Kap 5. Psychotic disorders

Question 1

Definition of Psychosis

Answer 1

A condition with a loss/disconnect of reality and interpreting environment, thoughts and experiences

It can be normal to have different interpretations, but when it affects ADL functioning its a problem!

Question 2

What are the diagnoses under Psychotic disorders?

Answer 2

1. Schizophrenia
2. Schizoaffective disorder
3. Schizotypal disorder
4. Acute and transient psychotic disorder
5. Delusional disorder
6. Substance induced psychotic disorders

Question 3

What is Delusional disorder?

Answer 3

Individual or connected Delusions

No hallucinations

Often long lasting

Question 4

What is the most important take away from the chapter of psychotic disorders?

Answer 4

Psychosis is a continuum!

Question 5

What is Acute and transient psychotic disorder?

Answer 5

Quick onset

It usually fades away over several days or weeks. It should not exceed 3 months. They are usually fully psychotic

Question 6

What is Schizotypal disorder?

Answer 6

It is a personality disorder that is seen as a form of or a precurser to Schizophrenia

weird speech
anhedonia
weird thinking
difficulties socially (which can make them depressed)

Although it is a personality disorder is it classified in the ICD-11 under the psychotic disorders

Question 7

What is Schizoaffective disorder?

Answer 7

It is Schizophrenia mixed together with a mood disorder

Often episodic

It is rather a diagnosis which describes the current state -> When the person has a mood episode, they get this diagnosis. When they are later schizophren, without mood episode, they will get normal schizoprenia.

Question 8

Substance induced psychosis

Answer 8

This can be triggered by consumption of a substance or by withdrawal

Question 9

Requirements for diagnosis of Psychosis

Answer 9

Lasting at least 1 month

Impaired functioning

No other causes

Question 10

What are the typical symptoms of Psychosis?

Answer 10

Positive Symptoms:
Hallucinations, Delusions, Disorganized thinking

Negative Symptoms:
Apathy, emotional/social disengagement, missing motivation, happiness, interest

All this in a cultural lense

Question 11

What can be used to diagnose Psychosis?

Answer 11

SCID-I
MINI

Question 12

What is important with Psychosis to get better outcomes?

Answer 12

An early diagnosis and treatment, can prevent it from going chronic and can reduce symptoms.

Question 13

What are risk factors for psychosis?

Answer 13

Biological factors
Social factors
Environmental factors

Question 14

What are Biological risk factors for psychosis?

Answer 14

Genes for dopamine/glutamat receptors
Big ventricles
Less active prefrontal cortex
Late maturity
Nutritional deficiencies
Stress during late pregnancy

Question 15

What are social risk factors for Psychosis?

Answer 15

1. Being bullied
2. Serious childhood trauma
3. General stress (Migrant background, racial discrimination)

Question 16

What are environmental risk factors for psychosis?

Answer 16

THC consumption (50% of diagnosed were users)
Amphetamines
Growing up in a city
Immigration background

Question 17

How can psychosis be treated?

Answer 17

With a good aliance
Using the Family (Expressed Emotion)

Question 18

What is Expressed Emotion therapy?

Answer 18

It is a family based therapy, for the client that is psychotic.

Here the central theme is, that the family expresses their negative emotions towards the person less and focuses more on the positive emotions. This has a big impact on the course of the disease

Question 19

Which type of medication is used for Psychosis?

Answer 19

Antipsychotics (neuroleptics)

Question 20

What are the two generations of Antipsychotics?

Answer 20

1. Generation (Typical):
   Block D2-Dopamine receptors
2. Generation (Atypical):
   Block D2-Dopamine and Serotonin receptors

Question 21

Antipsychotics give symptoms of another disease, which one and why?

Answer 21

Parkinsons disease, which is characterized by missing dopamine!

Question 22

What can be another negative side effect of psychosis relapse?

Answer 22

Whent the patient relapsed while on medication (maybe taking it inconsequently) the medication usually becomes less effective for the person.

Which is why injectables are better for people, so they do not forget to take their medication, which can often be a reason for why they might relapse

Question 23

Which types of hallucinations happen?

Answer 23

Auditive (60-70% of psychotic patients)
All other senses (taste, feeling, seeing)

Question 24

What is the difference between Psychosis and Schizophrenia?

Answer 24

Psychosis is a symptom characterized by a disconnection from reality

Schizophrenia is a psychiatric disorder encompassing a range of symptoms, including psychosis, cognitive impairments, and disruptions in social functioning.

Question 25

What is the Theory of Aberrant salience?

Answer 25

It tries to explain the positive symptoms of Schizophrenia as a problem of salience (aka how interesting or important information is). Because the dopamine system does not convey what is un-/important anymore. Therefore everything is seen as important, such as own thoughts, which become voices

Question 26

What are the phases of development of Schizophrenia?

Answer 26

1. Premorbid phase
2. Prodromal phase
3. Psychotic phase

Question 27

What is a hallucination

Answer 27

A perception without external/internal stimulus

Question 28

What is a delusion?

Answer 28

Firm and fixed belief based on inadequate grounding, a paranoid or grandious thought!

Examples:
Thoughts being deleted, inserted, transmitted, broadcast to others

Question 29

What can be used to diagnose the different psychotic disorders?

Answer 29

Diagnosis:
SCID
MINI

Symptom assessment:
PANSS - (Positive And Negative
Symptom Scale)
BPRS - (Brief Psychiatric Rating Scale)

Early detection:
CAARMS

Question 30

What are the symptoms of the prodromal phase of Schizophrenia?

Answer 30

• Nervousness and/or restlessness
• Depression
• Anxiety
• Thinking or concentration difficulties
• Worrying
• Lack of self-confidence
• Lack of energy and/or slowness
• Significant drop in grades or job performance
• Social isolation or uneasiness around other people
• Lack of attention to or care for personal hygiene

=> It is important to stabilize the person in their life and get them off drugs.