Title 11 AbPsy - Schizophrenia Spectrum and Other Psychotic Disorders.pdf ✅

11 – Schizophrenia and Other Psychotic Disorders ABPSY | 2024 - 2025 | NOT FOR SALE OUTLINE 1. Defining Schizophrenia Spectrum 2. Delusion Disorder 3. Brief Psychotic Disorder 4. Schizophreniform Disorder 5. Schizophrenia 6. Schizoaffective Disorder DEFINING SCHIZOPHRENIA SPECTRUM PERSPECTIVES ON SCHIZOPHRENIA Schizophrenia – characterized by a broad spectrum of cognitive and emotional dysfunctions including delusions and hallucinations, disorganized speech and behavior, and inappropriate emotions ● Can disrupt a person’s perception, thought, speech, and movement ● Full recovery from schizophrenia has a low base rate of 1 in 7 patients HISTORY OF SCHIZOPHRENIA Early Figures in Diagnosing Schizophrenia ● John Haslam ○ Wrote Observations on Madness and Melancholy ○ Defined schizophrenia as “a form of insanity” ○ “Sensibility appears to be considerably blunted: they do not bear the same affection towards their parents and relations” ○ “They become unfeeling to kindness, and careless of reproof” ● Benedict Morel ○ Described schizophrenia as démence (loss of mind) and précoce (early,premature) ○ Onset of the disorder was believed to be during adolescence ○ Mainly focused on early onset and poor outcomes ● Emil Kraeplin ○ Built on Haslam’s writings and provided the most enduring description and categorization of schizophrenia ○ Combined several symptoms of insanity that had usually been viewed as reflecting separate and distinct disorders ■ Catatonia: alternating immobility and excited agitation ■ Hebephrenia: silly and immature emotionality ■ Paranoia: delusions of grandeur or persecution ○ These underlying features were included under Dementia Praecox ○ He also distinguished dementia praecox from manic-depressive illness (now called bipolar disorder) ● Eugen Bleuler ○ Introduced the term schizophrenia ■ Skhizein = “split” ■ Phren = “mind” ○ Believed that victims exhibited an associative splitting of the basic functions of personality; breaking of associative threads ○ Wrote Dementia Praecox or the Group of Schizophrenias which emphasizes the complexity of the disorder ○ He highlighted what he believed to be the universal underlying problem of schizophrenia KEY FEATURES OF PSYCHOTIC DISORDERS Hallucinations – involuntary vivid and clear perception-like experiences that occur without an external stimulus and in the context of clear sensorium ● Auditory Hallucinations: involves hearing things that don’t exist ○ 2nd most common form of hallucination ● Visual Hallucinations: involve distortions of what one sees or visions of things that aren't there ○ Most common form of hallucination ● Tactile Hallucinations: involve physical sensations on or within the body ○ Least common form of hallucination ● Olfactory Hallucinations: involve smelling something that is not there ○ Referred to as phantosmia ● Gustatory Hallucinations: involve false taste perceptions ○ Fairly prevalent in people with epilepsy and less frequently in schizophrenia ● Hallucination involving Sleep ○ Hypnopompic Hallucinations: occur while waking up ■ Indicator of narcolepsy ○ Hypnagogic Hallucinations: occur while falling asleep ■ Short, usually auditory ■ Most common ○ Shows alpha rhythm 1 | @studywithky
Delusions – fixed beliefs not amenable to change in light of conflicting evidence ● Delirium: causes confused thinking and a lack of awareness of surroundings ● Delusions of Grandeur: belief that you are superior to other people ○ Ex. the chosen one, special destiny ● Delusions of Reference: thinking insignificant events relate directly to you ○ Ex. receiving special messages from the TV ○ Thought Broadcasting: belief that others know your thoughts ○ Thought Insertion: belief that ideas are implanted on your mind ○ Thought Withdrawal: belief that thoughts are being removed / stolen from your mind ● Persecutory Delusions: belief that someone or something is "out to get you" ○ Most common type of delusion in schizophrenia ○ Considered as an extreme form of paranoia ○ Fregoli’s Syndrome: belief that a stranger is a familiar person who changes their appearance or is in disguise ○ Capgras’ Syndrome: belief that familiar people have been replaced by imposters ● Jealous Delusions: belief that that your partner is unfaithful ○ Othello’s Syndrome: pathological and morbid jealousy ● Somatic Delusions: belief that something is wrong with your body ● Erotomanic Delusions: belief that someone, typically higher in status, is in love with you ○ Also called de Clerambault’s Syndrome ● Nihilistic Delusions: belief that something or someone no longer exists ○ Often occur with depression ○ Cotard’s Syndrome: belief that the body is dead or decaying Positive Symptoms (Type 1) – additional behaviors not generally seen in people without the condition ● Bizarre Behavior: problems in performing directed daily activities; catatonia ● Hallucinations ● Ambivalence: having conflicting reactions, beliefs, or feelings ● Abnormal Thought Form: distortions / disturbance in thought processes ● Delusions ● Develops over a short time Negative Symptoms (Type 2) – indicate the absence or insufficiency of normal behavior ● Alogia: lack of logic / poverty of speech / relative absence of speech ● Affective Flattening: lack of range in emotional reactions ○ Flat/Blunted Affect: lack of emotion where you normally expect them to; flat and toneless ● Anhedonia: lack of pleasure ● Attention Impairment: lack of concentration ● Avolition: lack of motivation ○ Apathy: lack of reaction to stimuli ● Asocial Behavior: lack of interpersonal relationships ● Anergia: lack of energy Disorganized Thinking (Speech) – distortion in thinking observed through speech ● Also called formal thought disorder ● Derailment / Loose Associations: switching from one topic to another ● Tangentiality: answering questions that are unrelated or obliquely related ● Incoherence: word salad, resembles receptive aphasia in its linguistic disorganization ○ Echolalia: repetition of words spoken by another person ○ Palilalia: repetition of words / syllables ○ Verbigeration: repetition of last spoken part of a sentence ○ Coprolalia: use of obscene / inappropriate words ○ Clang Association: use of rhyming words Grossly Disorganized or Abnormal Motor Behavior – movement that ranges from childlike "silliness" to unpredictable agitation ● Also called catatonic behavior ● Catatonic Behavior: marked decrease in reactivity to the environment ● Negativism: resistance to instructions ● Catatonic Excitement: purposeless and excessive motor activity without obvious cause ● Catalepsy: assuming different positions ● Stupor: lack of movement for a long period of time ● Stereotypy: repetition of purposeless movement ● Inappropriate Affect: exhibit bizarre behaviors such as hoarding objects or acting in unusual ways in public Historic Schizophrenia Subtypes – previously used in the DSM-IV-TR but dropped in the DSM-5 ● Paranoid: delusions of grandeur or persecution ● Disorganized: hebephrenic; silly and immature emotionality ● Catatonic: alternate immobility and excited agitation DELUSIONAL DISORDER DEFINING DELUSIONAL DISORDER 2 | @studywithky
Delusional Disorder – at least 1 month of delusion(s) but no other prominent psychotic symptoms ● Folie à Deux: condition in which an individual develops delusions simply as a result of a close relationship with a delusional individual ● Persistent delusion that is not the result of an organic factor such as brain seizures or of any severe psychosis ● Types of Delusions ○ Erotomanic: irrational belief that one is loved by another person, usually of higher status ○ Grandiose: believing in one’s inflated ○ worth, power, knowledge, identity, or special relationship to a deity or famous person ○ Jealous: believes the sexual partner is unfaithful ○ Persecutory: believing oneself (or someone close) is being malevolently treated in some way ○ Somatic: person feels afflicted by a physical defect or general medical condition ● Delusions are imagined events could be happening but aren’t ● Relatively rare type of disorder ● Onset is relatively late (35-55) ● Tends to fare better in life than people with schizophrenia but not as well as those with some other psychotic disorders, such as schizoaffective disorder ● Substance-Induced Psychotic Disorder: commonly affects those who abuse amphetamines, alcohol, and cocaine ● Psychotic Disorder Associated with Another Medical Condition: commonly affects those with brain tumors, Huntington’s disease, and Alzheimer’s disease DIAGNOSTIC CRITERIA A. The presence of one (or more) delusions with a duration of 1 month or longer. B. Criterion A for schizophrenia has never been met. Note: Hallucinations, if present, are not prominent and are related to the delusional theme (e.g., the sensation of being infested with insects associated with delusions of infestation). C. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and behavior is not obviously bizarre or odd. D. If manic or major depressive episodes have occurred, these have been brief relative E. to the duration of the delusional periods. F. The disturbance is not attributable to the physiological effects of a substance or another medical condition and is not better explained by another mental disorder, such as body dysmorphic disorder or obsessive-compulsive disorder. SPECIFIERS Erotomanic Type Applies when the central theme of the delusion is that another person is in love with the individual Grandiose Type Applies when the central theme of the delusion is the conviction of having some great (but unrecognized) talent or insight or having made some important discovery Jealous Type Applies when the central theme of the individual’s delusion is that his or her spouse or lover is unfaithful Persecutory Type Applies when the central theme of the delusion involves the individual’s belief that he or she is being conspired against, cheated, spied on, followed, poisoned or drugged, maliciously maligned, harassed, or obstructed in the pursuit of long-term goals Most frequent subtype Somatic Type Applies when the central theme of the delusion involves bodily functions or sensations. Mixed Type Applies when no one delusional theme predominates Unspecified Type Applies when the dominant delusional belief cannot be clearly determined or is not described in the specific types Ex. referential delusions without a prominent persecutory or grandiose component DIAGNOSTIC ISSUES Gender ● Delusional Disorder, jealous type is more frequent in males ● Generally affects more females than males Culture ● Cultural and religious background must be taken into account in evaluating the possible presence of delusional disorder BRIEF PSYCHOTIC DISORDER DEFINING BRIEF PSYCHOTIC DISORDER Brief Psychotic Disorder – presence of one or more positive symptoms such as delusions, hallucinations, or disorganized speech or behavior lasting 1 month or less; may or may not be accompanied by grossly disorganized or catatonic behavior ● Many eventually regain their ability to function in less than a month 3 | @studywithky