Schizophrenia Spectrum and Other Psychotic Disorders
Schizophrenia Spectrum and Other Psychotic Disorders PSYCH 3830
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This 7 page Class Notes was uploaded by Margaret Bloder on Monday April 11, 2016. The Class Notes belongs to PSYCH 3830 at Clemson University taught by Pam Alley in Winter 2016. Since its upload, it has received 19 views. For similar materials see Abnormal Psychology in Psychlogy at Clemson University.
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Date Created: 04/11/16
Schizophrenia Spectrum and Other Psychotic Disorders I. Schizophrenia (disconnect between reality and fantasy) Diagnostic Criteria Two (or more) of the following, each present for a significant portion of time during a 1-month period. At least one of these must be (1), (2), or (3): 1. Delusions 2. Hallucinations 3. Disorganized speech 4. Grossly disorganized or catatonic behavior 5. Negative symptoms For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of active phase symptoms and may include periods of prodromal or residual symptoms Prevalence/Age of Onset/Gender Differences Majority have poor insight (don’t recognize that they are psychotic) No more likely to be dangerous than the average person Lifetime prevalence: somewhat less than 1% More common in men (for every 3 men, 2 women develop it) Age of onset: late adolescent or early adulthood (18-30 years) o Tends to begin earlier in men o Peak age in men: mid-20’s o Peak age in women: late-20’s o Can develop in middle adulthood, but very rare Delusions Delusions are false beliefs that are held onto despite evidence to the contrary 90% of individuals with schizophrenia have delusions Delusions are positive symptoms of schizophrenia (an excess of something) Variations in Content 1. Persecutory Delusions (most common): person believes he or she is being tormented, followed, tricked, spied on, or ridiculed 2. Referential Delusions: person believes that certain gestures, comments, or passages from book or newspapers are specifically directed at him or her 3. Grandiose Delusions: person believes that they hold a unique relationship to God or that they have a special mission to fulfill. They may also have an exaggerated idea of self-importance or false beliefs of greatness Variations in Plausibility Delusions vary not only in content, but also in plausibility Some delusions are bizarre; that is, they are clearly implausible and are not consistent with ordinary life experiences Other delusions are nonbizarre. Although they are erroneous, they are plausible and consistent with ordinary life experiences Some examples of bizarre delusions include: 1. Thought Withdrawal: person believes his or her thoughts have been taken away by some outside force 2. Thought Insertion: person believes that thoughts that they did not produce have been put into their mind by an outside force 3. Thought Broadcasting: person believes that their thoughts are being broadcast to other people Hallucinations A sensory experience that occurs in the absence of any external stimuli (Not the same thing as an illusion, which is the misconception of stimuli that does exist) Also a positive symptom of schizophrenia Types of hallucinations Auditory (hearing voices coming from outside the head): Most common, about 50-70% Visual: about 40% Olfactory (smell) Tactile (feel, ex: feeling a burning or tingling sensation) Disorganized Speech Verbal manifestation of a disturbance in thought form Derailment or loosening of associations: individual is talking and slipping from one topic to another (topics are completely unrelated) Tangentiality: answers to questions are totally unrelated Incoherence or word salad: so disorganized that it’s totally incomprehensible Poverty of content: speech is adequate in terms of amount, but there is no real content/substance to what they’re saying Neologisms: individual makes up words Severity of Catatonic Behavior Marked decrease in one’s reactivity to the environment Disorganized Significant lack of goal-directed activity Resistance to instructions (negativism) maintaining a rigid, inappropriate or bizarre posture complete lack of verbal and motor responses (mutism and stupor) *Occurs along a continuum Examples: Echolalia Echopraxia: mimics movements Individual can occasionally go from one extreme to another (can become dangerous) Negative Symptoms Indicates a deficiency in or lack of normally present behaviors Affective Flattening (diminished emotional expression): flat or blunted emotional expressiveness Avolition: decrease in goal-directed activities Alogia: minimal speech output Anhedonia: decrease in capacity to experience pleasure Asociality: lack of interest in interacting socially *The best predictor of overall functioning is the severity of negative symptoms (If individual has severe negative symptoms, their prognosis is worse) Duration of Schizophrenia Continuous signs of disturbance, including prodromal, active, and residual symptoms must last at least 6 months Active phase symptoms must be present for at least 1 month 1. Prodromal: initial phase of schizophrenia characterized by mild symptoms that do not fully fulfill the diagnostic criteria 2. Active: diagnostic criteria for schizophrenia are met 3. Residual: period of partial remission in which some symptoms of schizophrenia still remain Schizophrenia and Dissociative Identity Disorder A. What is Dissociative Identity Disorder (DID)? Used to be called multi-personality or split personality disorder Individuals with DID exhibit two or more distinct identities that alternately govern their behavior (can differ in gender, age, handwriting, etc.) Each identity may manifest, for example, a different name, personal history, tone of voice, and/or physical appearance Sometimes individuals with DID exhibit amnesia regarding their experiences as well as other important personal information Some psychologists believe it is a coping mechanism for some individuals or they don’t want to accept responsibility for something they did, so they switch personalities B. Differential Diagnosis Schizophrenia Experiences a split within the person’s mind but does not manifest multiple distinct personalities Typically experience delusions, hallucinations, and/or disorganized behavior May have delusions of grandeur but not accompanied by changes in name, personal history, tone of voice, or physical appearance Dissociative Identity Disorder Experiences a split which manifests as multiple distinct personalities Does not typically experience delusions, hallucinations, or disorganized behavior Have multiple identities accompanied by changes in name, personal history, tone of voice, and/or physical appearance Etiology of Schizophrenia Strong genetic component o Out of 100 people: about 1% develop o Study a family: about 10% develop o Monozygotic twin: 50% develop Environmental factors Prenatal: some type of neurodevelopmental problem o Mom gets virus while pregnant o Nutrition deficiencies o Maternal stress o Structural abnormality (lesion) o Birth complications Stress o Higher prevalence in the city (urban areas) o Immigrants at greater risk Prognosis A lot of variability Age of onset is one of the predictors (if developed earlier on, the prognosis is worse) Men tend to have a worse outcome No cure About 16% that experience a schizophrenic episode will have a fairly good recovery (won’t need medication or therapy anymore) About 38% have a generally good outcome: will still need medication and therapy, but can still function in the world About 33% will have continued signs of the illness (more typically negative symptoms) About 12% will never recover at all Reduced life expectancy 20% will attempt suicide, 5-6% will succeed Treatment Types of Treatment Pharmacological: Antipsychotic medications nd o 2 generation antipsychotics o Helps alleviate positive and negative symptoms o Tries to block dopamine receptors o Studies have found that estrogen supplements for women with schizophrenia help Family Therapy o More likely to develop schizophrenia again if individual moves back in with parents or spouse after hospitalization rather than moving in by themselves or in a group home o EE (Expressed Emotion): measure of family environment, ranked on 3 dimensions 1. Criticism: how critical the family member is about the behaviors of the individual with schizophrenia 2. Hostility: how critical the family member is about the individual themselves, not their behaviors 3. Dramatic/over concerned attitude: excessive Individual Treatment o Try to educate the individual about their disorder (seems to be effective) Training o Social Skills training (less likely to relapse) o Cognitive remediation training: compensate for neurocognitive deficits (Ex: have them write down where they parked their car if they forget easily) Case Management o Individual who helps patients re-integrate back into the community (finding an apt, finding the closest grocery store, etc.) Other Psychotic Disorders Delusional Disorder (more mild): individual experiences beliefs that are considered completely false and absurd by others but otherwise behaves normally o Delusion that persists for at least a month o Ex: Erotomania: experiencing a great love for someone (typically someone famous) Brief Psychotic Disorder (a little more serious than delusional disorder): individual experiences a sudden onset of psychotic symptoms or grossly disorganized/catatonic behavior that lasts briefly (at least a day) o Triggered by a significant amount of stress Schizophreniform Disorder: individual experiences schizophrenia- like psychosis that lasts at least one month but not for six months Schizoaffective Disorder: individual experiences symptoms of schizophrenia that co-occur with symptoms of a mood disorder
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