PSYC3604 Lecture 9 Schizophrenia and Psychotic Disorders
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Course
PSYC 3604 (PSYC3604)
Institution
Chamberlain College Of Nursing
Schizophrenia Spectrum and Other Psychotic Disorders
- Psychotic disorders: characterized by unusual thinking, distorted perceptions, and odd behaviours
o Impaired reality
o Inability to think coherently
o Some long lasting, others temporary
- Psychosis: a severe mental condition characterize...
psyc3604 lecture 9 schizophrenia and psychotic dis
schizophrenia spectrum and other psychotic disorde
psychosis a severe mental condition characteriz
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PSYC 3604 (PSYC3604)
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PSYC3604 Lecture 9
Schizophrenia and Psychotic Disorders
PSYC 3604 Final Exam
PSYC3604 Lecture 9
Schizophrenia and Psychotic Disorders
Schizophrenia Spectrum and Other Psychotic Disorders
- Psychotic disorders: characterized by unusual thinking, distorted perceptions, and odd
behaviours
o Impaired reality
o Inability to think coherently
o Some long lasting, others temporary
- Psychosis: a severe mental condition characterized by a loss of contact with reality
o Delusion: a false belief
o Hallucination: a false sensory perception
o Both at the same time
o Loss of contact with reality
o Presence of them does not mean psychotic disorder
o Can occur in brain tumors, brain trauma, or exposure to toxic chemicals
o Voices as negative and upset by them and lack of control
What are the schizophrenia spectrum and other psychotic disorders?
- Abnormalities in 1 or more of 5 domains including delusions, hallucinations,
disorganized thinking or behaviour, and negative symptoms
- Includes…
o Schizophrenia
o Schizophreniform disorder
o Schizoaffective disorder
o Delusional disorder
o Brief psychotic disorder
o Substance/medication-induced psychotic disorder
o Psychotic disorder due to another medical condition
o Other specified schizophrenia spectrum and other psychotic disorder
o Unspecified schizophrenia spectrum and other psychotic disorder
- Schizotypal personality disorders considered apart of these disorders, but in DSM5 =
other personality disorders
- Lose contact with reality
- Schizophrenia = most severe psychopathology in this class
Movies
- Portrayed as violent
Early descriptions of schizophrenia
- Emil Kraepelin first formulated in 1800s
,PSYC3604 Lecture 9
Schizophrenia and Psychotic Disorders
o Dementia praecox
o Early onset and intellectual deterioration
o Defining features = disturbances perceptions in perceptual and cognitive faculties
- Eugen Bleuler
o Schizophrenia meaning split mind
o Disturbances caused by associative splitting
o Renamed it schizophrenia
o Did not believe in early onset
o Did not believe in progress towards dementia
o Phren = mind
o Tried to specify common denominator breaking of associative threads (core)
Words and thoughts
o 4 core symptoms
Ambivalence, disturbance of affect and association, preference for fantasy
over reality
Misconceptions about schizophrenia
- Common myths
o Split personalities split = between thoughts and feelings, not personality
o Multiple personalities compared to DID (2+ personalities each with own
thoughts, feelings, and behaviours)
o Violent rates of violence are no higher among people with other disorders
Rarely serious, perpetrated by someone with comorbid substance use
disorder
- Still not as well understood
- Inability to perceive environment appropriately
What is schizophrenia
- Schizophrenia: a severe psychological disorder characterized by disorganization in
thought, perception, and behaviour
- Ideas are not logically related
- Incapable of logical thought
- Flat or inappropriate affect
- Impaired motor activity
- Considerable variability in this disorder from person to person
- Symptoms of schizophrenia
o Positive symptoms group of symptoms including unusual thoughts, feelings,
and behaviours
Too much of a behaviour not apparent among most people
Excess or distortions
o Negative symptoms absence of a behaviour that should be in most people
Behaviourial deficits
- Some use 3 dimensions disorganized symptoms
,PSYC3604 Lecture 9
Schizophrenia and Psychotic Disorders
o Rambling speech, erratic behaviour, inappropriate affect (disorganized within
positive)
- Onset late adolescence or early adulthood
o Early vs. intermediate vs. late onset
o Abrupt or gradual
o Early = before 19 risk for lifelong disorder
o Socially withdrawn
o Long time before actively showing psychotic symptoms
- Course
o Prodromal phase before onset
Extended period of time before full onset
Unusual, less severe
Impairments
Social withdrawal, isolation, deterioration in personal hygiene, difficulty
functioning in school or work
Ideas of reference, magical thinking, delusions (feeling presence)
1-2 years, can take upwards of 10 years before meeting full criteria
o Acute phase positive symptoms emerge
Psychotic symptoms more noticeable
o Residual phase
Positive symptoms no longer present, negative may remain
- Epidemiology prevalence rates average 1% in Canada
o 16-40 of every 100,000 people develop
o More common in males
o 1% of population
o 0.3 – 1.6% in US
o Higher in certain urban settings
o Gender difference may be due to diagnostic criteria
- Comorbidity common – mood disorders, anxiety disorder, PTSD, substance use,
personality disorders
o Major depressive disorder (40%) violence, arrests, victimization
o 47% have anxiety social anxiety = common
o 43% have PTSD
o Up to 80% have history of substance abuse in lifetime
o Commonly abuse alcohol or cannabis poor recovery
o Self-medication hypothesis to relieve negative symptoms
o Personality disorder avoidant, antisocial, paranoid, dependent
- Functional impairment
o One of the top 10 most debilitating conditions in the world
o Symptom severity equals the level of impairment
o Correlation between severity and impairment
o Self-care, independent living, relationships, work, school = impairment
o Strange behaviour and social skills deficits = less connections
, PSYC3604 Lecture 9
Schizophrenia and Psychotic Disorders
o Overrepresented in jails and homeless shelters
o Significant human toll on the individual and family poor quality of life
o Personal care and independent living
o Interpersonal relationships
o Work and school
o Substance abuse
- Mortality decreased life expectancy of 10-20 years
o 3x risk of death drug use, lower family involvement, side effects of medication
o High risk of suicide
10% die by suicide
40-60% attempt
- Prognosis poorer than other disorders
o A number of acute episodes
o Chronic, relapse is common
o Chronic for 57%
o 39% have intermittent
o Only 1 in 3 achieve remission milder symptoms, shorter duration of psychosis
o Symptom severity, treatment response, and comorbidity impact outcomes
o Early treatment is important
o Comorbidity increases poor outcome
o Many remain chronically disabled
- Sex, race, ethnicity
o Gender differences in schizophrenia
Higher in men 4:1 ratio
Women develop later, milder forms, better social functioning
Later age of onset for women = more positive outcomes, developmental
milestones, better social functioning
Estrogen may be protective factor
Socialized to be more socially competent
o Symptoms common across racial and ethnic groups
o Cultural differences in outcomes
o Developmental factors, including early signs or symptoms
o Higher in African Americans or immigrant minority groups
o Hallucinations higher in African American populations
o Differing rates may reflect diagnosis
o Outcome varies from culture to culture
Positive in developing countries rather than developed
Developed place more importance on independence
Developing place emphasis on family, community, and social support
- Developmental factors
o Early signs or symptoms
Delusional experiences
Lower sociability
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