Psychopathology chapter 8: schizophrenia spectrum and other psychotic disorders

psychosis

a condition in which a person has lost contact with reality, shown by the presence of delusions and/or hallucinations

delusions

fake unshakeable beliefs that are held with strong conviction despite contradictory evidence

persecutory delusions

believing others are plotting to harm them in some way. paranoia is characterized by feelings or suspicion, resentment, malice, or beliefs in external influence without evidence

grandiose delusions

false beliefs that one has great power, knowledge, or talent or that one is a famous or powerful person.

delusion of reference

belief that everyday events, objects, or other people have an unusual personal significance.

delusions of thought insertion

belief that another person or object is inserting thoughts into one’s own mind

hallucinations

false or inaccurate perception that affect the senses and cause people to see, taste, touch, or smell what others have done

schizophrenia spectrum

a group of disorders characterized primarily thinking/behaviim and negative symptoms

formal thought disorder

disorganized thinking of people with schizophrenia

social kindling hypothesis

early depressive episodes are triggered by major interpersonal or social stressors but over time, episodes become more autonomous and occur with little or no external stress.

schizoaffective disorder

mix of schizophrenia and a mood disorder. simultaneously experience and occur with little or no external stress

schizophreniform disorder

a psychotic disorder with the same symptoms profile as schizophrenia, but with a shorter duration

brief psychotic disorder

show a sudden onset of delusions, hallucinations, disorganized speech, and disorganized behavior, only lasting one day to one month.

delusional disorder

have delusions lasting at least one month regarding situations that occur in real life, such as being followed, poisoned, deceived, or a disease. 

schizotypal personality disorder

a personality disorder marked by odd beliefs, unusual thinking, and social discomfort but not full psychosis

tardive dyskinesia

movement disorder caused by long term use of antipsychotic meds. often irreversible

positive symptoms

delusions, hallucinations, disorganized thought and speech. described as “positive” because they’re in ADDITION to expected behaviors.

negative symptoms

involves the loss or reduction in typical functions. reduction in social behaviors, poor motivation, adenonia, flattened speech, etc.

prodromal symptoms

early subtle changes that occur before the first full psychotic episode (usually predominantly negative symptoms, with milder forms of the positive symptoms)

residual symptoms

the ongoing symptoms that remain after a psychotic episode has resolved

catatonia

disorganized thinking of people with schizophrenia

restricted affect

severe reduction or absence of emotional expressions

abolition

inability to initiate or persist at common, goal-directed activities, including those at work, school, and at home.

pathogenic

capable of causing disease

phenothiazines/neurolectics

older antipsychotic drugs to treat psychotic disorders

mesolimbic pathway

one of the main dopamine pathways in the brain that’s linked to hallucinations, delusions, and agitations

social drift

a theory that suggests that cumulative exposure to environmental risk factors in deprived and urban areas over time increases risk of psychological disorders

expressed emotion

the emotional climate in a patient’s close family or caregiving environment. how relatives talk and behave towards schizophrenics

chlorpromazine

a first-generation (typical) antipsychotic medication. it was one of the earliest drugs used to treat serious mental health conditions and is still used today in certain cases.

atypical antipsychotics

newer drugs with lower risk of side effects and tar dive dyskinesia

assertive community treatment (ACT)

an intensive, team-based mental healthcare model designed to support people with severe mental illnesses who struggle with traditional outpatient treatment.

What is psychosis?

“State involving loss of contact with reality and the inability to differentiate between reality and one’s own subjective state.”

do we just see psychosis with schizophrenia?

no definitely not limited

How can we differentiate disorders along the schizophrenia spectrum - # of symptoms,

length, severity

• # of symptoms: ≥ 2 core symptoms (delusions, hallucinations, disorganized speech, disorganized/catatonic behavior, negative symptoms)

• Length: ≥ 6 months (with ≥ 1 month active symptoms)

• Severity: High — major impairment in functioning

cognitive symptoms of schizophrenia

problems with thinking, memory, and attention. They’re less obvious than hallucinations or delusions but strongly affect functioning.

What is the most common type of hallucination?

auditory hallucination

What is the typical course and impact of time for Schizophrenia?

months to years -

• Prodromal phase: subtle behavioral/cognitive changes, social withdrawal

• Active phase: prominent positive symptoms + emerging negative symptoms

• Residual phase: lingering negative/cognitive symptoms, partial functioning

• Chronic disorder: fluctuating severity over time, early intervention helps

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prodromal symptoms

symptoms before

residual symptoms

symptoms after

suspected causes regarding schizophrenia

Genes + Brain chemistry + Brain structure + Prenatal factors + Stress → schizophrenia risk

expressed emotion regarding schizophrenia

• High EE in families is linked to higher relapse rates in people with Schizophrenia

• Stressful family interactions can trigger symptom exacerbation or worsen prognosis

• Low EE (supportive, balanced communication) is protective and improves outcomes

what is expressed emotion

a measure of the emotional attitudes and behaviors that family members express toward a relative with a mental disorder—especially schizophrenia.

Substance/Medication Induced Psychotic Disorder

a mental disorder where psychotic symptoms (like hallucinations or delusions) are directly caused by substance use, intoxication, or withdrawal.

Which substance with strongest association with schizophrenia

cannabis, especially when:

• Use begins in adolescence

• Use is frequent or high-potency (high THC content)

• There is a genetic vulnerability (family history of schizophrenia)

• can trigger an onset

What role did antipsychotics play in deinstitutionalization?

• Antipsychotics (first-generation like chlorpromazine) reduced positive symptoms (hallucinations, delusions) in schizophrenia.

• This made community living feasible, allowing deinstitutionalization of long-term psychiatric patients.

• Shifted care from asylums → outpatient/community services, though inadequate support sometimes caused social problems.

How effective are antipsychotics? Do they work equally well for all symptoms? Why might

someone want to stop their antipsychotic medication?

• Very effective for positive symptoms (hallucinations, delusions, disorganized speech/behavior)

• Less effective for negative symptoms (flat affect, avolition, anhedonia) and cognitive deficits

• Can reduce relapse risk when taken consistently

Reasons someone might stop antipsychotic medication

1. Side effects

   • Weight gain, metabolic changes, sedation, movement disorders (tremor, tardive dyskinesia)

2. Feeling “normal” / symptom-free

   • May underestimate relapse risk

3. Stigma or personal beliefs

   • Don’t want to feel “medicated” or labeled

4. Cost or access issues

   • Medication may be expensive or unavailable