Published on December 25, 2008
Definition Psychosis is simply impairment in reality testing. What is reality testing? Reality testing story…..woke up dead.
Reality Testing Refers to an individual’s ability to discern, perceive, appreciate or “test” the qualities of their surroundings….
Psychotic Disorders Schizophrenia Schizoaffective Disorder Delusional Disorder
Schizophrenia Affects about 1% of the population 50% of all mental health hospital admissions Schizophrenics occupy roughly 25% of all hospital beds 35% - 50% of the homeless population
Schizophrenia A neurobiological illness that impairs: perceptions thinking language emotions social interactions
Demographics Males = Females Onset: Males 15 - 25 Females 25 - 35 Precipitators: Neurobiology Genetics Environment Prognosis: poor
Positive Symptoms Type I Schizophrenia Hallucinations Odd Speech Neologisms Delusions Word Salad Perseveration Clang Associations Thought Disorder Echolalia Paranoia Ideas of Reference Odd Behavior Loose Associations Agitation/Aggression Thought Broadcasting Catatonia Thought Insertion Regression Concrete Thinking Stereotypy
Schizophrenia Hallucinations Auditory Visual Delusions: Firm, fixed, false belief Grandeur Persecution Ideas of Reference Self-accusation Infidelity Paranoid
Schizophrenia Neologisms: new words or condensations of words used in an attempt to express a highly complex idea. Word Salad: an incoherent mixture of words & phrases Perseveration: pathological repetition of the same response to different questions. Clang Associations: using words similar in sound, but not in meaning. Echolalia: repeating of words or phrases of one person by another.
Schizophrenia Agitation/Aggression: constant movement, irritability, confrontation Catatonia: motor abnormalities Catalepsy: constantly maintained immobile position Excited: agitated purposeless motor activity w/o cause Stupor: marked slowed activity - immobile - unaware Rigidity: rigid posture - resists all attempts to be moved Posturing: voluntary assumption of position - long periods Cerea flexibilitas : person can be molded into position Negativism: motiveless resistance to all attempts to move Regression: may assume and maintain fetal position Stereotypy: repetitive fixed pattern of physical action or speech
Negative Symptoms Type II Schizophrenia Flat, Blunt, or Restricted Affect: lack vocal inflection, paucity of expressive gestures, poor eye contact, decreased movement, or unchanging facial expression. Alogia: poverty of speech Asociality: lack of social interaction Anhedonia: lack of interest in activities that formerly brought pleasure Avolition:lack of goal directed motivation Inattention: inwardly focused - not aware of surroundings or activity
Schizophrenia Schizophrenia can develop in children. Drug and/or alcohol abuse is common among schizophrenics. Psychotherapy can help them cope with life events such as losing a job or getting a divorce. Violence is rare with schizophrenics, but does occur. Schizophrenics can lead relatively normal lives today. Psychotherapy and drug therapy can prevent relapse. Taking medication will be life-long. Physical exercise has been shown to alleviate symptoms.
Schizophrenia Antipsychotic drugs help alleviate the negative symptoms. Early accurate diagnosis is critical to a more positive outcome. Schizophrenia can be inherited. A child with one schizophrenic parent has a 12.5% chance of contracting the disease. Contracting the disease seems to be a combination of genetic predisposition and environmental factors. Up to 60% of schizophrenics have no family history of it. A structured and predictable environment helps them cope. A child who develops schizophrenia is likely to have a father over 50. Has to do with number of time undeveloped sperm is divided. A 40 year-old man’s sperm has divided 660 times. More likely to be damaged.
Schizophrenia People born between February and April are more likely to develop schizophrenia. In Europe and North America roughly 10% more babies born in those months go on to develop schizophrenia. This is more than any other three month period. Cognitive Behavioral Therapy is helpful for schizophrenics with delusions. It teaches them to challenge the rationality of the voices. Nobody really knows the cause of schizophrenia. Lots of theories. Heavy use of alcohol seems to trigger psychotic symptoms, even if they are in treatment. Research in Germany showed that 62% started before or in the month of onset. Schizophrenics show less prefrontal cortex activity than normals. They also have less grey matter.
Schizophrenia People with schizophrenia have less grey matter than normals.
Schizoaffective Disorder Has symptoms of both Schizophrenia and a major mood disorder at the same time. Patients with Schizoaffective Disorder experience a combination of symptoms associated with both diseases, but do not meet the full criteria for either. Two types of Schizoaffective disorder: Bipolar type is where the patient has symptoms of a Manic or Mixed and/or a Depressive episode with his/her psychotic sx. Depressive type is where the patient has only the symptoms of a Major Depressive Disorder with his/her psychotic symptoms. Symptoms include: auditory/visual hallucinations, suspiciousness, unusual thought content, disorganization, emotional withdrawal, blunted affect, inability to express pleasure,and attention difficulties
Delusional (Paranoid) Disorder Nonbizarre delusions that involve situations occuring in real life, such as being followed, poisoned, infected, loved at a distance, having a disease, or being deceived by one’s spouse/lover. Subtypes: Erotomanic: someone of higher status loves me Grandiose: inflated self worth, power, knowledge, identy or special relationship with God or a famous person. Jealous: belief that one’s sexual partner is unfaithful Persecutory: belief that you are being wrongly treated in some way - often take their complaints to legal authorities Somatic: belief that you have some physical defect, disorder, or disease Unspecified: doesn’t fit any of the above
Shared Psychotic Disorder This psychotic mental disorder is diagnosed when delusions develop in an individual involved in a close relationship with another individual already afflicted with delusions arising out of a different psychosis such as Schizophrenia, Delusional Disorder or Major Depression with psychotic features. Delusional (Paranoid) Disorder
Dissociative Disorders Depersonalization Disorder Dissociative Amnesia Dissociative Fugue Dissociative Identity Disorder (formerly Multiple Personality DO)
Depersonalization Person feels a change in sense of self - feels mechanical, dreamy, or detached from their body Temporary state Usually follows a traumatic event, but is often present during panic attacks
Dissociative Amnesia Inability to recall important personal information Information is frequently traumatic in nature Sub categories: Generalized amnesia Localized amnesia Selective amnesia
Dissociative Fugue Sudden, unexpected travel away from usual surroundings coupled with amnesia of former life Usually time-limited Person suddenly remembers who they are and becomes amnesic for the time away Also follows traumatic event (?)
Dissociative Identity Disorder Splitting of personality into two or more separate and distinct personalities “ Primary” personality usually not consciously aware of others “ Alternates” may be very ill (suicidal) or extremely different from the primary Caused by extreme trauma in childhood
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