Delusions
What are delusions?
Fixed beliefs that are not amenable to change in light of conflicting evidence
What are hallucinations?
Perception-like experiences without external stimulus
(you experience something visual or auditory or a smell, taste, or feeling but it does not have an actual external stimulus that is causing it - is not truly there)
What is the other name for disorganized thinking (speech)?
Thought disorder
What does this (grossly disorganized or abnormal motor behavior - including catatonia) mean?
Covers a lot of different things, basically when we talk about motor behavior, we are just talking about the persons‘ physical movements
When we say disorganized, we mean the person seems to be engaging in movement or not engaging in movement in a way that indicates something is disorganized about their ability to move their body.
Why are they called negative symptoms?
because they have to do with taking something away, taking away a part of a persons‘ experience
Schizophrenia used to be confused with what disorder?
Multiple personalities (Dissociative Identity Disorder)
What is the only difference in criteria between schizophrenia and Schizophreniform disorder?
Same criteria as schizophrenia, expect:
- last at least 1 month but less than 6 months
Prevalence:
Approximately _% lifetime prevalence
Equal prevalence in ___ and ___
0.5% lifetime prevalence
Equal prevalence in women and men
What are “antipsychotic“ medications?
*Covers a board range of medications
*are used to treat more than just psychotic disorders
(schizophrenia spectrum disorders, bipolar disorder (especially prevention of manic episodes) major depressive depressive disorder, adjunctive medication for depression.
What are the three evidence-based psychotherapies?
1) daily living skills
2) medication adherence
3) stress and anxiety management
What are the 6 neurodevelopmental disorders?
1) intellectual developmental disorder (intellectual disability)
2) Communication disorders
3) Autism spectrum disorder
4) Attention-deficit/hyperactivity disorder
5) Specific learning disorder
6) Motor disorders
Persistent deficits in social communication and social interaction across multiple contexts (must have ___ __)
Must have all 3
1) Deficits in social-emotional reciprocity
2) Deficits in nonverbal communicative behavior
3) Deficits in developing, maintaining, and understanding relationships
What is ADHD?
A pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development
What are the two types of stimulants?
1) norepinephrine and dopamine reuptake inhibitors (NDRIs)
2) amphetamines
For eating binges, what two things MUST be present?
1) Eating in a discrete period of time (e.g., within any 2-hour period an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances
2) a sense of lack of control over eating during the episode
What are the six themes of delusions?
Persecutory, Referential, Grandiose, Erotomaniac, Nihilistic, and Somatic
What sense can these hallucinations take form in?
Any sensory modality (see, hear, smell, taste, or feel)
What do we do to infer that their thinking is disorganized?
We have to listen to see if their speech is disorganized - if they have disorganized speech, we assume that reflects their thought process
What are the eight grossly disorganized or abnormal motor behaviors?
Mutism, Stupor, Posturing, Waxy flexibility, Echolalia, Echopraxia, Agitation, and Catatonia
In contrast of positive symptoms, which include:
hallucinations and delusions - adding in additional experience
Hallucinations: adding in additional perceptual experiences based on things that are really there
Delusions: adding in additional fixed beliefs that are not amenable to change in light of conflicting evidence
Schizophrenia stands for? And why?
Split mind - called this because the idea that their mind was split due to part of their mind deteriorating and the other part was not
What are the diagnoses requirements for Brief Psychotic Disorder?
Must have 1 or more of these:
delusions, hallucinations, disorganized thinking (speech), or grossly disorganized motor behavior
*NO NEGATIVE SYMPTOMS*
Development and course:
Typically emerges ___ in men (late __to late __) than in women (early __ to early __)
Typically emerges earlier in men (late teens to late twenties) than in women (early twenties to early thirties)
First Generation Medication is also known as ____
Neuroleptics, typical antipsychotics
When can these therapies not be used? When should they be used?
these therapies cannot be used during a psychotic episode, they must be used between episodes
What are the four types of communication disorders?
1) Language disorder
2) Speech sound disorder
3) Childhood-onset fluency Disorder (stuttering)
4) Social (pragmatic) communication disorder
Restrictive, repetitive patterns of behavior, interests, or activities (must have at least __ of these)
Must have at least 2 of these
1) Repetitive motor movements or speech
2) Insistence on sameness or ritualized behavior
3) Restricted, fixated interests
4) Hyper/hypo reactivity to sensory input
Must have _ (or more) inattention symptoms AND/OR _ (or more) hyperactivity/impulsivity
For people age __ or older, must have at least _ symptoms
Must have 6 (or more) inattention symptoms AND/OR 6 (or more) hyperactivity/impulsivity
For people age 17 or older, must have at least 5 symptoms
What are the common issues with stimulants?
Issues with tolerance and withdrawal
* peoples bodies started to adapt and tolerate these medications causing them to need a higher dose or change medication
What is the criteria for Bulimia Nervosa?
- recurrent episodes of binge eating
- recurrent inappropriate compensatory behaviors in order to prevent weight gain (e.g., self-induced vomiting, misuse of laxatives, dietetics, or other medications, fasting, excessive exercise
- the binge eating and compensatory behaviors both occur (on average) at least once per week for 3 months
- self-evaluation is unduly influenced by body shape and weight
- does not occur in the context of anorexia nervosa
What are Persecutory delusions? Include examples
What is the feeling of being persecuted, thinking someone or something is after them, harassing them, or bothering them: “something is out to get them“
EXAMPLES: government is spying on them/out to get them or aliens are after them/out to get them.
*Not amenable to change in light of conflicting evidence*
What are Benign hallucinations? include example
Non-psychotic hallucinations
EXAMPLE: thought you heard or felt your phone vibrate, checked and there was no notification
What is another word for complete incoherence?
Word Salad
What is Mutism?
Where a person does not speak - has the ability to speak but something is making it so they cannot
What are the five types of negative symptoms?
Diminished emotional expression, Alogia, Avolition, Anhedonia, and Asociality
People with schizophrenia had impairment of ___ and ___ but their ___ and other cognitive functions were intact
Fill in the blanks
People with schizophrenia had impairment of perception and thinking but their memory and other cognitive functions were intact
How long must symptoms last to receive a brief psychotic disorder diagnose?
Must last at least 1 day but less than 1 month
Genetics:
__%-__% of differences in schizophrenia expression may be caused by genetics/heritability
70%-80% of differences in schizophrenia expression may be caused my genetics/heritability
What are side effects of neuroleptics (first generations)?
1) Sedation (feeling tired)
2) Dry mouth, constipation (anticholinergic effects)
3) Extrapyramidal side effects (including tardive dyskinesia: lip smacking, uncomfortable facial movements) - these kinds of cells are involved in your ability to move, if you taking these medications (pills), it can affect your ability to move.
What is daily living skills (psychotherapy)?
Helping patients hold down a job, remind them to take medication, and learn to cook for themselves at home
What are the three types of motor disorders?
1) Developmental coordination disorder
2) Stereotypic movement disorder
3) Tic disorder
Symptoms must be present early in ____ period
Childhood
*but not become apparent until social demands exceed capabilities
What are the 9 inattention symptoms?
1) Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
2) often has difficulty sustaining attention in tasks or play activities
3) often does not seem to listen when spoken to directly
4) often does not follow through on instructions
5) often has difficulty organizing tasks and activities
6) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
7) often loses things necessary for tasks and activities
8) is often easily distracted by extraneous stimuli
9) is often forgetful in daily activities
What are the withdrawal symptoms?
Feeling tired in mood, headaches, irritable mood, and shakes
Why is there no “must cause significant impairment or distress” criterion?
The behavior itself is pathological - they do not see it as pathological
What are Referential delusions? Include examples
Things in the environment are sending you (person with the delusion) a specific message
EXAMPLE: the way the chairs are arranged in the classroom are designed to send a specific message.
How common are Benign hallucinations?
Common in normal life - does not indicate any kind of psychotic experience
What is Tangentiality? Include example
Where a person cannot stay on track, keeps going off on tangents to complete incoherence (sometimes called: word salad - where a person just keeps saying words, but they do not make any sense when you string them together)
EXAMPLE: ”I cannot drive my basketball because yesterday was not that way”
What is Stupor?
What is Diminished emotional expression? Include example
Someone is not emotionally expressive
EXAMPLE: might tell you that they are feeling intense emotions - really sad, angry, or happy - but have a blank look on their face
To be diagnosed with schizophrenia, you must have at least __ or more of the required symptoms?
*fill in the blank
Two or more of the required symptoms
Schizoaffective Disorder diagnoses requirements:
Must have experienced a manic or major depressive episode, delusion and/or hallucinations, and not due to the effects of a substance or medical condition
Many neurotransmitter (including ___ and ___) are likely involved in schizophrenia
schizophrenia is not caused by a simple excess of ___ (or any other neurotransmitter)
(Including dopamine and serotonin)
excess of dopamine
Name two neuroleptic medications:
chlorpromazine (Thorazine) and haloperidol (Haldol)
What is medication adherence (psychotherapy)?
Helping a person stay on their medication
What is unique about this group of disorders?
The number of disorders - more disorders than any of the other disorders
Prevalence:
Has increased from __% in the 1990s to approximately __% now
Approximately __ times more prevalent in males
Increased from 0.5% in the 1990s to approximately 1.5% now
Approximately 4 times more prevalent in males
What are the 9 hyperactivity/impulsivity symptoms?
1) often fidgets with, this hands or feet, or squirms in their seat
2) often leaves seat in situation when remaining seated is expected
3) often runs about or climbs in situations where it is inappropriate (adolescents or adults - this may be limited to feeling restless)
4) often unable to play or engage in leisure activities quietly
5) is often “on the go,” acting as if “driven by a motor”
6) often talks excessively
7) often blurts out an answer before question is completed
8) often has difficulty waiting their turn
9) often interrupts or intrudes on others
How do these stimulants work?
* NE & DA reuptake inhibition (NDRIs)
* Increase in DA, NE, and 5HT release (amphetamines)
Requirements of binge eating disorder include:
* Recurrent episodes of binge eating
* The episodes are associated with at least 3 of the following:
- eating much more rapidly than normal
- eating until uncomfortably full
- eating large amounts of food when not feeling physically hungry
- eating alone because feeling embarrassed by how much one is eating
- Feeling disgusted with oneself, depressed or very guilty afterward
* Marked distress about binge eating
* Binges occur (on average) at least one per week for 3 months
* The binge eating is not associated with the recurrent use of inappropriate compensatory strategies
* Does not occur in the context of anorexia nervosa
What are Grandiose delusions? Include example
Beliefs that a person is special in a way/has special powers are abilities
EXAMPLE: might believe they have superpowers, might believe they are Jesus, might believe they have a relationship with someone famous (like the president of the USA) but they do not
*is unusual and only seen in severe cases that are untreated
What is Alogia?
*different from mutism - where a person does not speak at all
What are the five symptoms of schizophrenia?
(1) Delusions
(2) Hallucinations
(3) Disorganized thinking (speech)
(4) Grossly disorganized motor behavior
(5) Negative symptoms
To receive a Schizoaffective diagnoses, symptoms must last for at least __ weeks and must occur outside the context of a ___ or ___ episode.
Symptoms must last for at least 2 weeks and must occur outside the context of a manic or depressive episode
Brain structure and function:
* enlarged ventricles
what do these enlarged ventricles suggest? And does it cause schizophrenia or is it a consequence of medication?
Brain degeneration (loss of brain matter around the ventricles)
There is a possibility that the disorder is causing the degeneration but there is also a possibility that it is caused by medication.
Second Generation Medications are also known as ____
atypical antipsychotics
What is stress and anxiety management (psychotherapy)?
Reducing stress and anxiety which is a trigger for psychotic episodes
What ties the disorders together?
They all assume that these are neurodevelopmental issues; something is wrong with the brain; the cause
Why do we think the prevalence much higher in males than in females?
Partially due to a bias in the disorder
Several inattentive or hyperactive/impulsive symptoms must be present prior to age __
age 12
Methylphenidate (Ritalin, Concerta)
Dexmethylphenidate (Focalin)
What are Erotomaniac delusions? Include example
Believing that someone is in love with you (Usually a famous or powerful person)
EXAMPLE: Thinking Matthew Lillard is in love with you and wants to be together even though he does not know you exist
What is Waxy flexibility?
*Often goes with posturing - the idea that the person is postured* *unusual and only seen in severe, untreated cases*
What is Avolition?
Lacking motivation - extremely unmotivated
For a diagnoses, at least one symptom must be ___, ___, or ___
Delusions, Hallucinations, or Disorganized thinking (speech)
To receive a delusional disorder diagnoses, you must have:
1) One or more delusions for at least 1 montH
2) have never met criteria for schizophrenia, apart from the delusion (or its ramifications)
3) functioning is not impaired, and behavior is not obviously bizarre or odd
4) not due to the effects of a substance or medical condition
EXAMPLE: if a person has delusions that government satellites were sending mind controls raids down to earth and as a result, they put aluminum foil on their ceilings and over windows, and could not leave their house due to fear of their brain being controlled but they are still fully functioning within their hours (e.g., able to cook meals and clean)
Orbitofrontal is associated with _______
Ventromedial is associated with ______
Orbitofrontal is associated with disorganized thinking and negative symptoms
Ventromedial is associated with hallucinations
Name five side effects of atypical antipsychotics:
1) Sedation
2) Dry mouth, constipation (anticholinergic effects)
3) Sexual side effects
4) Metabolic syndrome
5) Extrapyramidal side effects are less common
Intellectual Developmental Disorder Criteria:
- deficits in intellectual functions confirmed by both clinical assessment and individualized, standardized intelligence testing
- onset of intellectual and adaptive deficits during the developmental period
- deficits in intellectual function confirmed by testing
- deficits in adaptive functioning
- onset during the developmental period
Why the increase in prevalence?
- Greater awareness and better detection (when looking for something, you are more likely to find it)
- Broadening of the diagnosis
- Parental age (evidence shows that the older parents are when they have children, the higher chance their offspring has to be diagnosed with ASD)
- Who is making the diagnosis (more nonspecialist, observation of few traits but not enough/correct testing)
Several inattentive or hyperactive/impulsive symptoms are present in __ or more settings (e.g., home, school, work)
two or more settings
What are two amphetamine medications? Why are these prescribed more often?
Dextroamphetamine (Adderall)
lisdexamphetamine (Vyvanse)
* harder to misuse than the NDRIs
What are Nihilistic delusions? Include example
Delusional beliefs that the world is ending or they have a special knowledge about the end of the world
EXAMPLE: might believe the apocalypse is coming
What is Echolalia?
When someone repeats back what you say to them, or the last few words that you said to them
EXAMPLE: you might ask “how are you doing today?” And they might repeat back “doing today” or the whole sentence “how are you doing today?” Before answering you
What is Anhedonia?
Does not experience joy or pleasure - they do not have the same kind of positive experiences, they do not enjoy thing, they do not have interest in things they used to have interest in
Can you get a schizophrenia diagnoses if functioning of work, relationships, and self-care have remained the same since the onset of he disorder?
No. Since the onset of the disorder, functioning in one or more major areas (e.g., work, interpersonal relationships, self-care) must be remarkably below where it was before the onset
*Must look at how they were functioning before and has to have declined
What is schizotypal (personality) disorder and when does it typically begin?
Beginning by early adulthood, a pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for close relationships
*hard time interacting with another people with the exception of one specific person
Classical and Operant Conditioning:
It is possible that classical conditioning could trigger ____ ____, but this is not well studied.
Psychotic episodes
Name atypical antipsychotic medications:
aripiprazole (Abilify), clozapine (Clozaril), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), paliperidone (Invega), iloperidone (Fanapt)
Severity of intellectual developmental disordered by ___
*Used to be determined by IQ scores*
ASD typically emerges between _ and _ years of age
1 and 3 years of age
*Chronic course*
6% and boys are about 2 times more likely to be diagnosed
What are non-stimulant medications?
Norepinephrine reuptake inhibitor (NRI)
- takes out the dopamine and removes that stimulate effect
What are Somatic delusions?
Delusions about the body
EXAMPLE: might believe there are bugs inside their body or aliens have removed their organs and replaced them with machines
What is Echopraxia?
Repeating physical movements of another person
EXAMPLE: if I am writing notes, they might move their hands as if they are writing notes, even though they do not have a pen or paper
What is Asociality?
Symptoms must last at least __ months, with at least __ month of “full“ symptoms (unless they get treatment)
Symptoms must last at least 6 months, with at least 1 month of “full” symptoms (unless they get treatment)
Schizotypal:
Must have _ or more of the required symptoms
Must have five or more of the required symptoms
People with delusions often interpret ____ ____ as relevant to their delusional beliefs
*Unclear if this maintains the disorder or if it is a symptom
unrelated information
Which atypical antipsychotic is most important and why?
clozapine (Clozaril) - individuals who are taking this medication must be placed on watch because it causes a significant loss in white blood cells, which makes ones’ immune system weak and can cause them to become severely ill often (most people do not want to be placed on this medication because they do not want to feel like someone is consistently watching them)
__% of differences in autism spectrum expression may be caused by genetics/heritability
50%
Why is there a higher prevalence in boys?
Could be that boys are more likely to show hyperactivity symptoms which are often more noticeable
Why might non-stimulants be better? and why might they not be better than stimulants?
They might be better because they have fewer issues with tolerance and withdrawal
They might not be better because they may not be as effective as stimulants
A delusion that could happen in real-life
EXAMPLE: the government is after them or a famous person is in love with them (these are highly unlikely, yet not impossible)
What is Agitation?
When a person is physically agitated - moving around, cannot stop moving, pacing, etc
What is important to know with the positive psychotic symptoms?
EXAMPLE: in some cultures, when a person is grieving, it is normal for them to see or hear their passed loved one
Can a schizophrenia diagnoses be given to someone who is experiencing these symptoms due to the effects of a substance or medical condition?
No. Symptoms cannot be due to the effects of a substance or medical condition
What are the 9 symptoms of Schizotypal (personality) disorder?
(1) Ideas of reference (not delusions): not completely delusional but they have these small ideas
(2) Odd beliefs or magical thinking that influences behavior and is inconsistent with (sub)cultural norms
(3) Odd thinking and speech
(4) Unusual perceptual experiences (including bodily delusions) - might think they have a microchip under their skin
(5) Suspiciousness or paranoid ideation
(6) Inappropriate or constricted affect (facial expressions might not match the emotions they are experiencing)
(7) Behavior or appearance that is odd, eccentric, or peculiar
(8) Lack of close friends or confidants
(9) Excessive social anxiety related to paranoid fears (people are watching them)
How does being raised in an urban setting affect schizophrenia? Why does this cause this effect? What might it cause this?
Being raised in an urban setting is associated with greater risk of developing schizophrenia - it is unclear what may contribute to this association - pollution, more exposure to viruses and bacteria, other stressors such as poverty and discrimination
What are the six problems and controversies regarding antipsychotic medications?
1) lack of effect on negative symptoms
2) extrapyramidal side effects
3) metabolic syndrome with atypicals
4) use of antipsychotics in children
5) use of antipsychotics in the elderly
6) effects of long-term use of antipsychotics
*White matter
* These connectivity differences seem to be related to social difficulties in ASD
ADHD is typically diagnosed between age _ and _
ages 8 and 10
*chronic course, but may be less impairing with age (potentially due to compensatory strategies)
Name a common non-stimulant medication
atomoxetine (Strattera)
What are Bizarre delusions? Include examples
Delusions that we do not think are possible according to our understanding of the world and of science
EXAMPLE: aliens have come down, abducted you and replaced your organs with machines or beliefs that you are Jesus
What is Catatonia?
*RARE*
What are ASD controversies?
* Some people believed there was a connection between vaccines and ASD (Wakefield et al 1998)
* Between 1999 and 2007, 20 studies found no links between vaccines or vaccine preservatives and ASD
* They looked at children in Japan and the diagnosis of ASD between a cohort of children with vaccines and a cohort of children without vaccines over a 4 year period between each (Uchiyama et al 2007)
* Wakefield’s data was proven to be fake
__% of differences in ADHD expression may be caused by genetics/heritability
75%
Why give a stimulant to people with impulsivity/hyperactivity? Are there abuse and dependence potential? What is the short term efficacy? What is the long term efficacy? What are the long term neurological effects?
1) have low baseline cognitive arousal and increases the arousal so they feel like they can focus
2) yes, several of these medications have abuse and dependence potential
3) short term effect shows several benefits on their cognitive and emotional tasks in short term and outperforms those who are not on medications
4) long term effect is questionable because the short-term effect lessens over time and shows fewer differences between those who received medication and those who did not
5) unsure what changes being on medications for a long period of time causes for neurological effects
If the connection between vaccines and ASD was proven to be false, why do some people still believe this idea?
False correlation (clustering illusion)
- Because children typically start experiencing noticeable signs of ASD around 1-3 years of age, and this is the age that children begin getting most vaccines
Power of anecdote over data
- Making better feel bad rather than using actual data
What is the age in class effect? What is driving this effect? What are the results?
- this is true across countries regardless of the month for the age cutoff for grade
What is driving this effect?
- children that are young for their grade are less able to be conformed to the expectations of their school
What are the results?
- these children are falsely diagnosed because they are less cognitively and emotionally developed than their (older) peers, less likely to happen if official testing is involved
What are psychotherapies used?
* few evidence-based psychotherapies for ADHD
* Trivially focus on developing organizational skills