midterm 3 Flashcards
Psychosis is a ?
syndrome
risk factors for schizophrenia
Genetic Heritability
prenatal factors
substance use
childhood trauma
racism (developing psychosis)
winter birth and urban living
promodal psychosis:
AND affective and behaviroal symptoms
clinical high risk
prodome
mild visual and auditory halluciantions
deja vu or dissociative states
paranoid ideas
brief hallucinations BUT insight intact
-mood + anxiety
-substance misuse
-declines in hygieneand
- academic functioning
schizophrenia diagnosis
At least two of the following for 1 month, one of which must be delusions, hallucinations, or disorganized speech:
Delusions
Hallucinations
Disorganized speech
Grossly disorganized or catatonic behavior
Negative symptoms
functional impairment
Symptoms persist (including prodromal/residual phases) for 6 months or more.
Not explained by another condition
hallucinations vs delusions
False sensory perceptions that occur without an external stimulus. The person perceives something that is not actually present.
False beliefs that are firmly held despite clear contradictory evidence and not explained by culture or religion.
Schizoaffective Disorder Diagnosis
Involves an uninterrupted illness with both:
A major mood episode (depression or mania), and
Symptoms of schizophrenia (e.g., hallucinations or delusions).
Key feature: At least 2 weeks of psychotic symptoms without any mood symptoms.
Mood symptoms must be present for the majority of the illness duration.
Cannot be due to substances or medical illness.
Perceptual Disturbances: hallucinations
Auditory (most common)
Visual
Olfactory (smells)
Gustatory (tastes)
Somatic/Tactile (bodily sensations)
unique, metaphorical experiences:
“Voices through my teeth”
“People put dust on me”
“Iridescent angel wings”
delusions
Delusions are fixed, false beliefs, held despite obvious evidence to the contrary.
Based on misinterpretation of external reality.
Resistant to logic or social norms.
Persecutory: Belief others are trying to harm or surveil them.
Ideas of Reference: Belief that unrelated events (e.g., TV shows, strangers’ conversations) are about them.
Thought Insertion/Removal/Broadcasting: Beliefs that thoughts are externally controlled or made public.
Grandiose: Exaggerated sense of self-importance (e.g., “I’m a prophet”).
Somatic: False beliefs about physical illness or deformity.
Religious: Beliefs involving special religious identity or mission.
Nihilistic: Belief that oneself or the world doesn’t exist.
Eromatic delusions: false belief that someone is in love with them (often someone famous)
disorganization
Subjective experiences:
“My thoughts felt thick or tangled.”
“Thinking became heavy.”
Speech abnormalities:
Flight of ideas: jumping rapidly between loosely connected thoughts.
Loosening of associations: ideas strung together with weak logic.
Word salad: incoherent, jumbled speech.
Clang associations: linking words by sound, not meaning (e.g., “the light is bright, might fight the night”).
Neologisms: made-up words.
negative symptoms
Affective Flattening: Emotional unresponsiveness, unchanging facial expression, poor eye contact, reduced voice tone.
absence or reduction of normal functions:
Alogia: Reduced speech output (less quantity or meaningful content).
Flat affect: Blunted emotional expression.
Anhedonia: Lack of pleasure or interest in normally enjoyable activities.
Avolition: Decreased motivation or goal-directed behavior.
Asociality: Withdrawal from social interaction.
Are present in most people with schizophrenia.
Are severe and persistent in ~25% of cases.
Tend to be less responsive to medication and more predictive of long-term functional outcomes.
mood symptoms
Depression: Affects 74% of first-episode psychosis patients.
Two-week depressive episodes occur in ~83% over the course of illness.
Strongly associated with increased suicide risk—10% suicide rate over 12 years; highest risk is in the first year of treatment.
Anxiety: Social phobia and Obsessive-Compulsive Disorder (OCD) are especially prevalent.
Post-Traumatic Stress Disorder (PTSD) is also frequently co-occurring.
cognitive symptoms
Global cognitive deficits (1–2 standard deviations below the mean).
Most affected areas:
- Verbal and visual learning
- Attention
- Processing speed
- Executive functioning (planning, inhibition, flexibility)
- working memory
Timeline:
Detectable as early as ages 6–7.
Steep decline during adolescence (12–17 years).
Deficits are often present years before the first psychotic episode.
After symptom onset, these deficits are generally stable but persistent.
prognosis
Prolonged remission – Symptoms abate, and the person maintains functionality for extended periods.
Episodic relapse – Periods of recovery are punctuated by psychotic episodes.
Refractory to treatment – Symptoms persist despite appropriate medication and therapy.
Prognosis – Factors Associated with Good Outcomes
Later onset and abrupt symptom development (rather than gradual decline).
Shorter duration of untreated psychosis.
Better premorbid functioning (academic, social, occupational).
Strong support systems: family, marriage, community ties.
Fewer negative symptoms.
Prominent mood symptoms (depression or mania often respond better to treatment).
Catatonia, which can respond well to certain treatments.
Adherence to treatment (meds, therapy).
Female gender and residing in countries with less stigma are also linked to better outcomes.
Pharmacological Treatments – Antipsychotic Medications
Positive symptoms (hallucinations, delusions) often respond well to meds.
Negative and cognitive symptoms tend not to respond as well.
No clear evidence that second-generation (atypical) antipsychotics are more effective than first-generation, but:
First-generation: Higher risk of extrapyramidal symptoms (e.g., tremors, rigidity, tardive dyskinesia).
Second-generation: More likely to cause metabolic side effects (e.g., weight gain, diabetes risk).
Psychosocial Treatments
Cognitive Behavioral Therapy (CBT) for delusions and hallucinations.
Cognitive remediation for improving memory, attention, and executive function.
Supportive therapy for emotional regulation and relationship-building.
Supported employment/education: Vocational training, coaching, and workplace accommodations.
Supported living: Housing assistance and independent living skills training.
Family therapy and psychoeducation: Reduces relapse by improving communication and problem-solving.
Community support groups: Peer-led spaces (e.g., Hearing Voices Network) reduce stigma and isolation.
Coordinated Specialty Care (CSC) Model
CSC is a multidisciplinary approach designed for first-episode psychosis.
Teams include:
Psychiatrists
Therapists
Vocational specialists
Case managers
Family liaisons
Services are youth-friendly, recovery-oriented, and focus on community integration.
coping strategies
sensory redirection & humor
dialouging with fear
DSM-5 Criteria for Schizophrenia
Two or more symptoms for at least one month, with at least one from the top three:
(1) Delusions
(2) Hallucinations
(3) Disorganized speech
Other possible symptoms: disorganized/catatonic behavior or negative symptoms (e.g., avolition).
Social/occupational dysfunction must be present.
Duration: At least 6 months, including prodromal/residual periods.
Rule-outs: Symptoms not due to substance use, another medical condition, or another psychiatric disorder.
schizophrenia symptoms
Positive symptoms: Additions to normal experience (e.g., hallucinations, delusions).
Negative symptoms: Losses of normal function (e.g., flat affect, avolition).
Disorganized/Cognitive symptoms: Disruption in thinking, speech, attention, and executive function.
disorganized behavior
Inappropriate affect: Emotion doesn’t match the context (e.g., laughing at a funeral).
Impaired grooming: Poor hygiene or odd clothing choices.
Odd mannerisms: Strange gestures or repeated behaviors.
Catatonia is a more extreme motor symptom:
Rigidity or waxy flexibility: The body remains in fixed positions.
Negativism: Resistance to movement or instruction.
Stereotyped movements: Repetitive, non-goal-directed motions.
Echolalia: Repeating others’ words.
Echopraxia: Mimicking others’ movements.
Wisconsin card sort task
Person is asked to sort cards by one rule (e.g., color, number, shape).
After several correct responses, the rule changes (e.g., now by shape).
People with schizophrenia often struggle to adapt, continuing to sort by the old rule—this is called perseveration.
other psychotic disorders
Brief Psychotic Disorder:
Same core symptoms as schizophrenia.
Duration: 1 day to 1 month.
Often triggered by stress or trauma.
Typically resolves on its own.
Schizophreniform Disorder:
Same symptoms as schizophrenia.
Duration: 1–6 months.
Used as a provisional diagnosis until 6-month threshold is met.
Good prognosis if resolved.
Delusional Disorder:
Only delusions are present (no hallucinations or disorganization).
Must persist for at least 1 month.
Functioning may otherwise be intact.
Clinicians must carefully rule out true beliefs—known as the Martha Mitchell effect (when outlandish beliefs are actually true).
Schizoaffective Disorder:
Combination of schizophrenia symptoms and a major mood episode (depression or mania).
Diagnosis requires 2+ weeks of psychosis without mood symptoms.
Often runs in families with bipolar disorder.
Psychotic symptoms can also occur in:
Manic episodes
Major depressive episodes with psychotic features
attentuated psychosis syndrome
Symptoms resemble a milder version of psychosis.
Occur at least once per week for the last month.
Person may have:
Odd thoughts
Suspiciousness
Vague perceptual disturbances
Still maintaining some insight, though distressed.
Criteria:
Must cause some functional impairment.
Symptoms should be present for 6+ months, though not constant.
