Psychosis and Schizophrenia_Pre_V1

Psychosis Overview

  • Definition: An abnormal mental state where an individual cannot distinguish between reality and unreality.
  • Broad vs. Specific Meaning:
    • Broadly: Can include symptoms from various conditions like delirium or dementia.
    • Specifically in psychiatry: Refers to primary psychosis independent of other medical/psychiatric conditions.

Focus on Schizophrenia

  • Symptoms Classification: Symptoms in schizophrenia are categorized into:
    • Positive Symptoms: Present in schizophrenia, absent in most people.
    • Negative Symptoms: Absent in schizophrenia, present in most people.
Diagnostic Criteria for Schizophrenia
  • Mnemonic - HDBS Network:
    • H: Hallucinations
    • D: Delusions
    • B: Disorganized Behavior
    • S: Disorganized Speech
    • N: Negative Symptoms

Positive Symptoms of Schizophrenia

  • Hallucinations:

    • Perceptions with no external stimulus; often auditory.
    • Clear voices that typically critique or demean the patient.
    • Patients may act upon these voices (responding to internal stimuli).

  • Delusions:

    • Fixed, false beliefs, resistant to contradictory evidence.
    • Common forms: paranoid/persecutory delusions, ideas of reference (e.g., interpreting news as personal messages).
    • Types of delusions:
    • Thought Broadcasting: Belief that thoughts are transmitted outwards.
    • Thought Withdrawal: Belief that thoughts are removed by outside forces.
    • Thought Insertion: Belief that thoughts are inserted into one’s mind.
    • Delusions of Control: Belief that one’s actions are controlled by external forces.

  • Disorganized Behavior & Speech:

    • Difficulty maintaining a coherent thought process.
    • Disorganized speech examples:
    • Clang Associations: Answers based on sound rather than meaning.
    • Neologisms: Creating new words.
    • Echolalia: Repetition of others' words.
    • Perseveration: Repeating the same word or phrase.
    • Word Salad: Nonsensical mix of words.
    • Disorganized behavior is purposeless and unpredictable.

Negative Symptoms of Schizophrenia

  • The Five A's:
    • Affect: Blunted or flat emotional expression.
    • Ambivalence: Difficulty making decisions, leading to indecisiveness.
    • Alogia: Reduced speech output; can range from small reductions to complete mutism.
    • Anhedonia: Inability to feel pleasure, leading to amotivation and neglect of basic needs.
    • Asociality: Withdrawal from social interaction and lack of interest in social relationships.

Diagnostic Criteria Summary

  • At least two symptoms must be present for six months for diagnosis (2-4-6 afrenia).

Prevalence and Onset of Schizophrenia

  • Population: 0.5% to 1% experience schizophrenia.
  • Age of Onset:
    • Earlier in men (18-25 years) than women (25-35 years).
    • Men show a more severe form and worse outcomes.
  • Prodromal Symptoms:
    • Early signs like odd beliefs, withdrawal, and clumsiness in childhood.
    • Not specific enough to reliably predict future illness.

Outcomes and Treatment

  • Schizophrenia leads to:
    • Lifelong acute symptomatic exacerbations.
    • Progressive functional impairment, even without active symptoms.
    • High recurrence (90% chance of future episodes).
    • Poor life expectations, with a significant number unable to hold jobs and a higher risk of homelessness.
    • Life expectancy reduced by 10-20 years; high suicide rates (15% of all suicides).
Treatment Approaches

  • Medications: Antipsychotics primarily block dopamine.

    • Effective at rapidly reducing positive symptoms but less effective for negative ones.
    • Hospitalization may be necessary for severe symptoms.

  • Psychotherapy:

    • Especially CBT for psychosis helps patients manage symptoms and discern delusions/hallucinations.

Related Disorders

  • Brief Psychotic Disorder: Symptoms < 1 month.
  • Schizophreniform Disorder: Symptoms between 1 to 6 months.
  • Delusional Disorder: Fixed false beliefs, but without the additional symptoms of schizophrenia.
    • Patients may still maintain normal functioning in other areas of life, though delusions can strain relationships.

Conclusion

  • For diagnosis, understanding the duration of psychosis plays a crucial prognostic role. The treatment of schizophrenia requires a multifaceted approach involving both medication and therapy to effectively manage symptoms and improve quality of life.