Clinical Psychology II
Psychotic Disorders
Formally: Disruption in the experience of reality/reality testing
DSM does not enter the debate on what is ‘psychotic’, but explicitly
chooses to define psychosis in terms of symptoms (significantly broader
than ‘reality testing’)
- They are subdivided in different ways:
o In all models: Positive (P) and Negative (N)
- Hallucinations (P): Hallucinations are perception-like experiences
which occur without an external stimulus
o Lifelike, full force and impact of normal perceptions, can occur
in all modalities (most common: auditory)
o In some subcultures, hallucinations are considered normal
(religious) experiences
o Audiovisual hallucinations:
Children around 8 years: +/- 9%
Generally, don’t persist: 76% no longer at 12/13 years
old
General population: 5%-28%
o Auditory hallucinations brain areas: Greater activity in
Broca and Wernicke’s area (probably due to a connection
problem between frontal lobe and the areas)
o Imaginary friends: Children 5-12 years old (46%)
- Incidence rate of psychotic experiences for every individual, 2 will
report new onset PE’s in a given year (highest in adolescents: 5 per
100 people each year, lowest for older adults: 1 per 100)
o About 30% of persons who experience PE’s will report a
second PE each year
- Delusions (P): Beliefs/convictions which conflicts with reality
o Complex: What is the line between delusion and belief?
o DSM-5: ‘… are fixed beliefs that are not amenable to change in
light of conflicting evidence’
They are deemed bizarre if they are clearly
implausible and not understandable to same-culture
peers and do not derive from ordinary life experiences
Bizarre vs non-bizarre (very hard to distinguish)
o Types:
Most common:
Persecutory (one is being targeted, hunted, spied
on etc.)
Referential (belief that neutral or irrelevant
stimuli in the environment are somehow directed
to or have special significance for the individual)
Less often:
Somatic (body experiences)
o E.g., bugs under the skin
, Grandiosity (exaggerated beliefs about one’s own
importance, ability etc.)
Erotomanic (‘celebrity X is in love with me’)
Nihilistic (‘impending catastrophe is likely to
occur’)
- Negative symptoms (N):
o Common:
Reduced expressivity (blunted affect)
Only revers to outward expression (not inward)
Avolition: Reduces self-motivated, goal-oriented
activities
o Less common:
Alogia: Reduced speech production
Anhedonia: Reduced enjoyment
Consummatory pleasure (amount of pleasure
experienced)
Anticipatory pleasure (amount of expected
pleasure)
A-sociality: Reduced interest in social activities
- Disorganized symptoms:
o Disorganized speech
Loose associations (derailment), where they can
have a conversation but are unable to stick to one topic
which makes it seem like ‘rambling’
o Severely disorganized or catatonic behavior: A set of
symptoms characterized by disturbances in movement and
behavior (catatonic is when they keep their limbs in a certain
posture for a long time)
- “Other symptoms”
o Anosognosia: Reduced insight into illness
o Disrupted self-experience
o Social cognition/metacognition/mentalizing
E.g., abilities to understand others, and the social world
o Different constructs all point to structural, and important,
deficits in social cognition (and neurocognition), jumping to
conclusions
Schizophrenia:
“Peak” men: early-mid
20s
“Peak” women: late 20s
12x more likely to die to
suicide
Schizoaffective disorder: Schizoaffective disorder is characterized by a
combination of symptoms of schizophrenia, such as hallucinations,
,delusions, disorganized thinking, or negative symptoms, along with
symptoms of a mood disorder, such as depression or mania
- Functioning is not markedly impaired, and behavior is not
obviously bizarre or odd
Delusional disorder: Characterized by the presence of one or more non-
bizarre delusions that persist for at least one month or longer
- Difference between delusional disorder and OCD/BDD:
o OCD/BDD fits better even if the belief of catastrophe/body
experience is extremely solidified, and there is anosognosia
- With mood disorders: Like schizoaffective disorder, symptoms of
mood have to be relatively short compared to symptoms of
delusional disorder
Epidemiology: (schizophrenia)
- Incidence (how many people get the illness per year): Around 15
new cases per 100.000 persons
- Prevalence (how many people have the disorder currently): 0,7-1%
(estimate)
Overview:
Diagnostics: classification
- A lot of psychiatrists confirm a variant of the praecox-Gefuhl
- Careful with: Differentiating between psychotic episode (or
psychosis) from psychotic disorder
MINI-PLUS: Structured interview tool
- It typically consists of a series of structured questions aimed at
eliciting specific symptoms and behaviors related to each disorder.
Based on the responses provided by the individual being assessed,
the interviewer can determine whether the diagnostic criteria for a
particular disorder are met
, Etiology:
Biological/neurological perspective:
- Strong genetic component (results from familial high-risk study)
o Having a parent that is also bipolar, might also increase
chances
o Twin studies: Higher risk of schizophrenia between identical
twins (44,3%) than fraternal (12,08%)
o Adoption studies: Showed that the control babies that were
raised by a schizophrenia mom, did not get schizophrenia, but
children with biological moms with schizophrenia that were
raised by people without it, did have a chance of being
diagnosed with schizophrenia (10,6%)
- Gene DRD2 (controversial) may have something to do with it
(encodes a specific type of dopamine receptor D2
o Mutations in the CNV may have an influence on the
prevalence of schizophrenia (20%)
o GWAS is done with a large sample size to avoid ‘chance’ gene
variation
Did conclude that schizophrenia is very much polygenic
(it involves many genes
- Dopamine hypothesis (/theory)
o Medication implies that dopamine is at the foundation of
(positive) symptoms
But don’t/barely work on negative symptoms
o Might also be due that the interaction between stress and
other parts of the brain might trigger the excess release of
dopamine that can cause the positive effects
o They also use a drug (that works partially on DRD2) that works
on 5HT2 (serotonin receptor)
- Brain structures:
o Enlarged ventricles
o Prefrontal cortex (reduction in size and gray matter, but not
neurons but there may be a disruption between the neurons,
due to loss of dendritic spines)
Plays a role in behavior, speech etc. (so makes sense)
Schizophrenic people perform worse on test that
measure prefrontal areas of the brain
o Temporal cortex and subcortical brain regions
Hippocampus reduced (and smaller volume) and other
subcortical brain regions
This reduction and smaller volume is also seen by
people with PTSD, maybe schizophrenic people are
more reactive to stress
o Less connectivity in the brain
- Slightly more men than women
o Women have a little bit more symptoms, but social functioning
remains a bit better
