Schizophrenia

• Struggle between what is real and what is not

• Onset in adolescence and adulthood 12-40

• Altered perception, unusual thoughts, odd behavior

• O distúrbio no espectro da esquizofrenia envolve sintomas como:

• Psicose - um senso prejudicado da realidade que frequentemente envolve alucinações e/ou delírios)

• processos cognitivos prejudicados - incluído discursos desorganizados

• Comportamento motor incomum ou desorganizado; e comportamentos problemáticos que afetam as interações sociais

• The symptoms associated with schizophrenia spectrum disorder fall into four categories:

• Positive symptoms

• psychomotor abnormalities

• Cognitive symptoms

• negative symptoms

• Need to have the symptoms for 6 months (does not have to be everyday but more days than not)

• How to assess/diagnose schizophrenia:

• battery of psychological test → speak with family

→ one of the questions would be: “does your family have a history”

→ test urine

→ MRI or CT scan to check the tumor.

→ tool - test level of functioning mental status exam.

other causes:

• Medication

• lack of sleep

• Drugs+ alcoholic

• Brain tumor

Positive symptoms

• positive means excess

• ??? The term “positive symptoms” refers to behaviors or experiences associated with schizophrenia that are new to the person.

1) delusion (a false believe that is firmly and consistently held) - “people can read minds” (are not able to distinguish between their private thoughts and external reality

2) Hallucination - seeing things that are not there.

3) Disorganized thinking (speach) - they do not make any sense - ex. Loose association

4) Catatonia - cant move

5) Disorganized behavior - cant organize their behavior to respond to the activity

Negative symptoms

- you are lacking - you don't have enough of it.

• Flat affect- no emotions

• Lack of meaningful speech

• social withdrawal

• hard time distinguishing relative stimuli and correlative stimuli.

• Avolition - lack of motivation

• Anhedonia - inability to feel pleasure

Its worst diagnosis is to have negative symptoms.

The negative symptoms represents irreversible deterioration in the brain

What responde best in medications? the positive symptoms. (anti-psychotic

Premorbid functioning - abnormalities occurred before the actual onset (you see illusions) of symptoms

• Most cases of schizophrenia have premorbid functioning

→ They include impairment in verbal reasoning, an inability to reason things ut, deficit in cognitive tasks.

• not able to reading things out, or things out

The typical course of schizophrenia consist of three phases: prodromal, active and residual

prodromal stage - Actual onset of psychotic symptoms

• social withdrawing

• Odd way of communicating

• poor communication pattern

• most common delusion is paranoid delusion

Most schizophrenics are violent? false

What percentage diagnosed in the world? 1% people are diagnosticated

The relationship between cannabis and Psychotic Disorder? one can lead other but the only thing we know is that they are related

• A full recovery is difficult

2) Other Psychotic Disorders

1. Brief psychotic disorder -

• sudden onset of the symptoms of schizophrenia that last less than a month.

• Typically caused by some severe stressor.

→ Person is suffering from delusions, hallucinations social withdrawal, and inappropriate reasoning and speech for 3 weeks, with brief psychotic disorder

More than a month is schizophreniform.

1. Schizophreniform -

• Symptoms of schizophrenia that last more than a month, but less than 6 months

.

1. Schizoaffective -

• schizoaffective disorder involves a combination of schizophrenia symptoms (such as delusions and hallucinations) + Depression or Bipolar (mood disorder symptoms)

• The difference between MDD (major depressive disorder) and Schizoaffective is that they have positive psychotic symptoms and have them when they are not having MDD, while MDD with psychotic symptoms has them at the same time.

→ Suppose a person has psychotic symptoms that only occur during period of mood disorder → MDD with psychotic features

1. Delusional disorders -

• The person has delusions, not as severe as schizophrenia. 6 months. no hallucinations

• Falso believe that someone is in love with them.

• The difference between delusional disorder and schizophrenia is that schizophrenic are more bizarre

→ types od DELUSIONAL desorder:

• Erotomania: False belief tha someone is in love with them

→ When someone say hi to you, and you start to think she is in love with you.

• GRandiosity: When you believe you have some special talent or have a relationship with someone that is important.

→ When you see a famous person in a rstaurante, you say hi to them, and they answer back and you start to think she is your friend.

• JEalosy: have a false belief that your partner is unfaithful.

• Persecution : Being conspired against, mistreated

• Somatic : have the belief that you have a physical defect for which no medical fix can be found.

Causes of Schizophrenia

• the cause is biologicaç (química (dopamine) embalace/ genetic) → too much dopamine in certain parts of the brain is connected to delusions and Hallucinations

→ one parent with schizophrenia = 15% chance of getting it

→two parents = 50%

• Neuroanatomy - a large ventricles (open spaces or cavities)in the brain means less cortex. Leads to devirginize thinking, speech…

• Prenatal conditions - If the mother has a infection it increases the probability to develop schizophrenia

Treatment of Schizophrenia:

• Type of medication is Anti-Psychotic medication (neuroleptics).

• How do antipsychotic works? it lowers dopamine

→ Typical Antipsychotic (haldol, thorazine) -

• Sidefecct: tardive Dyskinesia

–> Abnormal involuntary movements o face and mouth (like sucking the lip)

→ Atypical anti- psychtic - block dopamine but also increase serotonin (increase mood).

• Must be less likely to produce dyskinesia and less likely to produce side effects.

• Having some good results that works for negative symptoms

→ Antipsychotic block receptors and hang out in synapses, and the enzymes destroy the dopamine in the synapse

• Psychotherapy and medication

• Transcranial magnetic stimulations - is not FDA-approved for schizophrenia. It can be prescribed off-label for schizophrenia

Personality Disorder

• Ego Syntonic/ Ego Dystonic

• Cluster A = caracterized by odd or eccentric behaviors

• Ego syntonic -

→ Act in a consistent way in different situations or time periods.

→ pensamentos e comportamentos são aceitáveis para o ego.

• Ego Dystonic -

→ Behave a different of your typical ways of behaving. Act inconsistently

→ Unacceptable to your ego

• Personality disorder are chronic

• 6 month

• singnificantly impor function

• Cause more stress to others than to yourself

• To be diagnosticated at least 18 years old of age, because the brain still developing

• The 10 specific personality disorder in the DSM-5 are grouped into three behavior cluster (conjunto):

1. Odd or eccentric behavior

2. Dramatic, emotional, or erratic behavior (not regular/unpredictable)

3. Anxious of fearful behaiors

10 personality disorders:

Cluster A - Disorders Characterized by Odd or eccentric Behaviors

• characterized included overlapping environmental and genetic risk factors (similar to schizophrenia)

1. Paranoid -

• mistrust and suspiciousness regarding other motives.

• Very distant from others

• Don't confide on others;

• interpret random events to gave persona meaning

• Form of projection. They probably don't like themselves.

1. Schizoid -

• Very detached from others people

• Emotionally could

• socially isolated

• no desire to have close relationships

• very little pleasure in their lives. (anhedonia)

→ Schizoid vs Schizophrenia

• Schizoid have more sense on what they say

• Don't have delusion

• No magical off thinking

1. Schizotypal

• They do have desire to relationship

• But they have the discomfort in interacting with others, not a lack of desire.

• peculiar thoughts/behaviors

• No illusion and hallucination.

• Magical thinking that doesn't make sense.

Cluster B - Dramatic, Emotional, or Erratic behaviors (unpredictable)

1. Histrionic -

• Somebody over dramatic or emotional who when you interact with them, is performing.

• purpose to seek attention

• A person needs to be the center of attention in any group of people they interact with. When the focus is not them, they become uncomfortable.

• Tend to flirtation but emotionally shallow. They tend to act seductively to focus on them.

• More women were diagnosed than men.

• Women tend to have fewer close girl friends.

• Relationships are thought to be more intimate than they are.

→ Causes: Genetics could cause you to have inherent emotional excitability and overarousal of the sympathetic nervous system.

1. Narcissistic:

• A person who has an exaggerated sense of self-importance.

• Strong sense of entitlement; Think things should go their way because of who they are.

• They are very arrogant and have a lot of fantasies of power and wealth.

• It is very important to be in position of power. Often, let you and others know how wonderful you are.

• Overestimate ther talents -they tend devalue their partner or put them down.

• Low on empathy

• They tend to be in relationship where they can control the person

→ therapeutically what do you do: Treating personality disorder is usually always psychotherapy. Usually, an underlying insecurity, so try to get them to be in touch with the insecure side. You must show them that the therapy will help them get their needs back.

→ Healthy narcissism: Slightly think they are better than others.

• Have a feeling they are special, and a feeling of being a little better that others can help them overcome barriers.

→ Causes:

• Not muh validation or acknowledging themselves.

• not much bonding with parents, the only way to get validation was doing well - also, too much validation from siblings and parents' family.

conditional love: Love/warmth/acknowledgment comes at a condition.

• Unconditional love is that comes no matter what. You always see them as a good person.

1. Anti- Social personality disorder:

• They are against society’s law and rules.

• Someone impulsive, consistently aggressive, engages in thrill-seeking behaviors, and consistently violates the rights of others.

• They lack empathy, rarely feel guilt, and rarely learn from past experiences.

• Don't experience a lot of anxiety when they violate the rights of others

• very charismatic person.

• Lot of these people are in jail. LAck of conscience

→ Causes: Severe abuse/trauma; he was physically abused before they were born - rough upbringing.

→ Two types of antisocial personality disorder:

• Psychopath:

- Tend to be unemotional and cold-hearted

Lack of conscience, empathy, and autonomic nervous system arousal (they don't feel the alarm of adrenaline).

• They do not explode under pressure. When they are being interrogated , their hearts do not feel fear.

• They are sadistic (get pleasure from causing pain).

• Vet callous, lack of care for others.

• very little empathy

→ Exemplo: Um cara em uma lanchonete escuta conversa de dois menino sobre um o carro. Ele vai lá interagir com eles dizendo que estava escutando as conversas deles e tem um carro parecido com o q eles estavam falando e os chama pra ver. Ele leva os meninos em um beco escuro e os mata. Depois volta para a lanchonete e come o lanche deles.

• Sociopath antisocial personality disorder:

• More likely to blend in (se misturar) with the society, less severe than a psychopath, less aggressive, under interrogation, they will get emotional, quick to anger, mood swings, unstable moods.

1. Borderline personality disorder:

• A person who has intense and unstable fluctuation in mood, a history of unstable relationships, a hard time regulating their emotions, and a hard for them to soothe (acalmar) themselves.

• Very impulsive and strong fear of abandonment.

• Life is viewed as meaningless unless connected to others.

• They have a overactive amygdala.

• Develops a lack of stability in the attachment; bounding was inconsistent - sense of emptiness. Never learned how to self-soothe. Being around other people is their only way of self-soothing.

Cluster C - Anxious or Fearful behaviors

• This category includes the avoidant, dependent, and obsessive-compulsive personality disorder.

1. Avoidant -

• Fear of rejection

• very hesitant to enter into a relationship

• very shy, sense of inadequacy

• would like to connect with others, but the fear of being rejected is too strong

1. Dependent:

• Overly reliant (dependente) on others

• Lack self- confidence

• Overly clinging to someone else

• see themselves as inadequate and have no belief that they can make the situation better.

1. Obsessive-compulsive personality disorder:

• Someone who is extremely orderly

• hae a lot of focus on detail and rules, perfectionistic,

• someone who believes there is a wrong and right way to do things

• Very rigid

• Would label soups and stuff in cabinet perfectly ordered

Cause: Right and wrong ways can be a way to fight against anxiety. They feel as though structure helps anxiety.

Exemple: A woman in a restaurant only sits in 4 places in a restaurant and only orders one dish, she has obsessive-compulsive personality disorder.

Duvidas

• What is the difference between Schizotypal for Avoidand since both of them have anxiety of being with others but they want to be with each other at the same time? You told us during the class the difference between schizoid and Avoidant, which is that a schizoid doest want to socialize but Avoidand wants to socialize but is scary.

Exam Questions

1. What is it called when a patient has all symptoms of depression and some delusions + Hallucinations?

• Major Depressive Disorder with psychotic features

1. Person is suffering from delusion, hallucination, social withdraw, inappropriate reasoning and speech for 3 weeks

• Brief psychotic disorder