Psychosis inability to tell the difference between what s real and unreal Psychotic disorder when inability is distressing and impairing Schizophrenia the most common psychotic disorder Psychotic symptoms can occur within other disorders Exact schizophrenia diagnosis depends on the combination and nature of Chapter 8 Schizophrenia Psychotic Phenomenon Symptoms three kinds of symptoms o Positive o Negative o Cognitive Deficits Positive Symptoms Characterized by the presence of unusual perceptions thoughts or behaviors Positive means that symptoms are added experiences Include o Delusions o Hallucinations o Disorganized thought speech o Disorganized or catatonic behavior Delusions Ideas that an individual believes are true but are highly unlikely or simply impossible Types of delusions o Persecutory being persecuted watched conspired against o Reference random events are directed at oneself o Grandiose great power knowledge talent or is a famous powerful person o Guilt or sin committed a terrible act or responsible for a terrible event o Somatic appearance or part of body is diseases altered o Being controlled thoughts feelings behaviors are being imposed controlled by an external force Delusions differ from self deceptive thoughts in that o 1 Extreme impossible o 2 Preoccupation takes over their life o 3 Resistance not open to discussion Complex belief system different types of delusions are woven together intertwined Cultural relativism specific content of delusions differs across cultures Hallucinations Unreal perceptual experiences Bizarre and extremely distressing impairing Types of Hallucinations o Auditory Most common More common in women o Visual o Tactile o Somatic Second most common Shadows images of people animals Outside of body Bugs crawling all over the body skin itching Inside of body Insides burning intestines become snakes o Olfactory Smell Disorganized Thought Speech Formal thought disorder o Loosening of associations or derailment o Word salad incoherent combo of real words that don t make sense o Neologisms made up words Disorganized or Catatonic Behavior Disorganized unpredictable un triggered agitation This can explain o Disheveled appearances inappropriate hygiene clothes o Shouting swearing pacing o Often homeless people o Not dangerous but people are afraid of them Catatonia reflects extreme lack of responsiveness wont move unless they are moved easily treated with medicine Catatonic excitement wild agitation that is difficult to subdue Negative Symptoms Characterized by losses or deficits in certain domains Negative means the absence of behaviors feelings experiences Associated with a worse prognosis Include o Affective flattening no emotional response o Alogia reduction in speech o Avolition inability to complete tasks Positive vs Negative symptoms Negative symptoms are less obvious weird and not exactly bizarre BUT they re associated with more impairment less responsive to medication Cognitive deficits Deficits in working memory cognition and attention May cause difficulties with o Suppressing unwanted irrelevant information o Paying attention to relevant information o Reasoning communication problem solving Other features Associated with Schizophrenia Inappropriate affect laughing at sad crying at happy things Anhedonia lack of interest in everything Impaired social skills result of other symptoms Phases of Schizophrenia Prodromal not full blown schizo Acute Residual active psychosis DSM Criteria phase symptoms present before full criteria is met odd but phase symptoms present after acute phase A At least 2 greater than 1 month 1 Delusions 2 Hallucinations 3 Disorganized speech 4 Grossly disorganized or catatonic behavior 5 Negative symptoms B Social Occupational Dysfunction C Duration continuous signs of the disturbance for 6 months Prevalence 1 2 lifetime prevalence in US More common in men 5 2 lifetime prevalence worldwide Prognosis Course Schizophrenia is debilitating o Life expectancy cut 10 years short o High relapse 85 residual and or active symptoms o Higher rates of infectious circulatory diseases o 10 15 die by suicide comorbid w depression Gender Differences Age of onset o Women late 20s to early 30s o Men around 21 Course o Women have better prognosis health insurance ect Cognitive deficits o Women show fewer cognitive deficits Quicker brain development Fewer brain structure deficits Related psychotic disorders Brains could be better developed Have a better social network coping skills education work Schizoaffective schizophrenia mood disorder Schizophreniform schizophrenia symptoms 6 months Brief psychotic disorder acute schizophrenia symptoms lasting 1 day 1 month Delusional disorder only delusions for at least 1 month Schizotypal Personality Disorder Pervasive social interpersonal deficits Acute discomfort reduced capacity for close relationships Cognitive or perceptual distortions eccentricities or illusions Studies suggest genetic relationship btwn Schizotypal PD schizophrenia Schizotypal PD may be a milder form of schizophrenia Onset in early adulthood Present in a variety of contexts 6 to 5 2 lifetime prevalence 2x more likely in men Prevalence Biology Treatment Same Drugs that treat schizophrenia AND increased social contact social skills training Criteria 5 Magical thinking or odd beliefs Experiences unusual perceptions Paranoid ideation Eccentric behavior or appearance Constricted or inappropriate affect Unusual odd thinking and speech Lacks close friends Ideas of reference Anxiety in social situations Rule out psychotic and pervasive developmental disorders Biological theories Genetics o 50 concordance rate MZ twins vs 14 DZ twins o 50 likelihood of having schizophrenia if both parents do Structured brain abnormalities o Enlarged ventricles o Prefrontal cortex limbic system hippocampus speech memory problems determining what s real or fake Biological Theories ctd Birth complications o Perinatal hyposxia if the fetus doesn t get enough oxygen it can cause them to be schizophrenic later Prenatal Virus Exposure o High rates of schizophrenia associated with the flu o Particularly sensitive during 2nd trimester Higher chance if born in late winter or spring Herpes type 2 causes issues but mainly flu Neurotransmitters o Overactive o Underactive o Hypothesized role of dopamine dopamine in mesolimbic pathway dopamine in prefrontal areas Abnormal functioning in the prefrontal cortex Deficits in working memory difficulty attending only
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