Untitled Flashcards Set

THE PSYCHOTIC DISORDERS

This module will discuss the characteristics of psychotic behavior. It will then look into

some of these psychotic disorders, the presentation of these in behaviors and what are

some causes to the disorders.

TLO 16: Differentiate psychotic disorders by recognizing symptoms and features

TLO 17: Understand the impact of psychosis by analyzing some cases

TLO 18: Exhibit compassion towards those afflicted with psychotic disorders

ENGAGE:

Recall an encounter with a person who in lay term is “mad, insane” or

about to snap or lose his/her wits. List down your observations about

his/her behavior.

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The distinction between psychotic and non-psychotic disorders is all-important,

not only in terms of an assessment of the severity of the disorder, but also in function ofthe therapeutic approaches to be followed. For these reasons, clear diagnostic criteria

of the psychotic disorder (of any type) are imperative.

Psychotic behavior is characterized by five criteria.

1. Loss of Contact with the Reality

The subject-object relation, which is the basis for an objective assessment of

the reality (the “me” from the “not-me”), is distorted as the result of a regression to

an earlier state of symbiosis. Consequently, one with psychosis loses contact with

the real, objective world, and he creates an unreal world (“his/her” world), made

up of fantasies, fiction and fragments of dreams. This loss of contact may go to the

extent that the person has difficulties with his orientation in time and place and

other objective criteria of the reality.

2. Delusions

Delusions are thought contents contrary to the reality, which will not be given

up even in the face of clear evidence to the contrary.

 Delusions vary in degree of cohesion from unsystematic and incoherent to

tightly organized (in delusional disorder)

 The form and content of delusions can be:

o Self-destructive: delusions of guilt (unpardonable sins), delusions that

the world would be better off without the person, delusions of

worthlessness, impoverishment and so forth.

o Self-under-attack from others: delusions of persecution (others are

conspiring, threatening), delusions of influence (others are controlling

his thoughts and actions), delusions of reference (others are making

derogatory references to him), etc.

o Self-enhancing: delusions of grandeur (he is a famous, notable,

envied person). A special type is the Clerambault Syndrome

(erotomania) in which the patient, mostly female, maintains a

delusional belief that a man, usually much older and of higher social

status, is in love with her. The content of the delusion pertains to an

idealized romantic love rather than to sexual attraction. This

grandiose fantasy is a “solution” for her narcissistic wound that she is

unloved or unlovable.

3. Hallucinations

A hallucination is the apparent perception of an external object when no

corresponding real object exists. The presence of hallucinations is so common inpsychosis that it has become one of the differentiating symptoms for a psychotic

condition.

The most common hallucinations are the auditory, followed by the visual

hallucinations, which are typical at the onset of a psychotic condition and during

an acute crisis. But all sensory experiences can become a feeding ground for

hallucinations (ex: smelling all food as rotten).

4. Disturbances in Affect

Affect is the feeling tone of pleasure or displeasure that accompanies

experience. The emotional life of one with psychosis falls into two extremes – either

they are emotionally impulsive (which is unpredictable since it can be preceded

by emotional tranquility), or they lack emotional responsiveness.

Another aspect of emotional disturbance is the inappropriateness of the

emotional response, which does not fit with the situation or stimulus. In parathymia,

the emotional response is just the opposite of the one expected.

5. Disturbances in Verbal Communication

Because of lack of contact with reality, one with psychosis expresses in

highly personal ways. It is more self-expression rather than communication.

The verbal distortions can take different forms:

 Incoherence: he/she goes into seemingly meaningless mouthing.

 Neologisms: his/her communication, based on internal experiences,

may become so personalized that he invents new words.

 Verbigeration: a senseless repetition of the same words or phrases.

 Echolalia: echoing the words of others.

 Complex and grotesque way of conversing by using rigid and formal

ways of talking

Referring to the foregoing five behavioral characteristics common to

psychoses, it can be observed that persons in an acute psychotic episode

cannot meet even the most ordinary demands of life. Psychoses are

debilitating and some of the disorders here are the most severe of all the

psychological disorders. Most of the conditions that have been discussed in

the previous modules allow for some measure of adaptive functioning. In

many cases, people with these disorders can still look after themselves, earn

a living, carry on a reasonable conversation and so forth. Those in the midstof an acute psychotic episode cannot. For this reason – and because their

behavior is incomprehensible and disturbing to others – they are often

hospitalized.

The psychoses are divided into two broad categories:

Those associated with known physical conditions (mostly

organic brain disorders), are called biogenic psychoses.

Those for which no physical basis has been clearly identified

and which therefore may be at least partly psychogenic, are

called the functional psychoses

There are three main groups of functional psychoses:

1. 2. 3. The Schizophrenic Disorders - considered to be primarily disturbances of

thought.

The Delusional Disorders - in which the essential and possibly the only

abnormality is limited to a system of delusions.

The Mood Disorders – characterized primarily by disturbances of the mood.

EXPLAIN: A FOCUS ON FUNCTIONAL PSYCHOSES

UNIT 1: SCHIZOPHRENIA

The schizophrenia spectrum disorders consist of Schizophrenia, Schizophreniform disorder,

Schizoaffective disorder, and Delusional disorder. They are defined by one of the

following main symptoms: Delusions, Hallucinations, disorganized thinking (speech),

disorganized or abnormal motor behavior, and negative symptoms.

Individuals diagnosed with a schizophrenia spectrum disorder experience psychosis,

which is defined as a loss of contact with reality. Psychosis episodes make it difficult for

individuals to perceive and respond to environmental stimuli, which causes a significant

disturbance in everyday functioning.

Schizophrenia is the label given to a group of psychoses which deterioration of

functioning is marked by severe distortion of thought, and perception, by bizarre

behavior, and by social withdrawal.The History of the Schizophrenic Diagnostic Category

 In 1810, John Haslam described the case of a patient who appears to have suffered

from a variety of symptoms—including delusions—that are typical of schizophrenia

 In 1860, the Belgian psychiatrist Benedict Morel used the French term démence

précoce, which means mental deterioration at an early age, to describe the

condition and to distinguish it from the dementing disorders associated with old age.

 The German psychiatrist Emil Kraepelin (1856–1926) provided the description of what

we now regard as schizophrenia. Kraepelin used the Latin version of Morel’s term

(dementia praecox) to refer to a group of conditions that all seemed to feature

mental deterioration beginning early in life. Kraepelin also noted that the disorder

was characterized by hallucinations, apathy and indifference, withdrawn behavior,

and an incapacity for regular work.

 Eugen Bleuler (1857–1939), a swiss psychiatrist, gave us the diagnostic term we still use

today. In 1911, Bleuler used schizophrenia because he believed the condition was

characterized primarily by disorganization of thought processes, a lack of coherence

between thought and emotion, and an inward orientation away (split off) from

reality.

Features of Schizophrenia

The hallmark symptoms of schizophrenia include the presentation of at least two of the

following for at least one month:

- Delusions

- Hallucinations

- Disorganized speech

- Disorganized/abnormal behavior which can show itself in a variety of ways.

 The impairment of goal directed activity in areas of routine daily

functioning, such as work, social relations, and self-care.

 Catatonia is a virtual absence of all movement and speech

- Negative symptoms is the inability to initiate actions, speech, expressed emotion,

or to feel pleasure that are normally present. (Positive symptoms are those that

reflect an excess or distortion in a normal repertoire of behavior and experience,

such as delusions and hallucinations. There are six main types of negative

symptoms seen in patients with schizophrenia. Such symptoms include:

 Affective flattening – Reduction in emotional expression; reduced display of

emotional expression

 Alogia – Poverty of speech or speech content

 Anhedonia – Inability to experience pleasure

 Apathy – General lack of interest

 Asociality – Lack of interest in social relationships

 Avolition – Lack of motivation of goal-directed behavior