Schizophrenia and other psychotic disorders

psychosis

disconnect from reality

delusions

pos symptom. impossible/implausible beliefs that are strongly held even if contrary evidence is presented

persecutory delusions

belief that someone is out to get you

referential delusions

belief that random unrelated things are about you

grandiose delusions

inflated sense of self. thinking you are different or special or jesus.

erotomaniac delusions

belief that someone is in love with you (eg lorna from OITNB)

jealousy delusions

delusional relief that your partner is unfaithful even with no/contrary evidence

nihilistic delusions

belief that something terrible (catastrophe, apocalypse) is going to happen

somatic delusions

belief that something is wrong with your body (eg: bugs in your skin, smell bad when you dont)

control delusions

belief that your thoughts, feelings, etc are controlled by an outside force

hallucinations

pos symptom of schizophrenia. false perceptual experiences that occur in the absence of stimuli. can happen in all senses

___is the most common type of hallucinations. ___ is the second most common

auditory, visual

misattribution theory

people miss attribute their own internal dialogue to an external voice

disorganized speech

pos/disorganized symptom of schizophrenia. comes from disorganized thought. presents as loosening associations: “word salad”

tangentiality (disorganized speech)

going off on a tangent

neologisms (disorganized speech)

use of made up words that only make sense to them

perseveration (disorganized speech)

getting stuck on a word/phrase and repeating it over and over

clanging (disorganized speech)

speaking only in rhymes

blocking (disorganized speech)

negative symptoms

often remain after pos symptoms have been treated and continue to mess with quality of life

affective flattening

neg symptom. displays less emotions → limited visible emotional range. issue with expression rather than feeling emotions. feelings dont translate to expression properly

alogia

neg symptom. limited speech (different from mutism). speech lacks emotions.

anhedonia

neg symptom. inability to anticipate pleasure. can still experience it but cant predict it.

asociality

neg symptom. social withdrawal. no desire for relationships or connections. retreat into their own world

avolition

neg symptom. lack of motivation to perform basic daily tasks. can cause grossly disorganized behaviour of complete lack of hygiene

disorganized symptoms

sometimes viewed as pos symptoms.

grossly disorganized behaviour

behaviour and emotions inappropriate for the circumstance. eg: wearing inappropriate clothing, emotional display that doesnt match circumstances, lacking social inhibition or acting childlike.

catatonic behaviour

less common disorganized symptom. often indicative of more severe disorder.

psychomotor dysfunction

type of catatonic behaviour. can range from wild agitation to catatonic stupor.

waxy flexibility

type of catatonic behaviour. can be physically moved like a doll and hold that position no matter how unnatural looking

catatonic excitement

type of catatonic behaviour. wild aggitation. pacing. no apparent goals/destination

grimmacing

type of catatonic behaviour. making weird faces. (eg excessive blinking etc)

echolalia

type of catatonic behaviour. repeating words after they have been said.

echopraxia

type of catatonic behaviour. mimicking someone’s movements. how they walk etc

cognitive symptoms.

not part of the diagnostic criteria but important associated symptoms. often the first sign something is wrong.

examples of cognitive symptoms

memory, learning, processing speed, attention and problem solving/planning deficits

anosognosia

having awareness that you are ill. highly correlated with willingness to take meds

prodromal phase

first phase of development. marked by decline in functioning, increased emotional and behavioural problems, and occasional neg symptoms. can last several days to months

acute phase

distinct episode of psychotic symptoms. at least a month long. must have this phase to be diagnosed

residual phase

after acute phase. pos symptoms subside can look a lot like prodromal phase.

diagnostic criteria of schizophrenia

some symptoms have been evident for at least 6 months with at least a month of acute phase with these key symptoms: hallucinations, delusions or disorganized speech. grossly disorganized or catatonic behaviour, some neg symptoms.

delusional disorder

characterized by presence of persistent delusions in the absence of other schizophrenia symptoms.

diagnosing delusional disorder

must have had delusions for 2 months or longer. must identify subtype (based on nature of most dominant delusions)

brief psychotic disorder (BPD)

similar to schizophrenia but with no neg symptoms and shorter in duration (1 day to 1 month) psychotic symptoms must go away within this window. specifiers: marked stressors that triggered it

schizophreniform disorder

diagnosed when someone experiences 2 or more core schizophrenia symptoms for more than 1 month but less than 6 months. impairment in functioning is not required for diagnosis

schizoaffective disorder

characterized by presence of a mayor mood episode that occurs during the majority of a persons time with schizophrenia symptoms. must have at least 2 weeks where they are having schizophrenia symptoms without mood episode subtypes: bipolar type or depression type

stressors linked with vulnerability

• maternal viral infection

• birth complications

• childhood trauma (epigenetics)

• family structures

• cannabis (only if COMT gene is present)

dopamine hypothesis

idea that symptoms are caused by excessive dopamine activity in the brain

support for the dopamine hypothesis

first gen antipsychotics, drugs that cause excess dopamine can induce psychotic episodes

glutamate hypothesis

idea that symptoms are caused by reduced glutamate activity in PFC

support for glutamate hypothesis

• timeline of late adolescence adds up with maturing of PFC.

• PCP drug inhibits glutamate activity. can cause psychotic symptoms.

• immune illness inhibits glutamate and can cause psychotic symptoms

bio-cognitive model

how a person interprets hallucinations can make delusions much worse. how people in your life talk about hallucinations impacts severity of disorder.

first gen antipsychotics (when developed? treat ___ symptoms? what receptors? side effects?)

developed in the 50s/60s. primarily target dopamine receptors especially D2. treat pos symptoms but not really neg or cognitive. bad motor side effects

second gen antipsychotics (when developed? treat ___ symptoms? what receptors? side effects?)

developed in the 90s. now the first line of treatment. target mainly D1, D4 and serotonin receptors with a bit of D2. treat pos, neg and cognitive symptoms. different side effects (more similar to antidepressants)

agranulocytosis

side effect of second gen antipsychotics in ~1.5% of people. dramatic drop in white blood vessels. can be deadly

hallucination interpretation and acceptance therapy

used in combo w antipsychotics. form of CBT influenced by biocognitive model. aim is to change interpretation of hallucinations (acceptance)