Psychosis and Symptom categories
Define Psychosis
A state defined by a loss of contact with reality
Can be: substance-induced or caused by brain injury; or as a result of a psychotic mental disorder
Breakdown of Positive Symptoms
Delusions: grandiose, persecutory (most common), referential, thought control: insertion, withdrawal, broadcasting
Hallucinations: auditory (most common): sound, visual: sight, olfactory: smell, gustatory: taste, somatic/tactile: feel/touch
Genetics
heritability rate= ~.80
concordance rate is .40 to .50 for monozygotic twins (both will have it)
Prevalence of each of the disorders
Schizophrenia: overall: .25-.64% of adults
Schizophreniform: 0.2%, seen in males and females equally
Brief Psychotic: 2x more likely in females than males; unsure of overall lifetime prevalence
Schizoaffective: 0.3%
Delusional: 0.2%
Brief Psychotic Disorder
at least 1 positive psychotic symptom
duration:1 day to 1 month
returns to typical functioning
often triggered by extreme stress or trauma
Positive Symptoms
behavioral excess, delusions, and hallucinations
Breakdown of Negative Symptoms
flat affect: reduction of emotional expression
alogia: reduction of speech
avolition: reduction in goal-oriented, common tasks
anhedonia
Brain
enlarged ventricles in individuals with schizophrenia, failure in normal brain development, disrupted pathways between brain areas, areas related to cognition and language
Demographic Influences
males>females, males tend to have symptoms at younger age, more severe
higher prevalence in urban settings, developing countries
Schizophreniform Disorder
2+ psychotic symptoms (one must be positive)
duration: symptoms last between 1-6 months
impairment: 1/3 recover to regular functioning
Negative Symptoms
Breakdown of Disorganized Symptoms
tangentiality: jumping from one topic to the next
neologism: creating new words
loose associations: disconnected or jumbled phrases
erratic behavior
catatonia: motor dysfunction, ranges from agitation to immobility
inappropriate affect: laughing or crying at improper times
Biochemical
dopamine theory: excess dopamine
dopamine theory: revised, more about its role in certain areas of the brain, info processing in cortex = larger number of dopamine receptors
Comorbidities
50%, also increased rates of suicide
increased health problems: diabetes, infections, circulatory issues, heart disease, liver disease; severe side effects from medications: high blood pressure, weight changes, sleep problems
Schizophrenia
2+ psychotic symptoms; at least 6 months; at least 1 month of active symptoms
impairment: usually moderate to severe impairment
typical onset: late adolescence/early adulthood
median age of onset: ~22 years, late onset for females
Disorganized Symptoms
unusual speech, behavior, and/or affect
also considered positive symptoms
Breakdown of Miscellaneous Symptoms
deficits in: multiple cognitive functions, retention and recall
processing difficulty: sensory overload= positive symptoms; withdrawing from sensory overload= negative symptoms
Myth: people with schizophrenia are violent and/or dangerous, influenced by media that links schizophrenia to criminal violence
Truth: violence is not a symtom of schizophrenia, majority of those with schizophrenia are arrested due to misdemeanors
Prognosis
only 31% receive care from a specialist, after 10 years after diagnosis: 15% stayed in active phase, 50% had enough improvement to work/live independently, 25% needed higher level of treatment and support to complete daily activities
average potential life lost in the U.S. is 28.5 years
Schizoaffective Disorder
schizophrenia & mood disorder (major depressive, manic, and/or hypomanic episode)
simultaneous (but independent), BUT psychotic disorder must be primary
Miscellaneous Symptoms
mania, depression, cognitive deficits
Brain explanations of both positive and negative symptoms
Pos: temporal lobe underdeveloped, auditory processing, language; amygdala, hippocampus smaller in schizophrenia, verbal and spatial memory, processing emotion
Neg: reduction in total brain size and grey matter, overall lobe size and cognition impaired, grey matter= routes sensory or motor information, frontal lobe deficits, complex information processing, organizing functioning
Phases of Schizophrenia
Prodromal phase: (weeks to months), peculiar behaviors, negative symptoms
psychotic prephase: (<2 months), first full-blown, positive symptoms
active phase: (at least 1 month), positive and negative symptoms, often multiple of each
residual phase: (variable), low-grade symptoms similar to prodromal phase, can return to functioning
Myth: people with schizophrenia are homeless
Truth: 11.6% of people with schizophrenia are homeless, 26.2% of individuals with Any severe mental illness are homeless
Delusional Disorder
at least 1 month delusions only, typically non-bizarre delusions
can be short-term or chronic
impairment depends on severity/focus of delusions
subtypes: erotomaniac, grandiose, jealous, persecutory, somatic, shared delusions