schizophrenia is highest for an individual if their identical twin is diagnosed with schizophrenia

What did the Gottesman and Bertelsen (1989) research show?

• Twin with schizophrenia: 16.8% risk of twin having a child with schizophrenia

• Twin without schizophrenia: 17.4% risk of twin having a child with schizophrenia

• Both twins were equally likely to have a child with schizophrenia despite the parent having the condition

What neurotransmitter is associated withs schizophrenia?

dopamine

What is the dopamine hypothesis?

an overproduction of dopamine or an increase in sensitivity of dopamine receptors is responsible for schizophrenia

Where is there a low number of dopamine receptors in patients with schizophrenia?

the frontal lobe

What do dopamine medications do?

reduce positive symptoms

What does LSD do?

causes schizophrenia-like symptoms in patients without the pathology

What are some cognitive deficits caused by schizophrenia?

-Deficits in attention

-Deficits in working memory

-Deficits in executive functioning such as planning and problem-solving

Why is there a high prevalence of schizophrenia in those with lower SES?

social causation and social selection

What is social causation?

negative factors related to low SES led to the development of illness

What is social selection?

cognitive/social impairments associated with the illness lead individuals to drift to a lower SES

What are some important epidemiological factors?

-Lifetime prevalence is 0.3-0.7%

-Age of onset is late teens to mid 30’s

-Onset prior to adolescence is rare

-Earlier age at onset predicts a poorer prognosis

-Likelihood of onset drops significantly after age 55

-Men and women equally likely to be affected

-Comorbidity of schizophrenia and substance use disorder (outside of tobacco/nicotine)

What are some gender differences in schizophrenia?

• Age of onset (Men = 18-25; Women = 26-45)

• Premorbid social functioning

  • Women have better premorbid social functioning

• Typical symptoms

  • Men experience more negative symptoms and have more severe, long-term symptoms

  • Women experience more positive symptoms

• Course of illness

  • Men have a poorer prognosis than women

• Response to treatment

  • Women respond better to treatment

What is the prognosis of schizophrenia>

- ⅓ improve

-⅓ remain the same

-⅓ become chronically/severely disabled

True or False: In developed countries, schizophrenia is in the top 5 causes of disability. It’s the most debilitating of mental illnesses.

true

True or False: 11% of homeless individuals have schizophrenia and 6% if individuals with schizophrenia are incarcerated in jail or prison.

true

What is important to know about schizophrenia and suicide?

-10-15% die by suicide

-Sometimes occurs in response to command hallucinations

• -Hallucinations that instruct a person to act in a certain way

True or False: Individuals with schizophrenia are more likely to be a victim of violence than engage in violent behavior.

true

True or False: Black and Latino Americans are twice as likely to be diagnosed with schizophrenia, but it’s not due to them being more likely to experience the disorder.

true

What is important to know about the older antipsychotics?

• Target only dopamine receptors

• Side effects resemble Parkinson’s Disease (e.g., tremors, motor rigidity, involuntary movements of mouth and face, spasmodic body movements)

  • Motor problems won’t go away but can be managed with other medications

• Targets positive symptoms

What is important to know about the new antipsychotics?

-Target multiple neurotransmitters (e.g., dopamine, serotonin, norepinephrine)

-Side effects include weight gain

-Can target negative symptoms too

-Less motor problems, so patients are more complacent with the newer prescription

-Ex: Clozapine

-Called atypical antipsychotics

True or False: The largest risk of relapse in the first year because individuals will quit utilizing their medication.

true

What does psychosocial treatment focus on?

Focus on long-term strategies to improve aspects of patient’s life other than the reduction of psychotic symptoms such has improving social competence, housing stability, employment, etc.

What are types of psychosocial treatment?

• Family therapy

  • Provides education to the family

• Social skills training

• Vocational rehabilitation

  Assertive community treatment (ACT)

What is important to know about ACT?

• A comprehensive team works together to meet the needs of the client including:

  • Psychiatrists 

  • Nurses

  • Social workers

  • Vocational counselors

  • Recreational counselors

• Staff to client ratio is high, staff is available 24/7, and contact with clients is frequent

• Good outcomes

• Decreases the need for hospitalization and risk for psychotic relapse

• Increases medication complacent

• Clients are satisfied with act and finding it beneficial for themselves 

• Funds are provided through this program, so the team can prevent unnecessary admissions to the hospital

What are the goals for CBT?

-Decrease conviction of delusional beliefs

-Promote more effective coping strategies

-Reduce distress

What does CBT teach patients?

how to challenge and modify beliefs through experimental reality testing

What is the effectiveness of CBT for psychosis?

-Superior in control condition in clinical studies

-Significantly decreases positive symptoms

-Continued improvement at 6-month follow-up

What is important to know about pediatric schizophrenia?

-Rare, especially before age 12

-Poorer prognosis

-Tend to be more auditory hallucinations in the form of hearing voices

-Fewer delusions until later teenage years

-More mood swings and extreme moodiness

-Sometimes acting younger than developmentally appropriate

What is the treatment for pediatric schizophrenia?

• Medication:

  • Similar antipsychotics to adults

  • Mood stabilizers similar to bipolar disorder

• Therapy:

  • Similar to adults

  • Family-focused therapy

True or False: A high expressed emotion is negative and leads to a poorer prognosis.

true