Psychotic Disorders Flashcards
(184 cards)
1
Q
What does DSM stand for?
A
Diagnostic and Statistical Manual of Mental Disorders.
2
Q
Give the five symptom dimensions of psychotic disorders.
A
Delusions, hallucinations, disorganised thinking, grossly disorganised or abnormal motor behaviour, and negative symptoms.
3
Q
Name five positive symptoms.
A
Hallucinations, delusions, thought disorder, motor disturbances, and disorganisation in thought and behaviour.
4
Q
Define thought disorder.
A
A state of highly disorganised thinking characteristic of individuals with schizophrenia.
5
Q
Give three negative symptoms.
A
Affective flattening, alogia, and avolition.
6
Q
Define avolition.
A
The inability to initiate or persist with important activities.
7
Q
Define affective flattening.
A
A severe reduction or the complete absence of affective responses to the environment.
8
Q
Define alogia.
A
A deficiency in the quantity of speech.
9
Q
Give two other names for thought disorder.
A
Formal thought disorder or loosening of associations.
10
Q
How does the DSM-5 define a hallucination?
A
A perception-like experience with the clarity and impact of a true perception but without the external stimulation of relevant sensory organs.
11
Q
Roughly __% of patients with schizophrenia report hallucinations.
A
75
12
Q
Between what percent of people with schizophrenia report auditory hallucinations, particularly those of voices?
A
60-70%
13
Q
Between what percent of people with schizophrenia report command hallucinations?
A
33-74%
14
Q
Give an example of a visual hallucination.
A
Seeing the face of a tormentor.
15
Q
Give an example of an olfactory hallucination.
A
Smelling something rotting.
16
Q
Give an example of a gustatory hallucination.
A
Tasting something metallic.
17
Q
Give an example of a tactile hallucination.
A
A hand on your shoulder.
18
Q
What is a somatic hallucination?
A
A perception of a physical experience inside the body.
19
Q
Give an example of a multimodal hallucination.
A
A voice accompanied by the image of a figure.
20
Q
List the neurological conditions that can result in hallucinations. (4)
A
Temporal lobe lesions, complex partial seizures, migraines and brain injuries.
21
Q
What is intoxication with hallucinogens associated with?
A
Alterations in visual perception of the colour, size and shape of objects and the perception of more abstract images.
22
Q
What percent of psychotic experiences disappear over time?
A
70-95%
23
Q
Define hallucination.
A
A psychotic symptom entailing perceptual experiences that are not real, which can occur in any sensory modality.
24
Q
Define hallucinogens.
A
Substances including LSD and MDMA that can produce perceptual illusions and distortions.
25
Define delusion.
A psychotic symptom entailing a strongly held belief that is not consistent with what almost everyone else believes and despite obvious proof to the contrary.
26
Define paranoid delusion.
A false belief of delusional intensity that someone is seeking to harm the individual or their interests.
27
How does the person's beliefs and expectations influence the extent of distress associated with symptoms?
Distress is more likely if the voice is perceived as malevolent than benevolent.
28
Give another name for paranoid delusions.
Persecutory delusions.
29
What are delusions of references?
A false belief strongly held by an individual that environmental stimuli have a particular significance for them, for example, messages of a highly personal nature are being conveyed through neutral sources.
30
Which form of delusion is most commonly reported in clinical settings?
Paranoid delusions.
31
What is a somatic delusion?
A false belief of delusional intensity regarding the appearance of functioning of one's body.
32
What can somatic delusions be accompanied by? (2)
Somatic hallucinations, like a feeling of electricity through the body or heightened vigilance for internal bodily sensations.
33
Define grandoise delusions.
A false belief of delusional intensity about the self including ideas of inflated worth, power, knowledge, ability, identity or relationships with well-known figures.
34
What are grandoise delusions most often associated with?
The manic episodes of bipolar disorder.
35
Between what percent of people with schizophrenia have religious delusions?
25-39%
36
What are nihilistic delusions and delusions of guilt commonly associated with?
Episodes of severe major depression.
37
What do nihilistic delusions involve?
A conviction that one is dead or that parts of the body or environment have ceased to exist.
38
What do delusions of guilt involve?
Beliefs of personal responsibility and the idea that a punishment is deserved for specific events or outcomes of catastrophic proportions.
39
Give two other names for jealousy delusions.
Morbid jealousy, and Othello syndrome.
40
What do jealousy delusions usually involve?
The belief that a partner has been unfaithful.
41
How may people experiencing jealousy delusions arrive at the conclusion that their partner is unfaithful?
Based on illogical evidence, like coded messages from the television.
42
What are erotomanic delusions?
A false belief that the patient's romantic feelings for another, often a person perceived by the patient to be of significant status or influence, are reciprocated by the other person.
43
How do people experiencing erotomanic delusions justify a disavowal of feelings from the other party?
By alternative interpretations, including the conclusion that the person is prevented from directly expressing their love by other parties.
44
Are stalkers with psychotic disorders more or less likely to by violent than other stalkers?
Less likely.
45
What is passivity phenomena?
Delusions that entail a belief that the patient is under the control of some person, force or agency.
46
Give some examples of passivity phenomena. (2)
A belief that thoughts are being interfered with, either being implanted or removed from the mind, or the belief that actions, impulses or emotions are being directly influenced by external forces.
47
Give an example of a non-bizarre delusion.
The neighbour is spreading malicious gossip.
48
Give an example of a bizarre delusion.
Thought broadcasting, the belief that one's thoughts can be heard by others.
49
What are primary delusions.
Delusions that have formed without a prior psychopathological event or process having led to the false conclusion, seemingly out of the blue.
50
What are secondary delusions.
Delusions that are secondary to abnormal changes in mood, memory or perception, particularly hallucinations.
51
How are complex delusional belief systems affected by a change in environment?
They are highly adaptive, and will change to incorporate the new environment.
52
Name Haddock, McCarron, Tarrier, and Faragher's inventory for measuring psychotic symptoms.
The Psychotic Symptom Rating Scales (PSYRATS).
53
Who developed the Psychotic Symptom Rating Scales? (4)
Haddock, McCarron, Tarrier, and Faragher.
54
What do the Psychotic Symptom Rating Scales measure? (3)
The degree of preoccupation and distress associated with the delusional belief, the level of conviction in the belief, and the disruption to the person's life caused by the belief.
55
What does formal though disorder refer to?
Disturbances in the logical sequencing and coherence of thought.
56
How is the severity of formal thought disorder measured?
Through assessments of the person's speech, particularly thought sequencing (flow) and form (structure or coherence).
57
What can disturbances in the coherence of speech range from?
Subtle increases in the use of vague language to highly incoherent speech where the individual's phrases are disjointed and nonsensical.
58
What can disturbances in thought be divided into?
Positive or negative manifestations.
59
Name some examples of positive thought disorder. (7)
Circumstantiality, tangentiality, derailment, clang associations, echolalia, using words idiosyncratically, and neologisms.
60
Define circumstantiality.
Speech that is very indirect and long-winded in conveying meaning.
61
Define tangentiality.
Oblique or irrelevant responses to questions.
62
Define derailment.
The person's comments slip off one idea onto another, only partially-related topic.
63
What are clang associations?
A more extreme manifestation of thought disorder, where phrases become linked through sounds instead of meaning.
64
What is echolalia?
Occurring during acute phases of psychosis, repeating the utterances of others.
65
What are neologisms?
False words.
66
What is catatonic behaviour?
Marked motor abnormalities like adopting unusual postures or repetitive movements.
67
Name the twelve symptoms of catatonia.
Stupor, catalepsy, waxy flexibility, mutism, posturing, mannerism, stereotypy, agitation, grimacing, echolalia, and echopraxia.
68
Define stupor.
No psychomotor activity not related to environment.
69
Define catalepsy.
Maintaining a rigid body posture or rigidity of the limbs even when this would normally require effort.
70
Define waxy flexibility.
A tendency to remain in a posture even when limbs are moved into place by another.
71
Define mutism.
Opposition or no response to instructions or external stimuli.
72
Define posturing.
Spontaneous and active maintenance of a posture.
73
Define mannerism.
Odd, circumstantial caricature of normal actions.
74
Define stereotypy.
Repetitive, abnormally frequent, non-goal directed movements.
75
Define grimacing.
Odd facial movements like baring teeth in the absence of provocation.
76
Define echopraxia.
Mimicking another's movements.
77
How can grossly disorganised or abnormal motor behaviour be defined?
Any form of goal-directed behaviour, leading to difficulties in performing daily activities.
78
What suggests that catatonia has a neurological basis?
It is less responsive to treatment than schizophrenia.
79
What is the presence of catatonic symptoms associated with? (2)
Early onset of psychotic illness and poorer overall functioning.
80
What may alogia include?
Thought blocking; the cessation of speech mid-sentence.
81
How may people account for thought blocking?
Thought control from external sources.
82
What can negative symptoms be difficult to distinguish from? (2)
Adverse effects of medication and symptoms of depression.
83
Give the diagnostic criteria for schizophrenia.
Lasts at least six months, with at least one month of two or more symptoms including delusions, hallucinations, disorganised speech, grossly disorganised or catatonic behaviour, and negative symptoms; the person's functioning is below prior functioning, or there is a failure to achieve expected levels of functioning.
84
What is schizotypal personality disorder?
A pattern of pervasive social and interpersonal deficits and cognitive or perceptual distortions and eccentricities of behaviour beginning before early adulthood.
85
What is schizophreniform disorder?
Equivalent to schizophrenia except the disturbance is of lesser duration (one to six months).
86
Explain schizoaffective disorder?
The co-occurence of the symptoms of schizophrenia and a major mood episode, in addition to at least a two-week period of delusions or hallucinations without mood disturbance, with mood symptoms present for the majority of the total duration of the disorder.
87
Explain delusional disorder.
At least one month of delusions.
88
Define brief psychotic disorder.
A psychotic disturbance lasting more than one day but less than a month with eventual return to premorbid level of functioning.
89
Explain psychotic disorder due to another medical condition.
Prominent hallucinations or delusions that are the direct physiological consequence of another medical condition.
90
What is substance/medication induced psychotic disorder?
Delusions and/or hallucinations that develop during or soon after substance intoxication or withdrawal or after exposure to medication.
91
Define other specified schizophrenia spectrum and other psychotic disorder.
Symptoms of psychosis that cause clinically significant distress or impaired functioning but which do not meet full criteria for any other psychotic disorders, and the clinician must provide specific reasons for why the criteria for another disorder is not met.
92
What is unspecified schizophrenia spectrum and other psychotic disorder?
Symptoms of psychosis that cause clinically significant distress or impaired functioning but which do not meet full criteria for any other psychotic disorders.
93
What does attenuated psychosis syndrome involve?
Psychotic symptoms that are less severe and more transient, and the sufferer has insight into the pathological nature of the symptoms.
94
Define depression.
A state marked by sad mood or anhedonia, as well as hopelessness, suicidal ideation, psychomotor agitation or retardation, appetite and sleep disturbance, fatigue, poor concentration and a sense of worthlessness.
95
What is the reason for the high rates of suicide associated with psychotic disorders?
Comorbid depression.
96
What percent of people with schizophrenia commit suicide?
5-10%
97
What may the increased risk of suicide among people with schizophrenia over the past 100 years be attributable to? (3)
Deinstitutionalisation, side effects of antipsychotic medications, and the effects of withdrawal from antipsychotic medications.
98
Give two anxiety disorders commonly comorbid with psychotic disorders.
Social phobia and PTSD.
99
Give two factors that can lead to comorbidity of anxiety and psychotic disorders.
Trauma associated with the experience of psychosis, and coercive interventions during psychotic episodes.
100
What percent of psychosis patients report current cannabis use?
23%
101
What does cannabis have an increased risk of?
Relapse of psychosis.
102
What does COMT stand for?
Catechol-O-methyltransferase.
103
What is COMT?
An enzyme involved in the breakdown of dopamine and other neurotransmitters releases into synapses.
104
How does COMT relate to psychosis?
Variations of the gene are thought to cause a slower breakdown of dopamine, which is related to the positive symptoms of psychosis.
105
What percent of people with psychotic disorders are unemployed?
40-50%
106
What did Emil Kraepelin originally call schizophrenia?
Dementia praecox.
107
What does dementia praecox mean?
Senility of the young.
108
Define paranoia.
A state characterised by false beliefs that one is being harassed, persecuted, or unfairly treated, which may reach delusional intensity.
109
Who coined the term schizophrenia?
Eugen Bleuler.
110
Give three psychologists who had a significant role in defining schizophrenia.
Kraepelin, Bleuler, and Schneider.
111
Give Kurt Schneider's first rank symptoms. (3)
Hearing voices arguing, hearing voices commenting on the individual's actions and bizarre delusions including passivity phenomena.
112
What is the lifetime prevalence of schizophrenia?
Between 1 and 2%.
113
Give the gender ratio for schizophrenia.
3 men:2 women
114
What is the peak period for onset of psychotic disorders?
Late adolescence and early adulthood.
115
Give the phases of psychotic disorders. (4)
The premorbid phase, prodromal phase, acute phase, and the recovery phase.
116
Explain the premorbid phase.
The presence of risk factors prior to the onset of psychosis, like viral infections in utero, or behavioural problems may be subtle markers of risk for psychosis.
117
Define prodromal symptoms.
Milder symptoms prior to an acute phase of the disorder during which behaviours are unusual but not yet psychotic.
118
What are the active symptoms of psychosis normally preceded by?
A period of gradual deterioration in the individual's mental state and functioning.
119
Explain the prodromal phase.
The preliminary period of change, preceding the onset of delusions, hallucinations and other symptoms of psychosis.
120
What are acute psychotic episodes characterised by?
The emergence of persistent positive and negative symptoms.
121
What is the DUP?
Duration of untreated psychosis.
122
Give two reasons why there is a delay in seeking treatment in people experiencing psychosis.
The individual withdraws from others, and health professionals fail to accurately diagnose the disorder.
123
The longer the DUP, the longer:
The patient's symptoms take to improve with treatment.
124
What may occur during the early recovery phase?
Problems with depression and social anxiety may emerge for the first time as the person reflects on their diagnosis.
125
What recovery style is improved recovery most associated with?
An active effort to make sense of experiences and understand their vulnerability.
126
Name some challenges that occur in the late recovery phase. (3)
Re-integrating into social, recreational and vocational pursuits.
127
What is recurrence of psychotic symptoms associated with? (4)
Discontinuation of antipsychotic medication, the use of cannabis and amphetamines, poorer premorbid adjustment, and conflictual interpersonal relationships.
128
Explain expressed emotion (EE).
A family interaction style in which family members are overly protective and self-sacrificing towards the person with a psychological disorder while also expressing high criticism and hostility.
129
Name the three components of EE.
High levels of criticism, hostility, and emotional over-involvement.
130
Give some characteristics of enduring psychosis. (2)
Periods of very acute symptoms that require hospitalisation, interspersed by continuing symptoms that do not fully disappear.
131
What are more severe and persisting forms of psychosis associated with?
An earlier and more gradual onset of symptoms.
132
Give some risk factors for enduring psychosis.
Co-occurrence of substance abuse and long standing personality traits, which may compromise the person's ability to cope with stress.
133
Name three cognitive processes affected by enduring psychosis.
Attention, memory and executive functioning.
134
Explain the diathesis-stress model in the context of psychotic disorders.
A psychotic episode occurs when a triggering event interacts with an underlying vulnerability and overwhelms the coping resources of the individual.
135
Describe an adoption study.
A study of the heritability of a disorder by finding adopted people with a disorder and then determining the prevalence of the disorder among their biological and adoptive relatives in order to separate contributing genetic factors from environmental factors.
136
Describe a family study.
A study of the heritability of a disorder involving identifying people with a particular disorder and people without the disorder and then determining the disorder's frequency within each person's family.
137
What is concordance rate?
The probability that both members of a twin pair will develop the same disorder.
138
Family studies indicate that the risk of developing schizophrenia increases as what increases?
The degree of relatedness with an affected individual.
139
Give the percentage of schizophrenia in children with two parents affected.
46.3%
140
Give the percentage of schizophrenia in children with one parent affected.
9.4%
141
Give the percentage of schizophrenia in children with grandparents affected.
2.8%
142
What kinds of genetic structural variations occur in higher rates in people with psychotic disorders?
Microdeletions, or replications of genes that are known to play a role in neurodevelopment.
143
Define neurotransmitters.
Biochemicals released from a sending neuron to a receiving neuron so as to transmit messages in the brain and nervous system.
144
Explain the dopamine hypothesis of schizophrenia.
Excessive dopaminergic function in the central nervous system is associated with the occurrence of schizophrenia.
145
Give two pieces of evidence that support the dopamine hypothesis of schizophrenia.
Drugs which reduce dopamine activity are effective in treating schizophrenia, and amphetamines, which release dopamine, can produce symptoms of schizophrenia.
146
What proves that people with schizophrenia do not have higher levels of dopamine?
People with schizophrenia have the same amount of homovanillic acid as controls.
147
What is homovanillic acid?
The major breakdown product of dopamine.
148
How has the dopamine hypothesis been revised?
Schizophrenia is proposed to be associated with excessive numbers of or oversensitive dopamine receptors.
149
How do enlarged ventricles contribute to psychosis?
They indicate a loss of brain tissue.
150
Negative symptoms are associated with loss of grey and white matter in which brain area?
The prefrontal cortex.
151
Explain how abnormalities in the hippocampus predate the onset of psychosis.
People with schizophrenia, but no prior family history, have a smaller left hippocampus, and people with chronic schizophrenia have smaller bilateral hippocampal size.
152
Give some social factors that increase the chance of developing psychosis. (4)
Living in an urban environment, migration, being socially excluded and experiences of childhood abuse.
153
The annual prevalence rates for schizophrenia in Maori individuals is ___ times higher than non-Maori's.
Three.
154
Why are racial and ethnic minorities more likely to develop psychosis?
Accumulated adverse social and environmental circumstances, like racial discrimination.
155
How do cognitive models attempt to explain the development of psychosis?
Early experiences (like exposure to stress or trauma) result in dysfunctional cognition that trigger psychotic symptoms.
156
What is the core of Morrison's cognitive model for the development of positive psychotic symptoms.
Psychosis entails culturally unacceptable interpretations of intrusions into awareness, which are defined as thoughts, images or impulses that intrude upon consciousness and are uncontrollable.
157
What does Morrison believe culturally unacceptable interpretations result from?
Faulty knowledge about the self and others, which is the result of life experiences.
158
What is central to the development of psychosis in Morrison's cognitive model?
The manner in which intrusions into awareness are interpreted.
159
Give the final aspect of Morrison's cognitive model.
Interpreting intrusions into awareness in a culturally unacceptable and typically distressing manner triggers responses that serve to increase the likelihood of further intrusions.
160
Name some of Morrison's counterproductive responses to intrusions into awareness. (5)
Disturbances in mood and physiological arousal, behaviours designed to keep the individual or others safe, selective attention, and attempting to suppress intrusive thoughts, images and impulses by pushing them out of consciousness.
161
Name some triggering events in the development of psychosis.
Biological processes, psychosocial processes, or an interaction between the two.
162
What is the pituitary?
A major endocrine gland that produces the largest number of different hormones and controls the secretions of other endocrine glands.
163
What does a larger volume of the pituitary indicate?
Higher levels of stress hormones.
164
What does the dysfunction in auditory imagery theory state?
Individuals prone to auditory hallucinations are able to imagine particularly vivid sounds, which are so lifelike they are mistaken for real sounds.
165
What is the basis of the refined auditory imagery theory?
Hallucinating individuals typically experience deficits in the vividness of their auditory imagery so that when they experience unusually vivid auditory imagery, this is more likely to be confused for actual sound.
166
What does Seal believe auditory hallucinations result from?
A dysfunction in verbal self-monitoring.
167
Explain Seal's theory of auditory hallucinations.
Auditory hallucinations stem from a breakdown in the individual's ability to notice their intention to make internal speech, causing confusion between internally generated actions with externally generated actions.
168
What evidence supports Seal's theory of auditory hallucinations?
Hallucinating patients are more likely that non-hallucinating patients to misattribute their own speech to an external source when it is distorted in some way, which suggests they do not notice their intention to speak.
169
Bentall and Fernyhough developed a model of hallucinations that integrates: (3)
Cognitive deficits with dysfunctional beliefs and environmental adversity.
170
Explain Bentall and Fernyhough's model of hallucinations.
Trauma may lead to increased susceptibility to intrusive and unwanted cognitive activity and that poor self-monitoring ability may result in trauma-related cognitions being misattributed to an external source.
171
Where did Rossell and David find dysfunction and what was the result of this?
Dysfunction in the information storage system, or the normal connections between related terms that are stored closely together in memory is impaired, leading to retrieval problems.
172
Give the Personal Assessment and Crisis Evaluations's criteria for identifying individuals at high risk for psychosis. (4)
Less severe features of psychosis, transient psychotic symptoms, a substantial deterioration in general psychological functioning, and a family history of psychosis in a first-degree relative.
173
Give an example of a less severe feature of psychosis.
An increase in suspicious thinking.
174
Give an example of transient psychotic symptoms.
Auditory hallucinations that might appear intermittently for brief periods of time.
175
What percentage of individuals defined as being at risk for psychosis via PACE develop psychosis within nine months?
40%
176
What did two interventions did PACE find reduced the development of psychosis in high-risk individuals?
Early use of anti-psychotic medication and CBT.
177
Give one advantage of using CBT as an intervention for high-risk individuals.
It avoids giving antipsychotic medications, which have serious side effects, to people who may not have psychosis.
178
In the case of first-episode psychosis, what is the initial priority? (4)
Comprehensive assessment of mental state and physical health, family history, and presence of previous mental health issues.
179
What is the most common treatment for acute psychosis?
Medication, antipsychotics or neuroleptics for positive symptoms, and benzodiazepines for sleep regulation and reducing anxiety.
180
Name some commonly prescribed antipsychotics. (5)
Risperidone, olanzapine, quetiapine and clozapine, as well as haloperidol.
181
What is tardive dyskinesia?
A neurological disorder characterised by involuntary movements of the tongue, face, mouth or jaw, which can result from taking neuroleptic drugs.
182
What is the relapse rate one year after hospitalisation among those who have discontinued their medication?
65%
183
What medication is usually prescribed for people with long-term psychosis with persistent positive symptoms?
Alternative antipsychotic medications like clozapine.
184
What does the consumer recovery model highlight? (6)
Hope, personal responsibility, empowerment, respect from the broader community, the resilience of the consumer, and the importance of peer support.
