Abnormal Psychology Exam Notes

Size: px

Start display at page:

Download "Abnormal Psychology Exam Notes"

Adela Anthony
5 years ago
Views:

1 Abnormal Psychology Exam Notes Psychotic Disorders- Week 7- Chapter 4 Narrow definitions of psychosis only require the presence of hallucinations and delusions, whereas broad definitions of psychosis incorporate additional symptoms such as disorganised behaviour and negative symptoms. Symptoms: HALLCUCINATION, DELUSIONS, THOUGHT DISORDER, DISORGANISED BEHAVIOUR Hallucinations- Psychosis- Symptoms - Sensory percept that has a compelling sense of reality of a true perception but that occurs without external stimulation of the relevant sensory organ. - 75% of patients diagnosed with schizophrenia report hallucinations o These are generally auditory 60-70% of patients diagnosed with schizophrenia report auditory hallucinations consisting of voice speaking to them. o Voices are typically critical and hostile o Command instructions are between 33 and 74% of voice hearers. - Multimodal hallucinations, gustatory (metallic taste). - Does not mark the presence of a mental disorder Delusions DSM-IV- TR defines delusion as false belief based on incorrect inference about external reality that is firmly sustained despite what almost everybody else believes and despite what usually constitutes incontrovertible and obvious proof or evidence to the contrary. - Belief not shared by people in persons subculture Paranoid delusions are those most commonly reported by patients in clinical settings. These delusions entail a belief that someone, or a force or agency, is seeking to harm the patient or his/ her interests. As a consequence, the patient may attempt to avoid the threat, such as minimising threats. This state of vigilance is also associated with delusions of reference, which are comprised of a belief that messages of a high personal nature are being conveyed via neutral sources- such as newspapers etc. - Somatic Delusions: Which entail a false belief regarding an organ or organs of the body (belief that one has cancer), are also commonly described. - Sometimes accompanied by somatic hallucinations such as sensations of skin crawling. - Grandiose Delusions: Are primarily associated with, but not restricted to, manic episodes, illustrating that psychotic symptoms are not solely experienced in the context of psychotic disorders. - Nihilistic Delusions: Include a convictions that one is dead or that parts of one s body have ceased to exist.

2 - Delusions of Guilt: Include beliefs of personal responsibility for specific events or outcomes, often of catastrophic proportions, such as the 9/11 attacks on the World Trade Centre, or the spread of aids in the world. - Jealousy Delusions: Patients partner, false belief that they have been unfaithful - Erotomanic Delusions: Entail a false belief that the patients romantic feelings for another, are reciprocated by the other person. o Violence by stalkers is more reliably predicted by the stalker s previous history of violence than by the presence of delusions. - Passivity Phenomena: Entail a false belief that the patient is under control of some person, force or agency. - Dysmorphobia: Somatic delusion including a belief that part of the patient s anatomy (e.g. face or genitals) is disfigured or deformed- often leading to chronic social avoidance and depression. - Parasitosis: Belief that one has been infested by insects. - Misidentifications Delusions: Include a belief that people in the environment have changed their identity (that loved one has been replaced by an imposter). Delusions are also categorised into bizarre non-bizarre on the basis of their plausibility. This categorisation has implications for later diagnosis. Another distinction is that between so called primary and secondary delusions, although this dichotomy is debated because in practice because it may be difficult to make an accurate distinction. Primary Delusions: are those that have formed without a prior psychopathological event or process having led to the false conclusion. That is, the belief seems to have appeared de novo or out of the blue. Secondary Delusions: are theoretically secondary to abnormal changes in mood, memory or perception. Thought Disorder In addition to hallucinations and delusions, thought disorder is also frequently categorised as a psychotic symptom. Thought disorder refers to disturbances in the logical sequencing and coherence of thought. In clinical practice and research on psychosis, the depth of thought disorder is inferred through measurements of person s speech. This lets them measure the dimensions of though sequencing rather than the content of thought (delusions). Can be positive and negative manifestations Positive thought disorder - Include circumstantiality, which describes speech that is very indirect and long-winded in conveying meaning, although the goal may be eventually reached. - Tangentially describes oblique or irrelevant responses to questions. Negative thought disorder - Refers to a reduced stream of thought as evident in a poverty speech

3 Disorganised Behaviour - Grossly disorganised or catatonic behaviour is another symptom of psychosis. The DSM-IV- TR includes a catatonic subtype schizophrenia in which the clinical presentation is dominated by the presence of disturbances in movement (motor disturbance). - Current DSM requires two of the following five symptoms of catatonia for the diagnosis. o Immobility, such as waxy flexivility (i.e. the person maintains a posture which s/he is put into by another) o Excessive but purposeless motor activity that is not influenced by external stimuli o Extreme negativism or rigid posturing in response to requests to move o Peculiarities of voluntary movement as evidenced by adopting unusual postures, repeated movements or facial grimacing o Echolalia: parrot like repetition of the speech uttered by another person o Echopraxia: imitations of the movements of another. Negative Symptoms Can also have deficits in the expression of speech, emotion, and spontaneous behaviour are common in psychosis. - One negative symptom is Alogia: A reduction in thoughts as reflected in decreased speech. This might include thought blocking- that is, the cessation of speech, sometimes midsentence. - Affective Flattening: Lack of emotional expression - Avolition: Lack of initiation in activities. Diagnosing Psychotic Disorders - Core features: symptoms necessary for diagnosis - Psychotic symptoms persist for at least one to several weeks and cause significant interference with the persons functioning in every day life - SCHIZOPHRENIA: when there are two or more of the following symptoms present for a significant proportion of time during a one- month period o Delusions o Hallucinations o Disorganised speech o Grossly disorganised or catatonic behaviour o Negative symptoms. SCHIZOPRHENIA: Lasts at least siz months, with at least one month or two or more of the following: Delusions, hallucinations, disorganised speech, disorganised or catatonic behaviour and/ or negative symptoms. SCHIZOPHRENIFORM DISORDER: Equivalent to schizophrenia except the disturbance is of lesser duration (one to six months) SCHIZOAFFECTIVE DISORDER: The co-occurrence of the symptoms of schizophrenia and a mood disturbance, in addition to at least a two- week period of delusions or hallucinations without mood disturbance. DELUSIONAL DISORDER: At least one month of non-bizarre delusions

4 BRIEF PSYCHOTIC DISORDER: A psychotic disturbance lasting more than one day but less than a month SHARED PSYCHOTIC DISORDER: A psychotic disturbance in an individual who is influenced by someone else with a similar delusion. PSYCHOSIS DUE TO MEDICAL CONDITION: A psychotic disturbance that is the result of a medical condition SUBSTANCE-INDUCED PSYCHOTIC DISORDER: A psychotic disturbance that is the result of a substance abuse, a medication or exposure to a toxin. PSYCHOTIC DISORDER NOT OTHERWISE SPECIFIED: A psychotic disturbance that does not meet criteria for another psychotic disorder. EXEPTIONS: only one symptom is required if the delusions are bizarre, or if hallucinations include a voice that is keeping up a running commentary on the person s behaviour or two or more voices are conversing with each other. Typically when the diagnosis for schizophrenia isn t met then other forms are considered. ASSOCIATED FEATURES - Other relevant: o Depression o Anxiety Secondary anxiety problems: Social phobia and post-traumatic stress disorder. o Substance Abuse Exacerbate symptoms of psychosis. o Quality of Life Unemployment has been found to affect approximately 40-50% of people with disorder. o Stigma The epidemiology of psychotic disorders Prevalence and age of onset - Psychotic conditions have a relatively low prevalence. o Lifetime prevalence of schizophrenia is only 1-2 % o For every three men who develop the disorder, only two women develop it o Primary causal factors are underlying genetic and biological not environmental o Higher in people living in cities The course of Psychotic Disorders - Prodromal phase, the acute phase, recovery phase (early and later recovery) Prodromal phase: Symptoms develop in adolescence; enter into adulthood, often following a period of gradual deterioration: this is the prodromal phase.

5 The acute phase: The acute phase: For those whose symptoms do intensify, the next state is the acute phase. Acute psychotic episodes are characterised by the emergence of persistent positive and negative symptoms that clearly identify the condition as a psychotic disorder. The early recovery phase: In the majority of cases symptoms begin to improve within a few months of treatment. This is the time when things like depression and social anxiety tend to emerge as they begin to reflect on the past. The late recovery phases: Even when early recovery goes well serious issues still arise in the late recovery phase. Challenges include re-integrating into social, recreational and vocational pursuits. High unemployment etc. Enduring Psychosis: Small group of patients will have enduring psychosis, pattern of symptoms includes periods of hospitalisation, interspersed by continuing symptoms that do not fully disappear. Can gain relief from positive symptoms but not negative ones. Vulnerability Factors: Biological The aetiology of Psychotic Disorders Genetic: Large body of research including family, twin and adoption studies supports the existence of a genetic basis for schizophrenia. Risk of schizophrenia increases with the degree of genetic relatedness. - 1% link between spouses - 2.8% for grandchildren - 7.3% for siblings - 9.4% for one affected parent % for both affected parents Environmental Factors - Not as much of a link found, however various environmental factors play a role apparently o E.g. foetal development, early childhood trauma, exposure to illicit substances, living in cities, Neurotransmitters - Research focussed on dopamine, noradrenaline, serotonin - Dopamine hypothesis: the disorder is associated with excessive dopaminergic function in the central nervous system. o Drugs which reduce dopamine activity were found to be effective in treating the symptoms of schizophrenia. o Amphetamines, which cause the release of dopamine, can produce symptoms of schizophrenia. - Hypothesis was revised to suggest that schizophrenia was associated with excessive numbers of over receptive dopamine receptors. - Dopamine more related to positive symptoms.

6 Brain Structure - Associated with large ventricles, indicates a loss of brain tissue - Damage to prefrontal region Vulnerability Factors: Psychosocial - Social factors: location of living, - Cognitive factors: everyone hears stuff, it is about how one understand these noises. People thinking they hate their child and attributing it to an evil demon. - Cognitive Model of psychosis (Morrison, 2001) Triggering Factors Among vulnerable individuals, the occurrence of certain events will trigger psychosis. Triggering events can entail biological processes, psychosocial processes, or an interaction between the two. - Stressful life events Symptom Specific aetiological factors: hallucinations - Dysfunction in auditory imagery theory- states that individuals prone to auditory hallucinations are able to imagine particularly vivid sounds. This auditory imagery is so lifelike that the individual mistakes it for an actual sound. Yet research testing this theory have been generally unsupportive, with one study finding that hallucinating patients with schizophrenia actually experienced less vivid imagery than non-hallucinating patients. - Refined Auditory Imagery Theory: Suggests that hallucinating individuals typically experience deficits in the vividness of their auditory imagery so that when they do experience unusually vivid auditory imagery, this is more likely to be confused for the actual perception of sound. - Other theories suggest that auditory hallucination is a result of a dysfunction in verbal selfmonitoring. According to this theory hallucinations stem from a breakdown in the individual s ability to notice his or her intentions to act (e.g. intention to make internal speech). Symptom Specific aetiological factors: delusions - Tendency of patients with delusions to make cognitive errors in tasks of general reasoning. - Individuals prone to delusions tend to blame other people, rather than themselves or random misfortune, in explaining the causes of negative events. Whilst this style of attribution assists people to protect their self-esteem by avoiding self-blame, it may contribute to delusional thinking because it creates a bias towards suspiciousness of others. Symptom- specific aetiological factors: thought disorder - Researchers have found associations between the severity of thought disorder and deficits in certain cognitive processes. - There is evidence of problems in the storage of information among patients with schizophrenia, which way in turn give rise to disordered speech. - Dysfunction in the information storage systems among patients with schizophrenia.

7 Treatment of psychotic disorders The emergence of the Stress Vulnerability Model of psychosis in the late 1970 s has shaped treatment frameworks towards a bio psychosocial or integrated approach, involving assessment and intervention across biological, psychological and social domains. The guidelines are organised with reference to the specific phases of psychosis and outline the optimal combination of biological, psychological and social interventions corresponding to each state of the disorder. Prodromal Phase Interventions - Growing emphasis on early detection of individuals at risk of developing psychosis and offering them intensive interventions in order to prevent progression to more severe and enduring psychological disturbance. - Anti-psychotic medications combined with cognitive behaviour therapy - CBT alone is successful in reducing transition to psychosis for individuals at high risk of developing a first episode of psychosis. - Not sure whether the results were actually from CBT or just the support the patient received. Acute Phase Interventions - More thoroughly established and studied - Initial comprehensive assessment of the person s mental state along with an assessment of his her physical health and an understanding of his her individual and family history, including any previous mental health problems. - If an episode is diagnosed then treatment should begin in the persons home. If in hospital should be in special units away from adults suffering the same issues- should just be for young people. - Antipsychotic medication, neuroleptics often in combination with the brief use of benzodiazapines to assist the person to regulate their sleep and to reduce the severe anxiety associated with the acute phase. - SIDE EFFECT: Tardive dyskinesia, which occurs in approximately 10% of patients treated with neuroleptics. This condition consists of a range of abnormal body movements such as lip smacking, facial grimacing, piano like movements of the fingers and toes. Interventions to prevent relapse - Relapse is a major risk once symptom have remitted - Estimated relapse rate of 65% one year after hospitalisation among those who have discontinued their medication. - However, even with ongoing medication, relapse rates are still high, with approximately 40% of patients on medication relapsing within one year. - Effective preventive treatments have included both individual and family approaches. - CBT was also significantly more effective than standard treatment in reducing positive and negative psychotic symptoms and increasing social functioning. - Family interventions normally include a combination of joint sessions with the patients and the family, and individual sessions with the patient alone. - The core components of CBT family interventions include providing education about schizophrenia and its treatment; learning to set positive yet realistic goals; communication

Psychotic Disorders. Schizophrenia. Age Distribution of Onset 2/24/2009. Schizophrenia. Hallmark trait is psychosis

Psychotic Disorders. Schizophrenia. Age Distribution of Onset 2/24/2009. Schizophrenia. Hallmark trait is psychosis Psychotic Disorders Schizophrenia Schizophrenia Affects people from all walks of life Is about as prevalent as epilepsy Usually begins in late adolescence or early adulthood Hallmark trait is psychosis