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Summary Week 1 - Severe Mental Illness in Urban Context
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- Erasmus Universiteit Rotterdam (EUR)
Summary of the Literature for Week 1 - Severe Mental Illness in Urban Context
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Module 1: LiteratureCh 8: Schizophrenia Spectrum and Other
Psychotic Disorders Along the Continuum
Introduction
General Information
The SZ spectrum – refers to a set of psychotic disorders that share similarities with SZ
- But are not as (1) severe or (2) persistent
The psychotic disorders included in the spectrum are:
1. Schizophrenia – involves delusions, hallucinations, disorganized speech or behavior,
and/or negative symptoms – and functional decline for 6 months
2. Delusional Disorder – i.e., persistent beliefs that are unrealistic – but no other
symptoms of SZ
3. Schizoaffective Disorder – i.e., mixed symptoms of SZ and a mood disorder
4. Schizophreniform Disorder – i.e., symptoms of SZ for more than 1 month – but less
than 6 months
5. Schizotypal PD – i.e., paranoia, beliefs that random events are related to the
individual, magical thinking, perceptual illusions, social isolation, and restricted
emotions
6. Brief Psychotic Disorder – i.e., symptoms of SZ for less than 6 months
Deficits in attention and WM – may or may not lead to difficulties in communication,
thought, or social interaction
Schizophrenia
People with SZ experience psychosis – they see, hear, and feel things that are not real – i.e.,
hallucinations
- And may have fixed beliefs such as that their thoughts have been “removed” by some
outside force – i.e., delusions
,The symptoms that make up SZ can appear in mild to moderate form in many people who do
not meet the full criteria for any disorder
- E.g., 28% reported having had at least 1 symptom characteristic of SZ – such as
hearing voices that no one else heard
Biological family members of those with SZ – often show problems in attention and
memory
- As well as neurological abnormalities similar to those seen is SZ – but less severe
The DSM-5 – Continuum of Psychotic Experiences
The DSM-5 recognizes this continuum – by listing SZ and other psychotic disorders in order
of severity
Schizotypal PD
It is the first disorder along the continuum – and involves moderate symptoms resembling
those of SZ
- But with a retained grasp on reality
People with this disorder often (1) speak in odd and eccentric ways, (2) have unusual beliefs
and perceptions, and (3) have difficulty relating to other people
Delusional Disorder
Individuals have persistent beliefs that are contrary to reality
- They lack other symptoms of SZ – and are often not impaired in their functioning
Their delusions tend to be about things that are possible but untrue
Brief Psychotic Disorder
Individuals have symptoms of SZ for 1 month or less
Schizophreniform Disorder
Individuals have symptoms of SZ for 1-6 months – but usually resume their normal lives
Schizoaffective Disorder
Presents a mixed picture of (1) SZ and (2) major depression or mania
,Psychosis
Experiences and beliefs that are out of touch with reality – are called psychotic
- People with psychosis – may (1) speak incoherently and (2) act in unpredictable
manner
If one is unable to tell the difference b/n what is real and what is not – is experiencing
psychosis
Psychosis can take many forms – and one of the most severe and puzzling psychotic
disorders is SZ
1) At times – people with SZ think and communicate clearly, have an accurate view of
reality, and function well in daily life
2) At other times – during the active phase of SZ – their thinking and speech are
disorganized, they lose touch with reality, and they have difficulty caring for
themselves
Societal Costs
In any given year – more than 90% of people with psychotic disorders seek treatment in
mental health facility or general medical faculty
- Nations spend up to 3% of their health care budgets treating people with psychotic
disorders
- Billions of dollars more are lost in declines in productivity
Most people who develop psychotic disorders – do so in their late teenage or early adult years
- When they are ready to begin contributing to society
Symptoms, Diagnosis, and Course
SZ is a complex disorder with psychosis as its core diagnostic symptom
DSM-5 refers to the SZ spectrum to reflect the fact that there are five domains of symptoms
– that define psychotic disorders
- Their (1) number, (2) severity, and (3) duration – distinguish psychotic
disorders from each other
,People with SZ may show all – or just some – psychotic symptoms
- The disorder can look differently across individuals
Five Domains of Psychotic Symptoms
The domains include:
1) Four kinds of Positive Symptoms – i.e., delusions, hallucinations, disorganized
thought/speech, and disorganized or abnormal motor behavior – including catatonia
2) Negative Symptoms – e.g., restricted emotional expression or affect
People with SZ also often show numerous cognitive deficits – linked to declines in
functioning
- Cognitive deficits are not part of the diagnostic criteria
Positive Symptoms
These are described as positive – because they are over expressions of unusual perceptions,
thoughts, and behaviors
Delusions
Defined as ideas that an individual believes are true – but are (1) highly unlikely and (2)
often simply impossible
Self-Deceptions vs Delusions
First – self-deceptions are at least possible – whereas delusions are NOT
It is possible – that one would win the lottery
- But it is NOT possible that one’s body is dissolving and floating into space
Second – people harboring self-deceptions may think about these beliefs occasionally
- But people with delusions tend to be preoccupied with them
Delusional people:
1) Look for evidence in support of their beliefs
, 2) Attempt to convince others of these believes
3) Take actions based on these beliefs
Third – people holding self-deceptions usually acknowledge that their beliefs may be wrong
- People with delusions often are highly resistant to arguments or facts that
contradict their delusions
They may view the arguments others make against their beliefs as a conspiracy to silence
them – and as evidence of the truth of their beliefs
Type of Delusion Definition Example
False belief that oneself – or one’s loved ones – are Belief that the FBI or CIA are
Persecutory being persecuted, watched, or conspired against by conspiring to catch one in a sting
others operation
Belief that everyday objects, events, or other people Belief that newscaster is reporting
Delusion of have an unusual personal significance on your movements
Reference
False belief that one has great power, knowledge, or Belief that you are MLK Jr.,
Grandiose talent – or that one is a famous and powerful person reincarnated
Belief that one’s thoughts, feelings, or behaviors are Belief that an alien has taken over
Delusion of being imposed or controlled by an external force your body and is controlling your
Being Controlled behavior
Belief that one’s thoughts are being broadcast from Belief that your thoughts are being
Thought one’s mind for others to hear transmitted via the internet against
Broadcasting your will
Belief that another person or object is inserting thoughts Belief that your spouse is inserting
Thought into one’s mind blasphemous thoughts into your
Insertion mind
Belief that thoughts are being removed from one’s mind Belief that roommate is stealing all
Thought by another person or object your thoughts while you sleep
Withdrawal
, False belief that one has committed a terrible act or is Belief that you have killed
Delusion of Guilt responsible for a terrible event someone or responsible for a
or Sin natural disaster
False belief that one’s appearance or part of body is Belief that intestines have been
Somatic diseased or altered replaced by snakes
The most common types of delusions include:
1) Persecutory Delusions
2) Delusions of Reference
3) Grandiose Delusions
4) Delusions of Thought Insertion
Delusional beliefs can be (1) simple and transient – e.g., believing pain experienced in
stomach is result of someone shooting laser beam at you
- More often they are (2) complex and elaborate – with the person clinging to
these beliefs for long periods
Hallucinations
The hallucinations – i.e., unusual perceptual experiences – in SZ tend to be (1) frequent, (2)
persistent, (3) complex, (4) bizarre, and (5) often entwined with delusions
- They are not precipitated sleep deprivation, stress, or drugs
Type of Hallucinations Definition
Auditory E.g., hearing voices, music, etc.
May consist of a voice speaking the individual’s thoughts aloud – or carrying
a running commentary on one’s behavior
May consist of a collection of voices speaking about the individual in the third
person – or voices issuing commands and instructions
The voices may seem to come either from (1) inside the person’s head or from
(2) somewhere outside
They often have a negative quality – criticizing or threatening the individual
, or telling them to hurt themselves or others
People with SZ may talk back to the voices even as they are trying to talk to
people who are actually in the room with them
Visual They are often accompanied by auditory hallucinations
E.g., woman may see figure of a man standing at her bedside – telling her she
is damned and must die
An individual’s hallucinations may be consistent with their delusions
Tactile Involve the perception that something is happening to the outside of the
person’s body
E.g., bugs are crawling up one’s back
Somatic Involve the perception that something is happening inside the person’s body
E.g., worms are eating one’s intestines
Often very frightening
Disorganized Thought and Speech
The disorganized thinking of people with SZ is often referred to as a formal thought
disorder
One of the most common forms of disorganization in SZ:
- A tendency to slip from one topic to a seemingly unrelated topic with little
coherent transition – referred to as loose associations or derailment
Other forms include:
1) Word Salad – speech that is so disorganized as to be totally incoherent to the listener
2) Neologisms – making up words that mean something only to the person themselves
3) Clangs – making associations between words based on the sounds of the words –
rather than on the content
4) Repeating the same word or statement over and over again
5) Answering questions with unrelated – or barely related – comments
Men with SZ – tend to show more severe deficits in language than do women with SZ
- Possibly because language is controlled more bilaterally in women than in
men
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