T11: Schizophrenia Spectrum and Other Psychotic Disorders

• Schizophrenia is a startling disorder characterized by a broad spectrum of cognitive and emotional dysfunctions including delusions and hallucinations, disorganized speech and behavior, and inappropriate emotions.
• Emil Kraepelin combined several symptoms of insanity that had usually been viewed as reflecting separate and distinct disorders: catatonia (alternating immobility and excited agitation), hebephrenia (silly and immature emotionality), and paranoia (delusions of grandeur or persecution). He thought symptoms shared similar underlying features and included them under the Latin term dementia praecox.
• A belief that would be seen by most members of a society as a misrepresentation of reality is called a disorder of thought content, or a delusion. It has been called as "the basic characteristics of madness."
• Delusion of Grandeur is a mistaken belief that the person is famous or powerful.
• Delusion of Persecution is a common delusion in people with schizophrenia is that others are “out to get them.”
• Capgras syndrome, in which the person believes someone he or she knows has been replaced by a double.
• Cotard’s syndrome, in which the person believes he is dead.
• Erotomania is when a person develops “stories” around some issue—for example, a famous person is in love with her as attempts to deal with and relieve anxiety and stress.
• The experience of sensory events without any input from the surrounding environment is called a hallucination.
• Auditory hallucination is the most common type of hallucination experienced by people with schizophrenia in which a person is hearing things that aren't there.
• Metacognition or “thinking about thinking” is a phrase to describe examining your own thoughts.
• The part of the brain that is most active during hallucinations was Broca's area which is known to be involve in speech production.
• Negative Symptoms of Schizophrenia:

  • Avolition - inability to initiate and persist in activities.
  • Alogia - refers to the relative absence of speech.
  • Anhedonia - presumed lack of pleasure.
  • Affective Flattening - they do not show emotion when you would normally expect them to.
  • Disorganized Speech - they jump from topic to topic, and at other times they talk illogically.
  • Inappropriate Affect and Disorganized Behavior - laughing or crying at improper times.
• Schizophreniform Disorder is when people experience the symptoms of schizophrenia for a few months only; they can usually resume normal lives. To meet the diagnostic criteria, it should include onset of psychotic symptoms within 4 weeks of the first noticeable change in usual behavior, confusion at the height of the psychotic episode, good premorbid (before the psychotic episode) social and occupational functioning, and the absence of blunted or flat affect.
• Schizoaffective Disorder are people who had symptoms of schizophrenia and who exhibited the characteristics of mood disorders (for example, depression or bipolar disorder) were lumped in the category of schizophrenia. To meet the diagnostic criteria, in addition to the presence of a mood disorder, delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms.
• Individuals with delusional disorder tend not to have flat affect, anhedonia, or other negative symptoms of schizophrenia; importantly, however, they may become socially isolated because they are suspicious of others. It is often long-standing, sometimes persisting over several years.
• Delusional Subtypes:

  • Erotomanic type - the irrational belief that one is loved by another person, usually of higher status.
  • Grandiose type - involves believing in one’s inflated worth, power, knowledge, identity, or special relationship to a deity or famous person.
  • Jealous type - believes the sexual partner is unfaithful.
  • Persecutory type - involves believing oneself (or someone close) is being malevolently treated in some way.
  • Somatic Delusions - the person feels afflicted by a physical defect or general medical condition.
• Shared Psychotic Disorder (folie a deux) in which an individual develops delusions simply as a result of a close relationship with a delusional individual.
• Brief Psychotic Disorder is characterized by the presence of one or more positive symptoms such as delusions, hallucinations, or disorganized speech or behavior lasting 1 month or less. It is often precipitated by extremely stressful situations.
• Attenuated Psychosis Syndrome are people who have some of the symptoms of schizophrenia but are aware of the troubling and bizarre nature of these symptoms.