Chapter 12 notes

Overview of Psychotic Disorders

• Unusual Emotions, Thoughts, and Behaviors

  • Mental disorders may disrupt specific functions and are categorized into neurotic disorders (e.g., anxiety, depression) and psychotic disorders.

  • Neurotic Disorders: Affect limited areas of functioning, e.g., a person with social anxiety may struggle socially but function well in other areas.

  • Psychotic Disorders: Involve bizarre thoughts, emotions and actions that impair functioning across various life aspects.

Continuum from Normal to Psychotic Disorders

• Normal Emotions: Able to laugh or display appropriate sadness.

• Mild Symptoms: Slight restrictions in emotional range or responses that do not match situations (e.g., no reaction to a sad story).

• Moderate Symptoms: More significant emotional restrictions, odd behaviors, or perceptions causing challenges in social or work interactions.

• Psychotic Disorders (less severe): Present prolonged unusual emotional responses, delusions, or hallucinations.

• Psychotic Disorders (more severe): Complete disconnect from reality, characterized by extreme behaviors and a total inability to function in daily life.

Features of Psychotic Disorders

Symptoms

• Positive Symptoms: Excessive or overt symptoms including delusions and hallucinations.

  • Examples:

    • Delusions: Fixed irrational beliefs resistant to contrary evidence (e.g., a belief of persecution).

    • Hallucinations: Sensory experiences without an external stimulus (e.g., hearing voices).

• Negative Symptoms: Deficits in behavior, often harder to identify and treat.

  • Includes:

    • Alogia: Limited speech output.

    • Avolition: Lack of motivation (neglect of personal care).

    • Anhedonia: Loss of interest or pleasure.

Types of Psychotic Disorders

1. Schizophrenia

   • Characterized by both positive and negative symptoms.

2. Schizophreniform Disorder

   • Similar features but lasting from 1 to 6 months; lesser impairment.

3. Schizoaffective Disorder

   • Features of schizophrenia alongside mood symptoms (depression or mania).

4. Delusional Disorder

   • Presence of one or more delusions without other psychotic symptoms.

5. Brief Psychotic Disorder

   • Symptoms lasting from 1 day to one month, often following a stressor.

Specific Psychological Features

• Delusions: Fixed beliefs not based in reality.

  • Types:

    • Persecutory: Believing one is being targeted or harmed.

    • Grandiose: Believing one has exceptional abilities or is famous.

    • Referential: Believing events relate specifically to oneself.

    • Somatic: Beliefs concerning bodily functioning.

• Hallucinations: Most prevalent are auditory (hearing non-existent voices). May also be visual or tactile.

• Disorganized Speech and Behavior: Difficulty maintaining coherent conversations or actions. Common patterns include:

  • Disorganized speech: Incoherent, irrelevant speech or misuse of words.

  • Catatonia: Extreme lack of movement or response to the environment.

• Emotional Responses: May include inappropriate or flat affect, hindering social interactions.

Epidemiology of Psychotic Disorders

• Prevalence: Schizophrenia affects about 0.3 to 0.7% of the population, typically appearing in early adulthood.

• Gender Differences: Males tend to show more severe symptoms at an earlier onset than females.

Risk Factors for Psychotic Disorders

Biological Factors

• Genetics: Significant hereditary component identified through family and twin studies.

• Neurochemistry: Dopamine hypothesis relates excess levels of dopamine to psychotic symptoms.

• Brain abnormalities: Enlarged ventricles and reduced grey matter associated with schizophrenia.

Environmental Factors

• Prenatal: Complications, infections, maternal stress=risk factors.

• Stressful life events and substance use frequently precede onset of symptoms.

Assessment and Diagnosis

Methods

• Informal interviews and standardized rating scales to assess symptoms and daily functioning.

• Rule out medical conditions or substance abuse that might mimic psychosis.

Diagnosis Criteria

• DSM-5 outlines specific criteria for schizophrenia requiring a number of symptoms over a specified timeframe (e.g., delusions, hallucinations).

Treatment Approaches

Biological Treatments

1. Antipsychotic Medications:

   • Two categories: Typical (focus on dopamine) and Atypical (broader neurotransmitter effects).

   • Common side effects warrant careful oversight.

Psychological Therapies

1. Cognitive-Behavioral Therapy (CBT):

   • Aimed at reducing symptoms, addressing thinking patterns and relapsing triggers.

2. Family Therapy:

   • Supports communication and helps manage stressors affecting relationships.

3. Social Skills Training:

   • Enhances interaction abilities to reduce isolation and improve quality of life.

4. Vocational Rehab:

   • Supports returning to work through training and job placement assistance.

Long-Term Outcomes

• Varies significantly; many achieve good levels of functioning with treatment, but full recovery can be elusive.

• Prompt and comprehensive treatment correlates with better long-term prognosis.