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Neuro - Psychotic Disorders



Psychotic Disorders
Question Answer
Pathophysiology of SchizophreniaSPD and schizophrenia patients are thought to share common genetic disturbances. In this model, this underlying vulnerability makes the temporal cortex susceptible to insult from environmental factors (e.g., hypoxia). - suggests that social and cognitive deficits that characterize schizophrenia-related disorders is the result of an underlying genetic diathesis and in conjunction with environmental insults, adversely effects temporal and prefrontal structures.
Schizophrenia Positive symptomsHallucinations, Delusions - the most salient aspect in describing psychosis
Hallucinationsperceptions in the absence of a stimulus. Perceptions in a conscious and awake state in the absence of external stimuli which have qualities of real perception. (auditory- most common, visual, olfactory, tactile)
Delusionsfixed beliefs that are false. A false belief based on incorrect inference about external reality that is firmly sustained despite what others believe and despite what constitutes evidence to the contrary. (Not ordinarily accepted by other members of the person's culture or subculture.) If someone says “sometimes I think I am being followed by the CIA, but I know that is not the case, and it’s just my imagination”, that is NOT a delusion.
Persecutory delusionThe most common type of delusion. Involves the theme of being followed, harassed, cheated, poisoned or drugged, conspired against, spied on, attacked, or obstructed in the pursuit of goals. Some persecutory delusions are isolated and fragmented, but others are well-organized belief systems involving a complex set of assumptions ("systematized delusions").
Somatic delusionA false belief that pertains to bodily functioning, bodily sensations, or physical appearance. Usually the false belief is that the body is somehow diseased, abnormal, or changed.
Grandiose DelusionThe patient is convinced they have special powers, talents, or abilities. Sometimes, the individual may actually believe they are a famous person or character.
Delusion of controlThe false belief that another person, group of ppl, or external force controls one's thoughts, feelings, impulses, or behavior.
Delusion of reference The false belief that insignificant remarks, events, or objects in one's environment have personal meaning or significance. For instance, a person may believe they are receiving special messages from newspaper headlines.
Delusion of mind being read The false belief that other people can know one's thoughts. This is different from thought broadcasting in that the person does not believe their thoughts are heard aloud.
Thought Disorder: 1.A pattern of disordered language use that is presumed to reflect disordered thinking. It is usually considered a symptom of psychosis, although it occasionally appears in other conditions. 2. A disturbance of conscious thought that is manifested in speech and/or writing. 3. Derailment or flight of ideas (inappropriately switching topic mid-sentence) 4. Thought blocking (“I can’t think of what I was going to say so ask me again later”); Incoherent speech (word salad) such that words are intact but speech is incoherent; Tangentiality; Illogicality; Pressured speech (speaking incessantly and quickly- common in ppl with mood disorders that have psychotic features, esp if bipolar w manic tendencies); Neologisms (making up new words); Clanging (rhyming words)
Negative symptomsbehavioral deficits. 1. flat or blunted affect and emotion, poverty of speech, inability to experience pleasure, even in activities they used to enjoy, lack of desire to form relationship, and lack of motivation. 2. considered to be one of the major impediments to progress or treatment compliance in psychotic disorders (PD’s). - tend to be more longstanding and stable than the + sx. In addition, we know that most medications, anti-psychotics, are much more affective at treating + sx than neg sx. - - Deficit syndrome refers to psychotic disorders with predominantly negative symptoms.
Schizophreniform disorderWhen symptoms of schizophrenia are present for at least one month, but not for the full six months required for the diagnosis of schizophrenia.
Brief reactive psychosisReferred to in the DSM IV-TR as "brief psychotic disorder with marked stressor(s), it is a psychotic episode triggered by a stressful event in the life of the patient. (Death of a loved one, severe accident, trauma, etc.). However, this may progress to schizophrenia down the road if symptoms persist.
Delusional disorder1. The presence of one or more non-bizarre delusions in the absence of other significant psychotic symptoms. This is more common in the elderly. 2. Non-bizarre delusions are fixed beliefs that are definitely false, but are plausible (e g., someone who thinks he or she is under police surveillance, whereas bizarre delusions are non-plausable- eg. someone thinking aliens invaded their house and implanted a transister in their face). 3. In order for the diagnosis to be made auditory and visual hallucinations cannot be prominent, although olfactory or tactile hallucinations related to the content of the delusion may be present. In elderly people, these delusions often start following the decline in auditory or visual abilities. 4. To be diagnosed with delusional disorder, the delusion(s) cannot be due to the effects of a drug, or general medical condition, and delusional disorder cannot be diagnosed in an individual previously diagnosed with schizophrenia. A person with delusional disorder may be high functioning in daily life, and may not exhibit odd or bizarre behavior aside from these delusions. 5. Six subtypes are characterized as erotomanic, grandiose, jealous, persecutory, somatic, and mixed, i.e., having features of > 1 subtypes. 6. Delusional disorders are more common in elderly patients and individuals with sensory impairments.
Schizoaffective disorder 1. uninterrupted period of illness during which, at some time, there is either a major depressive episode, a manic episode, or a mixed episode concurrent with symptoms that meet criterion A for schizophrenia (e g., Two or more of the symptoms (mostly +sx) are present for the majority of a one-month period (or a shorter period of time if symptoms improved with treatment): The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.
Schizoaffective symptoms1. delusions 2. hallucination 3. disorganized speech (e.g., frequent derailment or incoherence) 4. grossly disorganized behavior (e.g. dressing inappropriately, random activity) or catatonic behavior 5. negative symptoms—e.g., affective flattening, alogia (lack or decline in speech), avolition, anhdonia, social withdrawal. 6. If the delusions are judged to be bizarre, or hallucinations consist of hearing one voice participating in a running commentary of the patient's actions or of hearing two or more voices conversing with each other, only that symptom is required to meet criterion A above .
Schizoeffective Subtypes1. Bipolar type ; if the disturbance includes a manic or mixed episode with or without depression. 2. Depressive type ; the mood disturbance only includes major depressive episodes.
Obstetrical factors associated with schizo1. Pregnancy complications (toxemia, bleeding) 2. Maternal viral infection 3. Rh incompatibility 4. Prenatal nutritional deprivation 5. Maternal exposure to psychological stress 6. Delivery complications (hypoxia)
Schizo CBT Key Stages 1. developing a therapeutic alliance based on the patient's perspective on their illness 2. developing alternative explanations of schizophrenia symptoms, 3.reducing the impact of positive and negative symptoms, and 4. addressing medication adherence.