Psychotic Disorders – Lecture Outline I) The Psychoses A set of disorders involving alterations of perception, thought, and consciousness. II) Schizophrenic Disorders – A) Dimensions 1) Positive Symptoms – Presence or Addition of behaviors 2) Negative Symptoms – Absence of behavior. 3) Acute Schizophrenia – Type I Schizophrenia 4) Chronic Schizophrenia – Type II Schizophrenia B) Characteristic Symptoms 1) Hallucinations – 2) Delusions – Most common: 3) Loosening of Associations – 4) Odd Speech – 5) Inappropriate Emotion – 6) Loss of Ego Boundaries – 7) Strange Motor Behaviors – 8) Lack of Motivation – 9) Inappropriate Social Behavior – C) Clusters of Schizophrenic Symptoms (Formerly Subtypes – DSM-IV) 1) Catatonia Prominent Sx’s: Bizarre or unusual body movements 2) Disorganized Most bizarre & obvious symptoms 3) Paranoid (formerly Paranoid Schizophrenia) All delusions & hallucinations related to persecution themes 4) Undifferentiated – 5) Residual – No new prominent symptoms – still some lingering . D) Phases of Schizophrenia 1) Prodromal Phase – Period of progressive deterioration of behavior 2) Active Phase – Period of prominent intense symptoms Duration - 3) Residual Phase – Continuing symptoms of disturbance, but not as intense E) Treatment Neuroleptics - 1) Problems – Tardive Dyskinesia – Neuroleptic Malignant Syndrome – Symptoms: High Fever Increase in white blood cells Kidney Problems Liver Problems Difficulty Swallowing 2) Psychodynamic & Other Psychotherapies 3) Behavioral – F) Causes (Some clues…) Positive Symptoms [Acute / Type I] – - Respond better to currently available meds that act on Dopamine. - Dopamine Hypothesis: An excess of Dopamine @ the synapse Negative Symptoms [Chronic / Type II] – - Do not respond as well to current meds - Those with more neg. symptoms – enlarged ventricles in the brain – - May represent a deterioration of brain tissue G) Industrialized (Developed) vs. Non-Industrialized (Developing) Countries & Schizophrenia Irony: - Two Explanations Biological - Type II -> Virulent form – more often seen in Developed countries - Type I -> Benign form – more often seen in Developing countries - With our medical technology – - Therefore -> Sociocultural - Collectivistic (Developing) countries -> - e.g., Sharma et al. (India) – H) Cultural Issues in Schizophrenia - Culture can affect how: 1) Symptoms are displayed. - Schizophrenics in Western societies report more -> - Schizophrenics in non-Western societies report more -> 2) Symptoms are interpreted. - Studies from the U.K. & the U.S. Schizophrenia is diagnosed more often among - III) Other Psychotic Disorders A) Schizoaffective Disorder (also has elements of Mood Disorder) - Overlap between Schizophrenia & a mood disorder - DSM – Sx’s of Schizophrenia are present & they experience sx’s of depression or mania – With the Mood disorder being prominent. - Distinction: - Better prognosis than - B) Brief Psychotic Disorder (Formerly known as “Nervous Breakdown”) - Sx’s: Delusions, hallucinations, disorganized speech, prominent affective sx’s - Previously known as: - DSM - - Specifiers: With or without marked stressors C) Schizophreniform Disorder - Bridge between - Sx’s: D) Delusional Disorders - A single striking delusion – could conceivably be true Types: 1) Erotomania – Delusion that one of higher status is in love with or infatuated with you. 2) Grandiose Delusional Disorder – Delusion of inflated worth or power. 3) Jealous Delusional Disorder – Delusion that one’s partner is unfaithful 4) Persecutory Delusional Disorder – Delusion that one’s being persecuted or plotted against 5) Somatic Delusional Disorder – E) Shared Psychotic Disorder – “Folie a’Deux” - One or more people develop psychotic sx’s from their close association with a psychotic individual F) Causes of Psychotic Disorders 1) Genetic Links – 2) Biological Findings Dopamine – Dopamine Hypothesis Related more to positive sx’s Enlarged Ventricles – Evidence toward - MRI Studies: Decreased functioning in areas associated with attention, planning, and volition. 3) Unusual Family Relations / Communications “Schizophrenic Families” – Characteristics: 4) Stressful Events may precipitate the first psychotic Episode… Diathesis- Stress Model G) Schizophrenic – Spectrum Disorders More likely to occur in families of individuals with Schizophrenia: Schizotypal PD Schizoid PD Paranoid PD Schizophreniform Disorder Delusional Disorder Schizoaffective Disorder H) Positive Prognostic Signs The following signs predict an adequate remission once Schizophrenia is diagnosed: Married, or at least prior history of stable sexual/social adjustment Having fewer Negative Symptoms Family history of Affective rather than Schizophrenic disorder Presence of an affective response (elation/depression) in acute stage. Abrupt onset and/or precipitating factors present Onset later than early childhood Being of higher SES Adequate premorbid school /vocational adjustment Premordbid competence in interpersonal relations Short length of hospitalization of hospitalized No history of ECT (electroconvulsive) treatment Stimulation-receptive rather than stimulation-avoidant response style Family environment: Lower levels of hostility, criticism and emotional over involvement upon hospital release.
