Psychotic Disorders

2. Definition
Psychosis is simply impairment in reality testing.
What is reality testing?
Reality testing story…..woke up dead.

3. Reality Testing
Refers to an individual’s ability to discern, perceive, appreciate
or “test” the qualities of their surroundings….

4. Psychotic Disorders
Schizophrenia
Schizoaffective Disorder
Delusional Disorder

5. Schizophrenia
Affects about 1% of the population
50% of all mental health hospital admissions
Schizophrenics occupy roughly 25% of all hospital beds
35% - 50% of the homeless population

6. Schizophrenia
A neurobiological illness that impairs:
perceptions
thinking
language
emotions
social interactions

7. Demographics
Males = Females
Onset:
Males 15 - 25
Females 25 - 35
Precipitators:
Neurobiology
Genetics
Environment
Prognosis: poor

8. Positive Symptoms
Type I Schizophrenia
Hallucinations Odd Speech
Neologisms
Delusions Word Salad
Perseveration
Clang Associations
Thought Disorder Echolalia
Paranoia
Ideas of Reference Odd Behavior
Loose Associations Agitation/Aggression
Thought Broadcasting Catatonia
Thought Insertion Regression
Concrete Thinking Stereotypy

9. Schizophrenia
Hallucinations
Auditory
Visual
Delusions: Firm, fixed, false belief
Grandeur
Persecution
Ideas of Reference
Self-accusation
Infidelity
Paranoid

10. Schizophrenia
Neologisms: new words or condensations of words used in an
attempt to express a highly complex idea.
Word Salad: an incoherent mixture of words & phrases
Perseveration: pathological repetition of the same response to
different questions.
Clang Associations: using words similar in sound, but not in
meaning.
Echolalia: repeating of words or phrases of one person by another.

11. Schizophrenia
Agitation/Aggression: constant movement, irritability, confrontation
Catatonia: motor abnormalities
Catalepsy: constantly maintained immobile position
Excited: agitated purposeless motor activity w/o cause
Stupor: marked slowed activity - immobile - unaware
Rigidity: rigid posture - resists all attempts to be moved
Posturing: voluntary assumption of position - long periods
Cerea flexibilitas: person can be molded into position
Negativism: motiveless resistance to all attempts to move
Regression: may assume and maintain fetal position
Stereotypy: repetitive fixed pattern of physical action or speech

12. Negative Symptoms
Type II Schizophrenia
Flat, Blunt, or Restricted Affect: lack vocal inflection, paucity of
expressive gestures, poor eye contact, decreased movement,
or unchanging facial expression.
Alogia: poverty of speech
Asociality: lack of social interaction
Anhedonia: lack of interest in activities that formerly brought
pleasure
Avolition:lack of goal directed motivation
Inattention: inwardly focused - not aware of surroundings or activity

13. Schizophrenia
Schizophrenia can develop in children.
Drug and/or alcohol abuse is common among schizophrenics.
Psychotherapy can help them cope with life events such as losing
a job or getting a divorce.
Violence is rare with schizophrenics, but does occur.
Schizophrenics can lead relatively normal lives today.
Psychotherapy and drug therapy can prevent relapse.
Taking medication will be life-long.
Physical exercise has been shown to alleviate symptoms.

14. Schizophrenia
Antipsychotic drugs help alleviate the negative symptoms.
Early accurate diagnosis is critical to a more positive outcome.
Schizophrenia can be inherited.
A child with one schizophrenic parent has a 12.5% chance
of contracting the disease.
Contracting the disease seems to be a combination of
genetic predisposition and environmental factors.
Up to 60% of schizophrenics have no family history of it.
A structured and predictable environment helps them cope.
A child who develops schizophrenia is likely to have a father over 50.
Has to do with number of time undeveloped sperm is divided.
A 40 year-old man’s sperm has divided 660 times.
More likely to be damaged.

15. Schizophrenia
People born between February and April are more likely to develop
schizophrenia.
In Europe and North America roughly 10% more babies
born in those months go on to develop schizophrenia.
This is more than any other three month period.
Cognitive Behavioral Therapy is helpful for schizophrenics with
delusions. It teaches them to challenge the rationality of the voices.
Nobody really knows the cause of schizophrenia. Lots of theories.
Heavy use of alcohol seems to trigger psychotic symptoms, even if
they are in treatment. Research in Germany showed that 62% started
before or in the month of onset.
Schizophrenics show less prefrontal cortex activity than normals.
They also have less grey matter.

16. Schizophrenia
People with schizophrenia have less grey matter than normals.

18. Schizoaffective Disorder
Has symptoms of both Schizophrenia and a major mood disorder
at the same time. Patients with Schizoaffective Disorder experience
a combination of symptoms associated with both diseases,
but do not meet the full criteria for either.
Two types of Schizoaffective disorder:
Bipolar type is where the patient has symptoms of a Manic or
Mixed and/or a Depressive episode with his/her psychotic sx.
Depressive type is where the patient has only the symptoms of a
Major Depressive Disorder with his/her psychotic symptoms.
Symptoms include: auditory/visual hallucinations, suspiciousness,
unusual thought content, disorganization, emotional withdrawal,
blunted affect, inability to express pleasure,and attention difficulties

19. Delusional (Paranoid) Disorder
Nonbizarre delusions that involve situations occuring in real life,
such as being followed, poisoned, infected, loved at a distance,
having a disease, or being deceived by one’s spouse/lover.
Subtypes:
Erotomanic: someone of higher status loves me
Grandiose: inflated self worth, power, knowledge, identy
or special relationship with God or a famous
person.
Jealous: belief that one’s sexual partner is unfaithful
Persecutory: belief that you are being wrongly treated in
some way - often take their complaints to legal
authorities
Somatic: belief that you have some physical defect,
disorder, or disease
Unspecified: doesn’t fit any of the above

20. Shared Psychotic Disorder
This psychotic mental disorder is diagnosed when delusions
develop in an individual involved in a close relationship with
another individual already afflicted with delusions arising out of
a different psychosis such as Schizophrenia, Delusional Disorder
or Major Depression with psychotic features.
Delusional (Paranoid) Disorder

21. Dissociative Disorders
Depersonalization Disorder
Dissociative Amnesia
Dissociative Fugue
Dissociative Identity Disorder (formerly Multiple Personality DO)

22. Depersonalization
Person feels a change in sense of self - feels mechanical,
dreamy, or detached from their body
Temporary state
Usually follows a traumatic event, but is often present during
panic attacks

23. Dissociative Amnesia
Inability to recall important personal information
Information is frequently traumatic in nature
Sub categories:
Generalized amnesia
Localized amnesia
Selective amnesia

24. Dissociative Fugue
Sudden, unexpected travel away from usual surroundings
coupled with amnesia of former life
Usually time-limited
Person suddenly remembers who they are and becomes amnesic
for the time away
Also follows traumatic event (?)

25. Dissociative Identity Disorder
Splitting of personality into two or more separate and
distinct personalities
“Primary” personality usually not consciously aware of others
“Alternates” may be very ill (suicidal) or extremely different
from the primary
Caused by extreme trauma in childhood