EXAM 3 - Psychotic Disorders Flashcards
Psychosis
gross departure from reality, which may include
Hallucinations
Sensory experiences in the absence of sensory input (e.g. hearing voices)
Delusions
Strong, inaccurate beliefs that persist in the face of evidence to the contrary
Schizophrenia
A pervasive type of psychosis characterized by disturbed thought, emotion, behavior
Psychosis: History Thinking
Emil Kraepelin – used the term dementia praecox to describe schizophrenic syndrome
Early subtypes of schizophrenia – Catatonia, hebephrenia and paranoia
Eugen Bleuler – introduced the term “schizophrenia”
“Splitting of the mind”
Psychosis: History Thinking
Bleuler’s 4 A’s (1857-1938)
Association (Thought disorder: loosening of associations where ideas have little connection to each other)
Affect (Decreased or inappropriate)
Ambivalence (Simultaneous opposite feelings)
Autism (Withdrawal from reality and illogical, fantasy-ruled thinking)
Positive (additive) Symptoms of Schizophrenia
Delusions Disorganized Speech Disorganized and bizarre behavior Hallucinations Unusual motor behavior
Negative Symptoms of Schizophrenia
Flat affect
Loss of energy
Loss of motivation
Loss of feelings of pleasure
Disorganized” Symptom Cluster
Confused or abnormal speech, behavior, and emotion
Nature of disorganized speech
Cognitive slippage – illogical and incoherent speech
Tangentiality – “going off on a tangent”
Loose associations – conversation in unrelated directions
Nature of disorganized affect
Inappropriate emotional behavior
Nature of disorganized behavior
Includes a variety of unusual behaviors
Catatonia
May be considered a psychotic spectrum disorder in its own right or, when occurring in the presence of schizophrenia, a symptom of schizophrenia
Subtypes of Schizophrenia: A Thing of the Past
Schizophrenia was previously divided in to subtypes based on content of psychosis
This is no longer the case in DSM-5, but outdated terms are still in partial use
Included paranoid, catatonic, residual (minor symptoms persist after past episode), disorganized (many disorganized symptoms) and undifferentiated
Former Subtypes of Schizophrenia in DSM-IV
Paranoid (Delusions of persecution or grandeur. May trust no one or be anxious or angry about supposed tormentors)
Disorganized (Incoherent speech and inappropriate, often silly, emotion. May be very withdrawn, have odd grimaces and mannerisms)
Catatonic (Bizarre physical movements, ranging from motionless stupor to violent hyperactivity, sometimes alternating)
Undifferentiated (Delusions, hallucinations, and incoherence, but doesn’t fit into any of the other subtypes)
Residual (Minor symptoms of schizophrenia lingering after a serious episode)
DSM-5 Diagnostic Criteria for Schizophrenia
A. 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 speech (e.g., frequent derailment or incoherence).
- Grossly disorganized or catatonic behavior. 5. Negative symptoms (i.e., diminished emotional expression or avolition).
B. For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning).
C. Continuous signs of the disturbance persist for at least 6 months.This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual percepptual experiences).
D.Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either 1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms: or 2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.
E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
F. If there is a history of autistic spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1 month (or less if successfully treated).
Specify if:
With catatonia
Incidence rate of Schizophrenia (1%)
Higher incidence rate for 1st degree relatives of individuals with schizophrenia, especially of parents and identical twins with schizophrenia
Schizophrenia: Statistics
Schizophrenia affects males and females about equally
Females tend to have a better long-term prognosis
Onset slightly earlier for males
The Course of Schizophrenia
Prodromal phase 85% experience 1-2 years before serious symptoms Less severe, yet unusual symptoms: Ideas of reference Magical thinking Illusions Isolation Marked impairment in functioning Lack of initiative, interests, or energy
