Chapter 25: psychotic disorders

Question 1

Different symptoms in psychosis

Answer 1

1. Cognitive symptoms: impairment in information processing, concentration etc.
2. Negative symptoms: emotional flattening, apathy etc.
3. Affective symptoms: depression, anxiety and mania.

Question 2

Diagnostic criteria for schizophrenia

Answer 2

At least 2 of the following symptoms and at least one of them form the first 3 categories:
1. Hallicunations
2. Delusions
3. Disorganized speech
4. Disorganized chaotic behaviour
5. Negative symptoms
Symptoms need to be present for >6 months.

Question 3

Four-factor model (of schizophrenia/psychosis)

Answer 3

1. An unexpected increase in dopamine levels leads to enhanced perception of stimuli.
2. Top-down processes consisting of inductive and deductive reasoning to give meaning to the intense and intrusive stimuli.
3. Cognitive tendencies (like excessive attention to danger, jumping to conclusions, expectancy bias) influence the experience.
4. Consolidation that continually reinforces the self-created delusional ideas and distorted perception.

Question 4

Etiology of psychotic disorders

Answer 4

Genetic factors play a role, which is also seen in relatives who have poorer cognitive performance.

Question 5

Neuropathology in psychotic disorders

Answer 5

People with schizophrenia and bipolar disorder have differences in structure, density and thickness of the grey matter and some brain regions. People who had a psychotic experience already show less grey matter and if they eventually get a psychotic disorder then they show even more reduced grey and white matter.
People with schizophrenia or MDD show more activation in the right medial prefrontal cortex and bilateral anterior cingulate cortex.

Question 6

Treatment

Answer 6

• First generation antipsychotics block the dopamine receptor D2.
• Second generation antipsychotics target serotonin and glutamate receptors.
• Cognitive rehabilitation.