Schizophrenia and Psychotic Disorders

November 7th, 2012 Kate Lieberman

What is psychosis?
 What characterizes psychotic disorders?
 Emotions
 Flat affect  Inappropriate affect  Cognitions  Delusions  Disorganized thoughts  Behaviors  Hallucinations  Catatonia  Avolition

S. substance or medical condition .Schizophrenia  Schizophrenia  A psychotic disorder/ group of related disorders  Lifetime prevalence: 1% of U. population  DSM-IV-TR Criteria  2 or more (or 1 if bizarre delusions/auditory hallucinations) during 1month period  Delusions  Hallucinations  Disorganized speech  Disorganized/catatonic behavior  Negative symptoms  Continuous sx for 6 months (at least 1 month active phase)  Significant disturbance/ impairment in daily functioning  Not due to affective disorder.

What is it like to have schizophrenia? (Paranoid) Schizophrenia Simulation As you watch the clip. note symptoms and characteristics of the disorder that are portrayed. .

bizarre behavior  Delusions  Irrational beliefs  Fixed/resistant  Types  Persecutory  Control  Grandiose  Referential  Somatic .Positive symptoms  What are positive symptoms of schizophrenia?  Excessive or overt  Unusual thoughts or perceptions. thought disturbances.

Positive symptoms cont’d  Hallucinations  Sensory experiences not based in environmental reality  Auditory (hearing): most common  Visual (seeing)  Olfactory (smelling)  Tactile (feelings)  Gustatory (tasting) .

work. interact with others  Unpredictable/inappropriate emotional responses  Catatonic behavior .Positive symptoms cont’d  Disorganized thoughts/speech  Loose associations  Neologisms  Perseveration  Clang  Disorganized behavior  Impaired ability to take care of self.

Negative symptoms  Deficits in behavior or absence of “normal” behaviors  Flat affect  Alogia  Believed to reflect slowed cognitive processes. or to result from cognitive overload (being overloaded with other sx)  Avolition  Anhedonia  Lack of insight regarding mental condition .

feelings.Cognitive symptoms  Difficulties with concentration and memory  Disorganized thinking  Slow thinking  Difficulty comprehending  Poor concentration and memory  Difficulty expressing thoughts  Difficulty integrating thoughts. behavior .

. rape or robbery) .Associated disorders and symptoms  Mood disorders and substance disorders often comorbid  Suicide more common in individuals with schizophrenia (4.03)  Risk factors for suicide in individuals with schizophrenia:  Single  Unemployed  Socially isolated  Male  Violence towards others not typical  More likely to harm self than others  More likely to be victims of crime (e.9%) than general population (.01-.g.

Phases of schizophrenia  Prodromal phase  Occurs before onset  Symptoms typical of depression  Psychotic prophase  First full-blown positive symptoms appear  May be triggered by stressful event  Active phase  6 months or longer of positive and negative symptoms  Residual phase  Less prominent symptoms. similar to prodromal phase  May constitute the majority of life for individuals with schizophrenia .

minority deteriorated  15 year study  40% showed periods of improvement  Sizable minority were not on medication  Long-term outcome may be more positive than portrayed in DSM-IV-TR .Long-term outcomes  Complete remission not likely  10 year study  Majority of patients improved over time.

less disordered cognition and behavior .Paranoid subtype  Marked by paranoia  Usually persecutory or grandiose delusions and auditory hallucinations  Paranoia may lead to difficulties in relationships  Long term prognosis: better than other subtypes.

not coherent or consistent  Appears earlier than other subtypes. with gradual onset  Poorer prognosis Disorganized schizophrenia clip .Disorganized subtype  Disorganized speech and behavior  Blunted or inappropriate affect  Difficulty taking care of self  Impaired communication. incomprehensible speech  If delusions and hallucinations.

Catatonic subtype  Characterized by abnormal motor symptoms  Immobility  Excessive movement  Odd postures maintained. motor unresponsiveness  Waxy flexibility: others can move their posture. and they will maintain it  Echolalia or echopraxia Catatonic schizophrenia clip .

blunted affect. cannot be characterized by any 1 of the other subtypes  Residual  Occurs after active phase of schizophrenia  Usually involves more negative symptoms  Continuance of symptoms like social withdrawal.Undifferentiated and Residual types  Undifferentiated  Mixture of symptoms/subtypes. odd beliefs or unusual perceptions (not full blown delusions or hallucinations). odd speech tendencies .

Problem with categorical approach  Heterogeneity in behavior of individuals with schizophrenia  People present with different combinations of symptoms and severity  May not fall into discrete types  Dimensional approach: sx rated as absent. or severe  Psychotic dimension  Disorganized dimension  Negative dimension . moderate. mild.

Other psychotic disorders  Schizophreniform disorder  Schizophrenic episode that lasts only 1-6 months  Not necessarily marked by impairment in social or occupational functioning  Schizoaffective disorder  Symptoms of schizophrenia and mood disorder  Primary symptoms of schizophrenia  Depressive type  Bipolar type .

Other psychotic disorders cont’d  Delusional disorder  Only psychotic symptom of delusions for at least 1 month  Delusions not bizarre  Erotomanic  Grandiose  Jealous  Persecutory  Somatic  No significant interference in daily functioning .

Other psychotic disorders cont’d  Brief psychotic disorder  One or more of following sx’s for less than 1 month:  Delusions  Hallucinations  Disorganized speech  Disorganized or catatonic behavior  Tends to follow environmental stressor (e.. spouse dying)  Postpartum psychosis  Postpartum depression plus psychosis  Shared psychotic disorder  Folie a deux  Person close to someone with a delusion comes to believe the delusion as well .g.

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