Psychotic/Somatic & Dissociative Disorders

Question 1

What are the core features of Psychosis?

Answer 1

Delusions 
Hallucinations 
Disorganised speech 
Grossly disorganised or catatonic behaviour 
Negative symptoms

Question 2

How are Psychotic Disorders diagnosed?

Answer 2

Schizophrenia: DSM-5 requires two or more of the core features (symptoms) of psychosis to be present over a 1-month period

Question 3

What are the types of Psychotic Disorders?

Answer 3

Schizophrenia - at least 6 months with one month of 2 or more of additional symptoms such as hallucinations
Schizotypal - personality disorder
Schizophreniform - Lesser duration
Schizoaffective - cooccurrence of schizophrenia and major mood episode
Delusional - at least one month of delusions
Brief Psychotic Disorder - lasting more than a day but less than a month
Psychotic disorder due to medical condition - hallucinations or delusions direct consequence of medical condition
Substance induced psychotic disorder - develop during or after intoxication or withdrawal

Question 4

What is the lifetime prevalence of psychotic disorders?

Answer 4

1–2 per cent

Question 5

What are Associated Features of Psychotic Disorders?

Answer 5

Depression

Secondary anxiety and trauma-related problems

Substance abuse

High rates of suicide

Lower quality of life

Stigma as well as being victims of violence

Question 6

What are the different phases of psychotic disorders?

Answer 6

Premorbid phase—presence of risk factors prior to the onset of any symptoms

Prodromal phase—preliminary period of decline in mental state and functioning prior to onset

Acute phase—active positive and negative symptoms

Early recovery phase—associated with depression and anxiety

Later recovery phase—challenges with reintegrating into social, recreational and vocational pursuits

Question 7

What are the different factors leading to Psychosis?

Answer 7

Vulnerability factors (biological, psychosocial).
Triggering factors.

Question 8

What are the different forms of hallucinations?

Answer 8

Dysfunction in auditory imagery theory: Hallucinating individuals and confusing them for actual sounds.

Refined auditory imagery theory: Hallucinating cannot tell the difference between actual and hallucinated sound.

Dysfunction in verbal self monitoring: Breakdown in ability to monitor one’s intention to make internal speech

Hallucinations and cognitive deficit: Increased susceptibility to intrusive and unwanted cognitive activity

Question 9

What can cause delusions?

Answer 9

A ‘jumping to conclusion’ bias

Blame other people rather than themselves when faced with negative life events

‘Spreading activation’ hypothesis

Question 10

How are Psychotic Disorders treated?

Answer 10

Prodromal phase: Use of anti-psychotics in combination with cognitive behaviour therapy

Acute phase: Need 24-hour access to treatment, or hospitalisation, Psychoeducation, Pharmacological approaches, Address co-morbidities including substance use, Psychosocial approaches

Question 11

What are key relapse prevention strategies for Psychotic Disorders?

Answer 11

High rates of relapse, particularly if medication is discontinued by patient

Psychological support for both individual and family

Cognitive model of relapse: to gain a sense of control over their symptoms

Group-based interventions: important for social support and reintegration into society

Family interventions: to reduce high expressed emotion

Question 12

What are Somatic Symptom and Dissociated disorders?

Answer 12

Somatic symptom and related disorders: Prominent somatic symptoms, illness / help seeking preoccupation and worry

Dissociative disorders: The loss of the normal integration of identity, memory, perception, emotion, behaviour, consciousness, body representation and/or motor control

Both involve some dissociation or disconnect

Question 13

How is Somatic Symptom Disorder diagnosed?

Answer 13

One or more debilitating somatic symptoms accompanied by “abnormal reactions”

Abnormal reactions include disproportionate and persistent thoughts regarding–seriousness of symptoms; persistently high anxiety about one’s health or symptoms; and–spending excessive time and energy over health concerns (e.g., excessive healthcare utilisation)

Question 14

How is Illness Anxiety Disorder diagnosed?

Answer 14

Preoccupation but somatic symptoms not particularly prominent

Worry about a particular disease/illness or several different types

Medical condition: level of preoccupation is excessive

Question 15

How is Conversion Disorder diagnosed?

Answer 15

Disturbance in motor or sensory functioning

Not consistent with any recognised medical condition

Causes significant distress and/or impairment

Question 16

How is Factitious Disorder diagnosed?

Answer 16

Fabrication of psychological or medical symptoms

Possible induction of injury or disease in oneself and / of presenting of oneself or others as ill

‘Munchausen’s syndrome’

An individual induces illness in another

Has been known as ‘Munchausen’s by proxy’

Question 17

What is the prevalence of somatic symptom and related disorders?

Answer 17

Somatic = 5-7% adult population
Illness Anxiety = 1.3-10% adult population
Conversion = 5% neurology clinic patients
Factitious disorder = 1% of patients in hospital settings

Question 18

What causes somatic symptom and related disorders?

Answer 18

Underactivity of the hypothalamic-pituitary-adrenal (HPA) axis

Trauma in childhood, Development of personality characteristics

Question 19

How are Somatic Symptom and Related Disorders treated?

Answer 19

Individual and group-based CBT

Reduce / normalise
focus on physical symptoms as well as associated anxiety and depression

Increase daily functioning

Question 20

How are Dissociative Disorders diagnosed?

Answer 20

Depersonalisation / derealisation - Depersonalisation disorder: persistent feeling of feeling detached, Derealisation disorder: experience of one’s surroundings as unreal

Dissociative amnesia - loss of memory for significant personal information.

Dissociative identity disorder - presence of two or more distinct identity or personality states that recurrently take control of the person’s behaviour

Question 21

What is the prevalence of dissociative disorders?

Answer 21

From 0.8 per cent to2.4 per cent for depersonalisation/derealisation disorder

From 0.2 per cent to7.3 per cent in community sample for dissociative amnesia

From 1.1 per cent to1.5 per cent in community samples, but much higher in clinical samples (0.4 per cent to6.0 per cent) for dissociative identity disorder

Question 22

What causes Dissociative Disorders?

Answer 22

Overall, stress/trauma as primary driver

Depersonalisation/derealisation disorder: childhood abuse

Dissociative amnesia: impact of stress on different systems in the brain; and motivated forgetting

Dissociative identity disorder: conceptualised as a childhood posttraumatic stress disorder response

Question 23

How are Dissociative Disorders treated?

Answer 23

Depersonalisation/derealisation disorder: Medication; CBT

Dissociative amnesia: High rates of spontaneously remission; imaginal exposure

Dissociative identity disorder: Coping skills; exposure work; and various techniques re integrating different identities

Question 24

When is peak onset of psychotic disorder?

Answer 24

Peak onset is in late adolescence and early adulthood

Question 25

What is the male to female ratio of psychotic disorders?

Answer 25

3:2