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PSY347 - Clinical 1 > Psychosis > Flashcards

Psychosis Flashcards

1
Q

What is psychosis?

A

A state of being out of touch with reality

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2
Q

What is Schizophrenia?

A

A psychiatric diagnosis comprising a specified range and number of psychotic symptoms as classified by the WHO or American Psychiatric Association

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3
Q

Diagnoses in the psychotic spectrum

A

Schizophrenia

Schizoaffective disorder
- Schizophrenia with a more emotional aspect to it

Delusional disorder

Schizophreniform disorder
- Looks a bit like schizophrenia but doesn’t quite meet all the criteria

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4
Q

Experiences of psychosis - thoughts and perceptions

A 
Hallucinations 
Unusual beliefs (delusions) 
Disorganised thinking 
Poor concentration 
Paranoia
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5
Q

Experiences of psychosis - feelings and emotions q

A 
Low motivation/energy 
Anhedonia (can't recognise their own emotions) 
Depression 
Anxiety 
Irritability 
Elation
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6
Q

Experiences of psychosis - behaviours

A

Withdrawal
Isolation
Reduced speech (poverty of content of speech)
Impulsivity

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7
Q

The nature of psychotic symptoms

A

Positive symptoms - excess of normal functioning

Negative symptoms - diminution of normal functioning

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8
Q

Positive symptoms of psychosis

A

Delusions

Hallucinations

Disorganised thinking (speech)

Abnormal motor behaviour

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9
Q

Delusions

A
  • Always about a person’s position in the social universe
  • Most common type is paranoia (more than 90% of people with Schizophrenia have been paranoid at one point)
  • Resistant to counterargument (although it is argued that most people don’t change their opinion on things anyway)
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10
Q

Hallucinations

A
  • Perception of something when there is nothing to account for it
  • Hearing voices is most common
  • Often highly critical voices
  • Can be ordering the individual to do something terrible
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11
Q

Disorganised thinking (speech)

A
  • Actually a communication disorder
  • Derailment - jumping to a completely different topic in the middle of speaking
  • Tangentiality - going off on tangents
  • Clanging - compulsive rhyming or alliteration
  • Neologisms - a newly coined or made up word
  • Word salad
  • Tends to be worse when the patients are talking about emotionally significant topics
  • Inability to subtly alter speech in response to other people
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12
Q

Negative symptoms

A
  • Lack of interest in other people
  • Few gestures
  • Decreased ability to start tasks
  • Inability to feel pleasure
  • Little display of emotion thorough facial expressions
  • Lack of spontaneity
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13
Q

Prevalence of psychosis

A

1% lifetime risk for diagnosis of schizophrenia or bipolar disorder
Up to 3% lifetime risk of any psychotic disorder

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14
Q

The highest incidence of schizophrenia spectrum disorders are seen in…

A

Disadvantaged urban areas

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15
Q

Peak age of onset of psychotic disorders

A

Late teens and early 20s

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16
Q

_____ countries have better recovery rates than _____ nations

A

Developing

Industrialised

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17
Q

Why do developing countries have better recovery rates?

A

Poorer countries tend to have larger families which cope better with the stress of having someone with a mental illness and when the family is less stress, the patient fairs better

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18
Q

Problems with diagnosis

A

Poor reliability and validity

  • Clinicians disagree
  • Symptoms don’t always cluster together
  • Diagnosis does not predict prognosis or course
  • Diagnosis does not predict response to treatments

Tells us nothing about the causes or nature of the problem
- Circular problem, ‘how do you know the patient has schizophrenia?’ ‘because they have hallucinations and delusions’ ‘why do they have hallucinations and delusions?’ ‘ because they have schizophrenia’

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19
Q

Why are diagnoses helpful?

A
  • They simplify communication between clinicians

- Some people find them reassuring

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20
Q

Alternative to diagnosis

A

Individual, symptom-focused approach

- Tries to develop explanatory models and treatments for specific symptoms

21
Q

Brief psychotic disorder

A

< 1 month in duration

May account for 9% of cases of first-onset psychosis

Sudden onset of at least 1 of the main psychotic symptoms

Change in state occurring within 2 weeks

Associated with emotional turmoil or overwhelming confusion

22
Q

Schizophreniform disorder

A

1 - 5 months duration

23
Q

Schizophrenia

A

> 6 months duration

24
Q

Schizoaffective disorder

A

Mix of schizophrenia and bipolar symptoms

25
Q

Delusional disorder

A

Previously termed paranoia

Just having delusions instead of anything else
- Mostly crystallised - very well thought out, elaborate theories

Lifetime prevalence is around 0.2%

Persecutory/paranoia type delusions are most common

26
Q

Shared psychotic disorder

A

Two people share the same delusion

Very rare and potentially not real

27
Q

Bipolar affective disorder

A

Classified as a mood disorder in DSM-5

Evidence increasingly supports the concept of a spectrum of bipolar disorder (Akiskal et al., 2000)

28
Q

What is a mixed episode?

A

Presence of high and low symptoms at the same time

May be the most dangerous as there can be suicidal thoughts (low symptoms) and impulsivity (high symptoms) which can lead to suicide

29
Q

Experiences of mania

A

Elation

Irritability/anger

Decreased speech

Increased goal-directed activity

Risk-taking behaviour

Impulsivity

Pressure of speech

Energy and drive

Flight of ideas

Distractibility

Grandiosity

Psychotic symptoms (hallucinations, paranoid, delusions)

30
Q

Three types of models of psychosis

A

Aetiological models
- Causes of experience and prevalence rates (genetic, life experience)

Relapse models
- Factors that predict relapse/reoccurrence of previous condition

Phenomenological models
- Accounts and explanations of individual experiences and behaviours

31
Q

Continuum model

A

Psychotic symptoms occur on a continuum and more people than are diagnosed specifically may have psychotic experiences

There is no clear boundary between normal and psychotic

Different symptoms show cultural diversity of experience and meaning

32
Q

Population surveys of psychotic experiences

A
  • Hallucinations = 10-15% (Tein, 1991)
  • Delusions = 12% (van Os et al., 2000)
  • Paranoia = 12.6% (Poulton et al., 2000)
  • Bipolar spectrum = 6.4% (Judd & Akiskal, 2003)
33
Q

van Os & Reininghaus (2016)

A

Weak expressions of positive psychotic symptoms (psychotic experiences) can be measured in the general population

80% of these are transitory (brief) and only 7% go on to develop a psychotic disorder

Argument for the continuum model as these experiences are clearly experienced on a spectrum

34
Q

Stress-vulnerability model

A

Zubin et al. (1992)

People have an underlying biological or psychological vulnerability to certain disorders

When presented with environmental stress, this vulnerability can be triggered and result in a mental health disorder

35
Q

Trauma

A

Voices occur as a result of traumatic experiences and their purpose is to draw attention to the trauma in order to promote recovery
In third person as a defence mechanism against the emotional upset caused by memories of the trauma
(Romme & Escher, 1989)

Bereavement, sexual abuse, assault and bullying have been associated with hallucinations
(Varese et al., 2012)

36
Q

Genetic predisposition

A

If you have one parent with schizophrenia you have an approximately 17% chance of developing the disorder

If you have two parents with the disease you have an approximately 46% chance of inheriting the condition

If you have an identical twin with the disorder you have about a 48% chance of developing the disorder

Grottesman (1991)

37
Q

Adoption studies of child with schizophrenic parent

A

Child with a schizophrenic parent is brought up by non-affected adopted parents still demonstrated a higher risk factor for schizophrenia

Tienari et al. (2000)

Shows genetic element is important, not just due to the social environment or learned behaviour passed on to the child from the schizophrenic parent

38
Q

Enlarged ventricles

A

MRI studies show that on average the ventricles of patients with schizophrenia were 26% larger than those without the condition

Wright et al. (2000)

39
Q

Frontal and temporal areas in schizophrenic patients

A

Frontal and temporal areas in schizophrenic patients have been shown to be smaller

Lawrie et al. (2008)

Temporal lobes are responsible for aspect of language and emotion and therefore might account for difficulties displayed in these domains

Frontal areas are associated with drive and motivation and so some of the negative symptoms may be a result of this brain abnormality (Galderisi et al., 2008)

40
Q

Grey matter in parietal, temporal and frontal areas in schizophrenics

A

PET study showed that adolescents with schizophrenia show a loss of grey matter in these areas over 6 years, indicating that the volume of these areas and total brain volume is decreasing

(Thompson et al., 2001)

41
Q

Dopamine hypothesis

A

Drug used to reduce positive symptoms of schizophrenia reduces dopamine within the brain
Stahl (1996)

L-DOPA - used to reduce Parkinson’s symptoms works by increasing the amount of dopamine and too much can lead to schizophrenic-like symptoms and vice versa
Jaskiw & Popli (2004)

42
Q

Dopamine in delusions and hallucinations

A

Dopamine has been thought to tag certain thoughts, experiences and behaviours as important to us

If dopamine system is overactive then many seemingly irrelevant events may be identified as being special

This may explain delusions and hallucinations experienced in schizophrenia
Kapur et al. (2005)

43
Q

Positive/negative symptoms and dopamine

A

Suggested that an increase in dopamine is associated with positive symptoms and a decrease in dopamine is associated with negative symptoms
Lieberman et al. (1990)

44
Q

Problems with the dopamine hypothesis

A

Up to 30% of patients do not respond to treatment with antipsychotic medication suggesting that dopamine is not the only factor in schizophrenia as they still exhibit symptoms despite the reduction of their dopamine levels
Conley & Buchanan (1997)

45
Q

Theory of mind deficits

A

Theory of mind (Frith, 1992) explains the ability that we develop where we are able to understand the self-generated nature of our own thoughts

If this process is deficient, we cannot tell which thoughts are self-generated and therefore might think that our inner monologue has been implanted into our heads

46
Q

Evidence for the theory of mind deficits in schizophrenia

A

Stirling et al. (2001)

Found that patients with schizophrenia were not able to recognise geometric drawings that they had made themselves

Marjoram et al. (2005)

Found that schizophrenics were poorer that controls in understanding cartoon jokes of which a key element was seeing the situation from a particular character’s perspective
They could not see the situation from another person’s POV

47
Q

Attentional overload

A

Hemsley (1996)

Auditory hallucinations may be a result of problems focusing attention properly

Usual mechanisms which filter out irrelevant or unwanted material are not working properly

Results in the individual being bombarded with information and consequent difficulty focusing on and interacting with the relevant environmental cues appropriately

Hallucinations result from attention paid to irrelevant sensory information

Delusions result from the individual trying to derive meaning from a plethora of confusing information stemming from both internal and external sources

Negative symptoms occur due to a natural response to cope with sensory overload

48
Q

Delusions as a defence mechanism

A

Bentall et al. (2001)

Delusions operate as a self defence mechanism when there is discrepancy between the actual self and the ideal self

If someone is unemployed, with few prospects or little money, then it would be a psychological defence to attribute the failings to conspiracy between employers and the government rather than their own inadequacy

PSY347 - Clinical 1 (9 decks)

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