Psychotic disorders (general definition)

characterized by unusual thinking, distorted perceptions, and odd behaviors, out of touch with
reality and to unable to think in a logical or coherent manner
Psychosis
severe mental condition characterize by a loss of contact with realty
Delusion
false belief
Hallucination
false sensory perception, perception-like experience without an external stimulus, such as
hearing voices when no on his there
Other mental disorders in which hallucinations and delusions can form
bipolar disorder, depression, PTSD, and substance related disorders

children with bipolar disorder, obsessive compulsive disorder, autism spectrum disorder, and
conduct disorder
Physical illness that may result in hallucinations and delusions
brain tumors, Alzheimer's or parkinson's disease or other brain damage
Typical difference between schizophrenic delusions and other delusions
individuals without psychotic disorders report that often the voices are positive, not upset by the
presence of the voices and felt in control of the experience and in contrast, psychotic patients
perceive the voices as negative and do not feel n control of the experience
Schizophrenia (general definiton)
disorganization in thought, perception, and behavior, do no think logically, perceive the world
accurately, or behave in a way that permits normal everyday life and work
Kraeplin's theory of schizophrenia (name and symptoms)
dementia praecox, ambivalence, disturbances of affect, disturbance of association, and
preference for fantasy over reality
Etiology of the name dementia praecox
highlight its pervasive disturbances or perceptual and cognitive faculties (dementia) and its early
life onset (praecox) and to distinguish it from the dementia associated with old age
Do people with schizophrenia have split or multiple personalities
no, split in schizophrenia implies split of thoughts and feelings, people with DID can
successfully negotiate with the environment while schizophrenics perceive the enviornemtn
properly and deal with
Positive symptom (definition)
denotes the presence of an abnormal behavior, behaviors that people most often associate with
disorder
Positive symptoms of schizophrenia
unusual thoughts, feelings and behaviors
Most common delusion
persecutory delusions
Persecutory delusions
belief that someone is harming or attempting to harm the person
Delusions of influence
beliefs that others control one's behavior or thoughts, their thoughts are being manipulated by
processes known as thought withdrawal, thought broadcasting, or thought insertion
Processes of delusions of influence
thought withdrawal, thought broadcasting, or thought insertion
Thought broadcasting
the person believe that his or her private thoughts are being revealed to others
Most common type of hallucination
auditory hallucination
Schizophrenic auditory hallucination
voices are most commonly negative in quality and content but can be comforting or kind

voices that keep a running commentary on the individual;s behavior or several voices that have a
conversation
Least common type of hallucination
gustatory (taste)
Loose associations
thoughts that have little or no logical connection to the next thought
Thought blocking
exemplified by long pauses in the patient's speech that occur during a conversation
Clang associations
speech is governed by words that should alike, rather than words that have meaning, rendering
communication meaningless
Catatonia
condition in which a person is awake but is non-responsive to external stimulation, may not
move or make eye contact with others, may be mute or muscularly rigid
Wavy flexibility
parts of the body (usually the arms) remain frozen in a particular posture when positioned that
way by another person
Negative symptoms (definition)
behaviors, emotions, or thought processes that exist in people with schizophrenia
Negative symptoms of schizphrenia
diminished emotional expression, anhedonia, abolition, or apathy, logia, and psychomotor
retardation
Diminished emotional expression
reduced or immobile facial expression and a flat, monotonic vocal tone nah does not change even
when the topic of conversation becomes emotionally laden
ex) parent may describe horrific thoughts with very little emotional expression in the face or
voice
Anhedonia
lack of capacity for pleasure, patient feels no joy or pleasure
Avolition
apathy, an inability to initiate or follow though on plans
Alogia
decreased quality or quantity of speech
Psychomotor retardation
describes slowed mental or physical activities
ex) speech can be slowed to the point that it is difficult or impossible for others to follow the
person's conversation
Difference in treatment of positive and negative symptoms
positive symptoms can largely be controlled by medication, negative symptoms are treatment
resistant
Cognitive impairments in schizophrenia
impairments in visual and verbal learning and memory, inability to pay attention, decreased
speed of information processing, and impaired abstract reasoning, and executive functioning,
take things very literally
One of the earliest signs of schizophrenia
cognitive deficits
Social cognition
ability to perceive, interpret, and understand social information \including other people's beliefs,
attitudes and emotions
Social cognition and schizophrenia
often have difficulty with social cognition and are often deficient in the basic skills necessary for
positive social interactions including the ability to perceive social nuances and engage in basic
conversation, impairment in the ability to identify sarcasm or lies
Paranoia and schizophrenia
delusions/hallucinations of a persecutory and frightening nature
Echolalia
repeating verbatim what others say
What percentage of schizophrenics are comorbid with depression
45% and 5% commit suicide
What percentage of schizophrenics are comorbid with anxiety
47%
Why is schizophrenia comorbid with PTSD
patents are left vulnerable to victimization and violence as a result of poor living conditions or
homelessness
What percentage of schizophrenics are comorbid with substance abuse
50%
What substance abuse is commonly comorbid with schizophrenia
alcohol, marijuana, and benzodiazapenes
Self medication hypothesis
suggests that patients with both schizophrenia and substance abuse disorders have fewer negative
symptoms that patients who do not abuse substances
Relationship between substance abuse and schizophrenic negative symptoms
might relieve negative symptoms, thus providing support for the self medication hypothesis
those with few negative symptoms are less likely to abuse these substances
Definition of the recovery from schizophrenia
no psychotic symptoms, no negative symptoms, and demonstrations of adequate psychosocial
functioning (working at least half time, moderate social activity and no hospitalizations)
Definition of "in recovery" from schizophrenia
still may have symptoms of the disorder but are able to manage other aspects of their life such as
work, education, friendships, and self determiatnion of life's various challenges
Coexisting depression increases the chance of what with schizophrenia
poor outcome, lesser chance of recovery, more frequent hospitalizations, unemployment, poorer
general physical health, increased chance of infectious disease, and excessive medical morbidity
(rates of illness)
Positive outcomes of schizophrenia are more often found in what type of nations (and why)
developing nations, developed nations may have fewer social supports for people and more
limited access to family, less central role of family, easier for a patient in a developing country to
negotiation the enviornment
The rate of violence committed by with schizophrenia compared to people without a mental
illness and people with other psychiatric disorders
rate of violence committed by people with schizophrenia is higher than the general population
but is not higher than among patients with other serious disorders
Schizophrenics as the victims of violence
impaired cognition can make them easy targets, disorder limits their occupational choices,
income, and therefore puts them at a lower socioeconomic status and are forced to live in a more
crime infested area
Schizophrenia and cultural prevalence
approximately the same in all cultures, populations, and levels of industrialization
Percentage of people with schizophrenia
1%
What can the onset of schizophrenia be
acute or gradual
Gradual onset
person often has some deterioration of functioning before the positive symptoms of the disorder
emerge
Prodromal phase
social withdrawal or deterioration in personal hygiene may occur, have difficulty functioning in
work or school
Premorbid phase
before the illness
Acute phase
as the disorder progresses, he or she exhibits the positive symptoms including hallucinations,
delusions, and thought disorder
Residual phase
psychotic symptoms are no longer present, but the negative symptoms often remain
Sex and prevalence of schizophrenia
women tend to develop schizophrenia at a later age than men do, women often have a milder
form of the disorder and experience few hospital admissions and better social functioning
Estrogen and schizophrenia
has a strong protective influence on brain development and is hypothesized to lessen the
abnormal brain development commonly seen among those with schizophrenia
Social functioning and early onset of schizophrenia
when the disorder develops later individuals have more opportunity to achieve adolescent and
young adult developmental milestones and develop better social functioning
Sociocultural factors which influence sex imbalance in schizophrenia
females are socialized from a very early age to be more socially competent than males, and they
have more extensive social networks
Most common type of schizophrenia
paranoia
Least common type of schizophrenia
catatonic subtype
Diagnosis of schizophrenia and ethnicity
african americans are much more likely to receive a diagnosis than white people or hispanic
people, particularly when based on unstructured interviews
Racial bias and diagnosis of schizophrenia
when clinicians make a diagnosis based on a written transcript of a diagnostic interview rather
than conducting an actual interview, where blacks are much more likely to be diagnosed
Other reasons for ethnic discrepancy in diagnosis
inattention to cultural differences in behavior, lack of cultural competence among clinicians,
language barriers and a few bilingual therapists, and diagnostic errors as a result of inadequate
clinical interviews conducted in busy outpatient clinics
Symptoms of schizophrenia in childhood
may have situational anxiety, nervous tension, depression, and psychotic like experiences such as
perceptual disturbances, magical thinking and referential ideas
Magical thinking
the belief that thinking about something can make it happen
Ideas of reference
interpret casual events as being directly related to you
Delusions of reference
you would be sure that they were talking about you
Retrospective design of childhood histories
better than nothing but has limitations such as the cognitive deficits in schizophrenics, may limit
the ability to recall premorbid functioning accurately, parents' recall of an adult child's early
history may be affected by her or his more recent behaviors
Results of the danish youth experiment
poor sociability and abnormal odor functioning may be factors uniquely related to the onset of
schizophrenia
Age of onset (general)
typically around early adulthood, rare in childhood and slightly more common in adolescence
Early onset schizophrenia
when disorder beings in childhood or adolescence, before the age of 18, has severe consequences
Biological consequences of EOS
lose are cortical gray matter than children without a psychological disorder, occurs on bot sides
of the brain and progresses from front to back, indicates signifitan biological deterioration in
brain functioning
Behavioral consequences of EOS
more impaired, have additionally psychotic episodes, need more continuing psychiatric care, and
are more impaired in the area of social functioning and independent living
Children and adolescents with EOS are
socially withdrawn, have difficulty interactiong with peers, and have school adjustment
problems, does not allow much oppurtinut for normal social development
Brief psychotic disorder
sudden onset of any psychotic symotos such as delusions, hallucinations, disorganized speech, or
grossly disorganized or catatonic behavior, amy resolve afterr one day and does not last for more
than a month, afterwards the person returns to normal functioning, associated with significant
psychosocial stressors, such as the death of a loved one or birth of a child
Schizophreniform disorder
symptoms are identical to those of schizophrenia with two exceptions:
duration of the lines is shorter, ranging from 1-6 months
impaired social or occupational functioning is a possibility but some people can still conduct
their daily lives
Schizoaffective disorder
might be considered to have both schizophrenia and an affective disorder, also suffers from a
major depressive, manic or mixed episode disorder at some point during the illness
Delusional disorder
presence of a non bizarre delusion, an event that might actually happen, do not have other
psychotic symptoms except hallucinations that are directly related to the delusion, few changes
occur in the person's overall functioning other than the behaviors immediately surrounding the
delusion
Shared psychotic disorder
folie a deux, begins when one person develops a psychotic disorder with delusional content,
dominant person in the relationship with a second individual (usually related by blood or
marriage and living in close physical proximity, and over time, imposes the delusional system on
the second person, who then adopts the belief system and acts accordingly, if the relationship is
interrupted, the delusional beliefs of the second person quickly disappear
Primary case
also called inducer, the person who firsts develps the psychotic disorder in the relationships
What is folie a deux commonly comorbid with
dementia, depressiona,d n mental retardation
Dopamine hypothesis
disorder association with an excess of dopamine
How was the dopamine hypothesis created
emerged from clinical observations that chemical compounds such as amphetamines and
levodopa, increases the amount of dopamine available in the neural synapse, which, in turn, can
lead to the development or worsening of psychotic symptoms
Three possibilities of the correlation between excess dopamine and schizophrenia
excessive dopamine could lead to the development of schizophrenia
chronic stress created by a disorders serious as schizophrenia may create many different brain
abnormalities including excess dopamine
both excess dopamine and schizophrenia could result from some third vairbale
Excess dopamine causes which symptoms
positive symptoms
Lack of dopamine causes which symptoms
negative symptoms
Negative symptoms of schizophrenia may be caused by a lack of
serotonin
GABA and glutamate and schizophrnia
play an important role with respect to learning and remembering new material, may be
associated with some of the cognitive impairments found among people with schizophrenia
Two possible genetic pathways involved with schizophrenia
direct transmission of the actual disorder from one family member to another or indirect
transmission by affecting the functioning of neurotransmitters such as dopamine
Loci studies and schizophrenia
identified seven loci associated with schizophrenia, identified an area which is known to be
associated with neuronal development, create the hypothesis that actions of hundreds of genres
are likely to play a role
Structural abnormalities and schizophrenia
enlargement of brain ventricles, reduction of gray matters
Ventricles
cavities in the brain filled with cerebrospinal fluid, acts a fusion to prevent brain damage if there
si a blow t the head
When do schizophrenic structural abnormalities develop
present at the onset of the disorder
Cellular differences in schizophrenic brains
mild structural disorganization at the level of the individual brains cells and altered neuronal
connections in multiple brain areas
When do cellular abnormalities develop
during the second trimester of pregnancy, develop long before the onset of the observable
symptoms of schizophrenia
Prenatal factors identified as potentially associate with the later onset of schizophrenia
maternal genital or reproductive infections during the time of conception, influence during the
first or second trimester, bleeding during pregnancy,a dn severe prenatal maternal stress
Maternal exposure to influenza virus during pregnancy
babies were at a greater risk of developing schizophrenia when they became adults, resulted in a
sevenfold increase in the risk of the infant's developing schizophrenia when exposure occurred
during the first trimester
How does influenza affect the fetus
does not cross the placenta, the virus itself is not responsible for any abnormal brain
development, the immune system produces antibodies to fight the infection which cross the
placental barrier and react with the fetal brain antigens producing an immunological responses
that disrupts fetal brain development, abnormalities in structure
Antigens
substance that stimulates production of antibodies
What structural abnormalities does exposure to influenza cause
recuses the number of cells in the cortex and hippocampal areas of the brain, the same
neuroanatomical areas that have been identified as abnormal in patients with schizophrenia
Problems with attributing schizophrenia to influenza
this complication occurs in 25-30% of all pregnancies, not all children born to women with
pregnancy complications will develop schizophrenia
Synaptic pruning
the loss of gray matter during adolescence through a normal biological process that eliminates
the weaker synaptic contacts and enhances the already strong ones
Synaptic pruning and schizophrenia
synaptic pruning occurs at a rate faster than it does in people without schizophrenia, time of this
acceleration coincides with the emergence of subtle behavioral, motor, and cognitive
abnormalities
Schizophrenic mother
the previously believed cause of schizophrenia which describes patients' mothers as dominant,
overprotective, and rejecting, was based on observations or descriptions of family interactions
when the patient already had schizophrenia
Expressed emotion
family's emotional involvement and critical attitudes found among people with a psychological
disorder, in this case, schizophrenia
Patients with schizophrenia who live in family environments that are high on EE variables...
are more likely to relapse and have higher rates of rehospitalization, however this trend may be
unique to white people, high levels of criticism and and intrusive behavior were associated with
better outcomes for African American patients
Passing of traits to people with schizophrenia
family members may have some behaviors associated with the disorder, such as exaggerated
distrust of strangers, but not at a level that produces impairment, such as social cognition
Social perception
mental operations underlying social interactions, which include the human ability and capacity to
perceive the intentions and dispositions of others
Gene environment correlation
the same person who provides a patient's genetic makeup also provides the environment in which
that person lives, individuals who are at increase genetic risk for the disorder may also be
exposed to environments that increase the risk of developing symptoms
lobotomies
entering a person's brain either through a hole drilled in the skull or by s=inserting a device
similar to an ice pick above the eyeball, emotions were though to be seated in the brain and thus
removing some of the brain matter would alleviate suffering, outcomes were generally negative
Hypotherapy
water therapy, used to calm schizophrenic patients, would give prolonged baths of 8 to 24 hours
in length or wrap them in wet sheets to reduce agitation
What treatment changed the treatment of schizophrenia
chlorpromazine, allowed patients to be discharged form the hospital, led to the community
mental health movement, which emphasized treatment, recovery, and reintegration into the
community
Antipsychotics (general)
block dopamine receptors at four different receptor sites labeled D1, D2, D3, and D4, blocking
may be temporary, permanent, partial, or complete, and the type of blocking affects how well the
drug works, do not improve the negative symptoms or the cognitive deficits found among people
with schizophrenia
Typical antipsychotics
effectively reduced the positive symptoms of schizophrenia but produced serious side effects
such as muscle stiffness, tremors, and tardive dyskinesia
Tardive dyskinesia
side effect of typical antipsychotics, neurological condition characterized by abnormal and
involuntary motor movements of the face, mouth, limbs, and trunk, about 52% of patients will
develop this
Theory behind antipsychotics causing tardive dyskinesia
create super sensitivity of the dopamine receptors, leading them to overreact and proceed these
abnormal movements
Atypical antipsychotics
have been preferred for the treatment of schizophrenia in both youths and adults, treat other
symptoms just as well but are much less likely to proceed tar dive dyskinesia, also have some
effects on negative symptoms and cognitive impairments
Side effects of atypical antipsychotics
producing diabetes and high triglycerides, type of fat, lowers the white blood cell count, and
weight gain
Ethnicity and preference of treatment
white patients prefer medication and counseling treatments, minorities preferred a religious
activity, other treatments, or no treatment at all, however all were equally willing to comply with
prescribed treatment
Type of psychotics and relation to ethnicity
white people are six times more likely to receive atypical antipsychotics than african americans,
but this may be because blacks are more likely to become diabetic and have their white blood
cell count drop
Medication compliance
approximately 50% of patients never take their medication or do not take it as prescribed,
associated with high relapse rates and poor treatment response
How are psychosocial treatments used
adjunctive interventions that seek to further reduce primary symptoms and to decrease daily
stress on the patient and/or family
Psychoeducation
a process that educates patients and family members about the disorder, goal is to reduce family
members' distress and allow clinicians' to increase the effectiveness of their work with the patient
and caregiver
CBT and schizophrenia
psychoeducation about psychosis and hallucinations, exploration of individual beliefs about
hallucinations and delusions, eduction using coping strategies to deal wth the symptoms, and
improving self esteem
Reason for social skills training with schizophrenia
the inability to interact with others in a socially acceptable way interferes with social,
occupations and vocational functioning
Social skills training
teaches the basics of social interaction including nonverbal skills such as eye contact, vocal tone,
voice volume, and verbal skills such as initiating and maintaining conversations, expressing
feelings, and acting assertively
Reasons for supported employment
to ability to maintain full time competitive employment is associated with higher rates of
symptoms improvement, enhanced leisure, and financial satisfaction, and enhanced self esteem
Supported employment
includes a rapid job search approach, individual job placements that match patient preferences,
strengths, and work experience, follow along treatment team, find an maintain competitive
employment