Psychotic Disorders

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Psychotic Disorders

  1. 1. Psychotic Disorders
  2. 2. Schizophrenic Symptoms <ul><li>Delusions (bizarre thoughts, beliefs) </li></ul><ul><li>Hallucinations (perceptual events: Hearing or seeing things that are not really there) </li></ul><ul><li>Speech symptoms: e.g. loose associations, incoherence, neologisms, poverty of content </li></ul><ul><li>Grossly inappropriate behavior e.g. silliness, agitation, inappropriate sexual behavior, poor hygiene) </li></ul><ul><li>Flat affect </li></ul><ul><li>Interpersonal withdrawal </li></ul><ul><li>Withdrawal from involvement with the environment </li></ul><ul><li>Positive vs. Negative symptoms </li></ul>
  3. 3. Course of Schizophrenia <ul><li>Childhood: often children are difficult to differentiate from children who do not develop schizophrenia later in life </li></ul><ul><li>Prodromal Phase: Adolescence. Involves odd behavior, social withdrawal, increasingly flat affect </li></ul><ul><li>Psychotic Break: The first episode of clearly and dramatically psychotic behavior typically age 18 – 22) </li></ul><ul><li>Adulthood: Active vs. Residual Phases </li></ul>
  4. 4. Subtypes of Schizophrenia <ul><li>Disorganized </li></ul><ul><li>Catatonic </li></ul><ul><li>Paranoid </li></ul><ul><li>Undifferentiated </li></ul><ul><li>Residual </li></ul>
  5. 5. Etiology of Schizophrenia <ul><li>Genetic: Inheritance of a flawed fetal immune system gene </li></ul><ul><li>Viral infection disrupting the formation of the nervous system in early pregnancy (nonrandom distribution of birthdates) </li></ul><ul><li>Neural pruning </li></ul>
  6. 6. Neurobiological features of Schizophrenia <ul><li>Excessive Dopamine </li></ul><ul><li>Underfunctioning Frontal Lobes </li></ul><ul><li>Disrupted functioning of the thalamus </li></ul><ul><li>Enlarged ventricles </li></ul>
  7. 7. Medications for Schizophrenia <ul><li>Traditional Antipsychotic Meds block receptor sites in the brain that are usually stimulated by the neurotransmitter Dopamine. This is followed by a reduction in Dopamine levels. </li></ul><ul><ul><li>Examples include Stelazine, Thorazine, Haldol, Mellaril, Prolixin </li></ul></ul><ul><ul><li>Tardive Dyskinesia </li></ul></ul>
  8. 8. Medications for Schizophrenia (cont’d) <ul><li>Atypical Antipsychotic Meds block a range of different Dopamine receptors </li></ul><ul><ul><li>Are generally more effective at controlling positive symptoms (hallucinations, delusions, bizarre behavior) </li></ul></ul><ul><ul><li>Generally less likely to cause tardive dyskinesia </li></ul></ul><ul><ul><li>Clozaril, Risperdal, Zyprexa, Seroqel </li></ul></ul>
  9. 9. International Studies of Schizophrenia <ul><li>Prevalence rates vary (Ireland and the USA have the highest prevalence rates of schizophrenia) </li></ul><ul><li>Schizophrenics course is more positive in “Third World” societies than in industrialized societies </li></ul><ul><li>Importance of belongingness; importance of continuum model of psychopathology; importance of being needed, valued </li></ul>
  10. 10. Brief Psychotic Disorder <ul><li>Presence of one or more of the following symptoms for at least one day, but less than one month </li></ul><ul><ul><li>Hallucinations </li></ul></ul><ul><ul><li>Delusions </li></ul></ul><ul><ul><li>Bizarre behavior </li></ul></ul><ul><ul><li>Disorganized speech </li></ul></ul>
  11. 11. Schizophreniform Disorder <ul><li>Presence of symptoms characteristic of Schizophrenia </li></ul><ul><li>Duration of symptoms 1 – 6 months </li></ul>
  12. 12. Shared Psychotic Disorder <ul><li>A delusion develops in an individual in the context of a close relationship with another person who has an already-existing delusion </li></ul><ul><li>The delusion is similar in content to that of the person who already had the established delusion </li></ul>
  13. 13. Delusional Disorder <ul><li>Presence of a nonbizarre delusion for at least one month (e.g. being followed, persecuted, having a peculiar disease or infection, etc) </li></ul><ul><li>No hallucinations, bizarre behavior or incoherent speech </li></ul><ul><li>Functioning is not so impaired (other than the delusion), and behavior is not obviously odd except in the context of the delusion </li></ul><ul><li>Erotomanic, Grandiose, Jealous, Persecutory, Somatic, and Mixed Types of Delusions are possible </li></ul>
  14. 14. Schizoaffective Disorder <ul><li>The patient experiences either a Major Depressive Episode, a Manic Episode, or a Mixed Episode simultaneous with Schizophrenic symptoms such as delusions, hallucinations, bizarre behavior, incoherent speech </li></ul><ul><li>The patient has experienced delusions or hallucinations for at least two weeks in the absence of any mood symptoms </li></ul><ul><li>Mood symptoms are present for a substantial proportion of the duration of the patient’s psychotic symptoms (e.g. delusions, hallucinations) </li></ul>
  15. 15. Additional Psychotic Disorders <ul><li>Psychotic Disorder due to a Medical Condition (Psychotic symptoms resulting from brain tumors, cerebrovascular disease, epilepsy, etc) </li></ul><ul><li>Substance-Induced Psychotic Disorder (hallucinations or delusions that are a direct result of intoxication or withdrawal from a substance) </li></ul><ul><li>Psychotic Disorder N.O.S. (e.g. Auditory hallucinations in the absence of other psychotic symptoms; Postpartum psychosis) </li></ul>

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