Psychotic Disorders 03/15

A group of disorders marked by irrationality, distorted perceptions, and lost contact with reality.

Schizophrenia

Most serious of all mental disturbances. Most heavily researched psychological disorders.

Criteria for Diagnosis: Two or more of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3). Delusions, hallucinations, disorganized, catatonic behavior, negative symptoms.

Symptoms

Delusions and hallucinations. Acoustic hallucinations, just sounds, is the most prominent. Those noises are always negative.

ex: seeing rice as maggots. Person thinks they’re touching a girl’s hair, they can feel it, but there’s nothing there.

Positive Symptoms: Reflect an excess of distortion of normal functioning.

Negative Symptoms: Reflect a restriction or reduction of normal functions.

Disorganized Thinking: (fragmented thinking). This is thought to be caused by a breakdown in selective attention.

Word Salad: Could show up in other illnesses as well. A patter of speech which is essentially incomprehensible at times. Their words are all mixed together. Word salads are relatively rare. When it occurs, it tends to be severe or extreme, and mild forms are quite uncommon.

ex: the house burnt the cow horrendously always.

Clang Associations “clanging”: When the word choice is dictated and connected by sound (rhyming) rather than appropriate meaning.

“You wear clothes and how much does this watch cost? Have you a sister? I have three and they are all fine girls, curls, furls, isn’t that funny?”

Flat affect: Negative symptom. Diminished emotional expression. A person’s face does not move, or they may talk in a dull or monotonous voice. Scientists are not entirely sure of the exact cause.

Impaired theory of mind: Negative symptom. Difficulty perceiving facial expressions and reading others’ states of mind.

Three Phases of Schizophrenia

These phases tend to occur in order and cycle throughout the course of the illness. People who develop schizophrenia may have one or many psychotic episodes during their lifetime.

Phase 1, Prodromal Phase: Initial onset, there are barely noticeable changes in the way a person thinks, feels, and behaves. Person might start to perceive things different, withdraw from others, become superstitious. (Watch Beautiful Mind).

Phase 2, Acute Phase: During the next phase, clearly psychotic symptoms are experienced.

Phase 3, Recovery Phase: Following an active psychotic episode, symptoms recede, and depression may develop as people regain insight into their behavior and begin to realize the impact the illness has had on their lives. Residual symptoms may remain and their ability to function effectively can decrease after each active phase.

Chronic VS Acute Schizophrenia

Chronic: Slow-developing process. Most patients fall under this. Recovery is more difficult.

Acute: Develop symptoms rapidly following particular life stresses. Tend to have more positive symptoms. Recovery is much more likely. Drug therapy is recommended.

Onset of Schizophrenia

A disease that the onset of symptoms typically begin during adolescence/young adulthood. Men (ages 15-25) tend to get develop schizophrenia slightly earlier than women (ages 25-35). It’s rare for ages under 10 or over 40 but possible.

Different Types of Schizophrenia

1) Paranoid: frequent visual or auditory hallucinations and one or more delusions. Most commonly diagnosed.

2) Disorganized: marked by disorganized speech and behavior. Hallucinations and delusions may occur, they are not very prominent.

3) Catatonic: characterized by noticeable abnormal motor behavior. Motor behavior can range from stupor (extreme immobility) to waxy flexibility. They take a position and just stay there for hours. Need immediate hospitalization. Rare but mainly men.

4) Undifferentiated: characterized by vague symptoms. The patient may behave in ways that can be seen in two or more of the other subtypes of schizophrenia.

5) Residual: often considered the recovery phase in which severe symptoms usually begin to fade. Has reduced or no symptoms, BUT may still feel paranoid or have strange beliefs.

Cause

Research suggests a combination of biological, genetic, psychological and environmental factors, can make a person more likely to develop the condition. Schizophrenia tends to run in families, but no single gene is thought to be responsible. Combinations of genes make people more vulnerable to the condition. However, having these genes doesn’t necessarily mean you’ll develop schizophrenia.

Abnormal Brain Structure

Loss of gray matter tissue (cerebral cortex … frontal lobes). Decreased brain weight (temporal lobes/hippocampus, corpus callosum). Thalamus (overactive). Amygdala (increased activity).

The Dopamine Hypothesis

Excess activity of dopamine in the brain produces the positive symptoms. (There is also an imbalance of glutamate).

Have to keep a calm, stress free environment. The voices don’t stop but if a person is on meds, it’s just them whispering.