psychosis

PSYCHOSIS STUDY NOTES

Course Information

  • Course: PSYO 343-001
  • Date: November 25, 2025
  • Presented by: Kristen Zentner, B. Sc.

Outline of Presentation

  • Clinical Description of Psychosis
  • Prevalence of Psychotic Disorders
  • Causes of Psychosis
  • Treatment for Psychotic Disorders

Clinical Description

General Overview
  • Psychosis is characterized by a variety of unusual behaviors and symptoms.
Types of Psychotic Disorders
  1. Bipolar Disorder - Includes episodes of mania and depression with possible psychotic features.
  2. Depression with Psychotic Features - Major depression accompanied by psychotic manifestations.
  3. Transient Psychotic Episode - Short-term, sudden onset psychotic symptoms that typically resolve.
  4. Autoimmune Encephalitis - Inflammation of the brain due to autoimmune response leading to psychosis.
  5. Postpartum Psychosis - Severe mental illness occurring in women after childbirth.
  6. Personality Disorders:
    • Schizotypal Personality Disorder (PD)
    • Borderline PD
  7. Schizophrenia Spectrum Disorders:
    • Delusional Disorder
    • Brief Psychotic Disorder
    • Schizophreniform Disorder
    • Medication/Drug-Induced Psychosis
    • Schizophrenia
    • Schizoaffective Disorder

Schizophrenia Diagnostic Criteria

  • Criterion A: Must have at least 2 of the following for a significant portion of time during a 1-month period, with at least one being (1), (2), or (3):
    1. Delusions
    2. Hallucinations
    3. Disorganized speech (e.g., frequent derailment or incoherence)
    4. Grossly disorganized or catatonic behavior
    5. Negative symptoms (e.g., diminished emotional expression, avolition)
  • Criterion B: Significant functional impairment in one or more major areas since the onset.
  • Criterion C: Continuous signs of disturbance lasting at least 6 months, including at least 1 month of Criterion A symptoms.
  • Criterion D: Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out.

Symptoms in Psychotic Illness

Positive Symptoms
  • Hallucinations: Sensory experiences without external stimuli (e.g., auditory hallucinations).
  • Delusions: Fixed, false beliefs. Types include:
    • Delusions of grandeur
    • Delusions of persecution
    • Delusions of jealousy
    • Cotard’s syndrome
    • Capgras syndrome
Negative Symptoms
  • Affective Flattening: Reduced emotional expression.
  • Amotivation: Inability to initiate or persist in activities.
  • Anosognosia: Lack of awareness of one’s illness.
Disorganized Symptoms
  • Disorganized Speech: Non-coherent communication patterns.
  • Inappropriate Affect & Disorganized Behavior: Emotional responses that are inappropriate to the context.
  • Catatonic Immobility: Retention of body positions as set by another.

Prevalence & Course of Schizophrenia

Age of Onset
  • Males: Early to mid-20s
  • Females: Late 20s
Prevalence
  • Estimated prevalence rates range from 0.2% - 1.5%.
  • Symptoms may develop during a 1-2 year period before full criteria are met, but may take up to 10 years for the full criteria for a psychotic episode to be attained.
  • There are periods of symptom remission as well.

Causes of Schizophrenia

Genetic, Psychological, and Social Influences
  • Genetic Vulnerability: Heritability estimated between 60% - 80% due to multiple gene variances.
  • Sociogenic Hypothesis: Suggests a higher occurrence in lower social classes.
  • Social Selection Hypothesis: Proposes that individuals with schizophrenia may drift down into lower social classes.

Treatment for Schizophrenia

Biological Interventions
  • Neuroleptics: These are dopamine antagonists that aim to clarify thought processes and diminish psychotic symptoms such as hallucinations and delusions.
    • Efficacy in 60% – 70% of patients.
    • Newer antipsychotics include:
    • Clozapine
    • Risperidone
    • Olanzapine
    • Quetiapine
    • These newer medications generally have fewer side effects (e.g., Tardive Dyskinesia).
    • Can reduce both positive and negative symptoms and improve cognitive function.
Psychological Interventions
  • Therapy Techniques:
    • Behavioral Family Therapy: Ongoing sessions with both patients and families for effective support.
    • Cognitive Behavioral Therapy for Psychosis (CBTp): Targets symptom management.
    • Acceptance and Commitment Therapy for Psychosis (ACTp): Focuses on acceptance strategies for both patients and family.
    • Emphasis on hygiene, sleep, nutrition, and medication management.

References

  • Boyette, L. L., Korver-Nieberg, N. et al. (2014). Quality of life in patients with psychotic disorders. The Journal of nervous and mental disease, 202(1), 64–69.
  • Corcoran, C. M., & Cecchi, G. A. (2020). Using Language Processing and Speech Analysis for the Identification of Psychosis. Biological Psychiatry. Cognitive Neuroscience and Neuroimaging, 5(8), 770–779.
  • Li, Y., Rekhi, G. et al. (2023). Impact of negative symptoms on health-related quality of life in schizophrenia. Frontiers in psychiatry, 14, 1252354.
  • Novick, D. et al. (2015). Impact of Negative Symptoms on Quality of Life in Patients with Schizophrenia. Value in Health, 18(7), A836–A837.
  • Trubetskoy, V. et al. (2022). Mapping genomic loci implicates genes and synaptic biology in schizophrenia. Nature, 604(7906), 502–508.