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UGA / Psychology / PSYC 3230 / prodromal definition psychology

prodromal definition psychology

prodromal definition psychology

Description

School: University of Georgia
Department: Psychology
Course: Abnormal Psychology
Professor: Cyterski
Term: Fall 2015
Tags: abnormal and Psychology
Cost: 25
Name: Abnormal Psych Psychosis Prodrome Outline
Description: These notes are on the Psychosis Prodrome Outline.
Uploaded: 02/23/2017
4 Pages 89 Views 0 Unlocks
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 What % of individuals identified as being at risk develop a psychotic disorder?




 Diagnostic criteria in DSM5 for attenuated psychosis syndrome - symptoms with sufficient severity and/or frequency to warrant clinical attention  How do you define psychosis?




o Why does society believe the myth that all people, especially those with psychosis, are violent?



Psychosis Prodrome Outline  Psychosis is on a continuum o Clinicians assume the distribution of psychosIf you want to learn more check out 180 mmhg to atm
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is to be bimodal o But it is actually semi-continuous o 15 % of individuals who have hallucinations but do not come into  contact with the medical field (not due to drugs of medical problems)  1% meets psychotic disorder DX  First episode psychosis o Definition o Typical course o Duration of untreated psychosis is bad because it predicts a number of  poor outcomes: community/social interactions, quality of life,  depression/anxiety, negative symptoms, disorganized symptoms, and  psychotic symptoms  Violence in untreated psychosis – there is a myth in science of psychosis o Rates of violence are elevated, but only if psychosis is untreated. If the  individual has ever been treated, rate of violence goes down to that of  the general population. The mere prescription of the drug can do this. o Violence is rare any violence (34.5%), serious violence (16.6%), severe  violence leading to bodily harm of others (0.6%) o Before treatment the rate of violence is high because untreated o Homicides rare during first episode, 1.6 homicides per 1000 o After treatment the rate of violence is – homicide annual rate is 0.11  per 1000 patients o Why does society believe the myth that all people, especially those  with psychosis, are violent? They only show the bad parts, make you  think that every homicide is by a psychotic person. More likely men,  drugs, lower socioeconomic class – predict probability of committing  violent act.  Early identification and prevention o Is treatment after onset and management of symptoms the best we  can do in the medical field? The field has shifted towards a model of  early identification and prevention. o New model = early identification and prevention o Model in Australia vs USA o Prodromal phase: psychotic risk period; an early symptom indicating  the onset of a disorder. Period preceding onset of first florid psychotic  episode when there is increasing symptomatic presentation and  functional deterioration. o Medical example – fever is prodromal to measles  Course of the prodrome  o Early prodrome symptoms/course – (usually high school age) usually  starts with negative symptoms; stop being expressive, develop alogia  (reduction in quantity of speech), have perceptual abnormalities  (illusions – elongating table), changes in motor activity (writing, threading a needle), avolition (lack of motivation), asociality (stop  hanging out with friends), anhedonia (stop enjoying otherwise  enjoyable things to them), lose friendships, develop educational  problems, vocational problems (can’t work anymore) o Late prodrome symptoms/course – mood symptoms develop  (anxiety/depression), further social withdrawal, very isolated, changes in social cognition (recognizing and understanding others’  emotions). Attenuated psychotic symptoms; unusual thoughts,  suspiciousness, paranoia, bizarre thinking – main transition btwn early  and late o Onset o Premorbid phase  Home video studies  Diagnostic criteria in DSM5 for attenuated psychosis syndrome - symptoms  with sufficient severity and/or frequency to warrant clinical attention  How do you define psychosis? o Intensity: conviction (how much someone believes something is true), degree of implausibility (how bizarre the symptom is – how  impossible the thing they believe is), preoccupation (are they  thinking about it constantly), disruption (how much it affects their  lives) o Frequency: at least 1 hr a day at an avg frequency of 4 days per week  over 1 month (def present for more than ½ days over 1 month) –  frequency reduced in prodromal phase to bout once a week o Urgency: seriously disorganizing or dangerous, regardless of duration.  What % of individuals identified as being at risk develop a psychotic disorder? 8-10% identified to have it. 15% of population has low level symptoms o What are the most common trajectories for those who do not convert  to a psychotic disorder? 20-35% (out of the 15% that have  symptoms) transition rate by 2 years. This is how many people  actually develop the disorder based off of those with the symptoms.  Rate rises as time goes on. This is bad because it can lead to self fulfilling prophecies.  What differentiates converters (someone we identify as being at risk that  actually develops a psychotic disorder) from non-converters? o Neuropathology   Reduced synaptic density/connectivity – McGlashan and Hoffman ∙ Connections multiply from birth – age 5 and plateau until  adolescence ∙ Pruning (normal developmental process) occurs in adolescence to increase efficiency ∙ Converters have reduced white matter integrity ∙ Converters have greater grey matter reduction in cortex: o Orbitofrontal cortex – decision making, reasoning  (delusions) o Para hippocampal – memory (cognitive  impairments) o Fusiform – facial recognition (social cognition)o Cerebellar – motor functions ∙ Greater presynaptic dopamine o Reduced dopamine synthesis in the striatum o Dopamine abnormalities are related with  conversion o Demographics  Male gender  Genetic risk o Symptoms – negative and disorganized symptoms, general symptoms  (reduced tolerance to stress), higher positive symptoms = more likely  to convert  Comorbid symptoms ∙ Anxiety, depression, substance use (30% control and 40% CHR  use cannabis) o Drug abuse o Cognition - individuals who convert have more cognitive impairments  than those who don’t; cognitive impairment is not as severe in the  prodromal than it is when people have diagnostic schizophrenia o Social cognition – is impaired in prodromal phase but not to the level of the first episode of chronic schizophrenia (MSCEIT & TASIT) o Stress reactivity/HPA axis – hypo pituitary adrenal axis (fight or flight  system); cortisol (salivation); axis is irregular  Stress reactivity and abnormalities in HPA axis predict the  development of psychosis in individuals who are at risk  What happens to the youth who do not convert? o Within 2 years:  36% symptom remission  30% functional recovery  40% experiencing continued attenuated psychosis and  functional impairment  Most common nonpsychotic Axis I conditions (mood and anxiety) about 25%  Can conversion to psychosis be prevented in clinical high-risk youth?  o Why early intervention?  Greatest risk of deterioration in first 1.5 yrs of illness  Prevent decline – cognitive, social, vocational  Reduce duration of untreated psychosis  Reduce chance of violence to self and others o Do clinical trials show that treatment is effective for preventing  conversion?  10% treated convert  30% untreated convert o What are recommendations from different agencies about use of  antipsychotics and psychosocial therapy?  Do not give people antipsychotics unless people are fully  psychotic (someone reaches the first episode)  Throughout the world, recommendation is careful and frequent  monitoring and offering psychotherapyo What are some barriers to treatment?  Denial on part of patient and family due to stigma  Poor recognition of symptoms by others during early stages,  until frank psychosis begins o Lack of mental health education  Limited knowledge on part of mental health providers  Child-adult chasm – most present mid-late teens and early  adulthood  Few programs in the USA (15-20) Summary 1:  Most psychotic illness begin in early 20s  Current mental health services intervene late  Service gap a critical period – adolescence  Need for care precedes psychiatric diagnosis  The untreated psychotic period is of greatest risk for violence to self and  others (reduces to roughly the level of general population from  antipsychotics)  The earlier psychosis is identified and treated, the better the outcome Summary 2:  New advances have allowed up to better predict who is at risk  Early treatments may delay or prevent psychosis onset  Early intervention may prevent self harm and harm to others  Community awareness of warning signs and early referral are critical to reach those who need help most

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