Definition

Psychosis is simply impairment in reality testing.

What is reality testing?

Reality testing story…..woke up dead.

Reality Testing

Refers to an individual’s ability to discern, perceive, appreciateor “test” the qualities of their surroundings….

Psychotic Disorders

Schizophrenia

Schizoaffective Disorder

Delusional Disorder

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

Schizophrenia

A neurobiological illness that impairs:

perceptions

thinking

language

emotions

social interactions

Demographics

Males = Females

Onset: Males 15 - 25 Females 25 - 35

Precipitators: Neurobiology Genetics Environment

Prognosis: poor

Positive SymptomsType I Schizophrenia

Hallucinations Odd SpeechNeologisms

Delusions Word SaladPerseverationClang Associations

Thought Disorder EcholaliaParanoiaIdeas of Reference Odd BehaviorLoose Associations Agitation/AggressionThought Broadcasting CatatoniaThought Insertion RegressionConcrete Thinking Stereotypy

Schizophrenia

HallucinationsAuditoryVisual

Delusions: Firm, fixed, false beliefGrandeurPersecutionIdeas of ReferenceSelf-accusationInfidelityParanoid

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.

Schizophrenia

Agitation/Aggression: constant movement, irritability, confrontation

Catatonia: motor abnormalitiesCatalepsy: constantly maintained immobile positionExcited: agitated purposeless motor activity w/o causeStupor: marked slowed activity - immobile - unawareRigidity: rigid posture - resists all attempts to be movedPosturing: voluntary assumption of position - long periodsCerea flexibilitas: person can be molded into positionNegativism: motiveless resistance to all attempts to move

Regression: may assume and maintain fetal position

Stereotypy: repetitive fixed pattern of physical action or speech

Negative SymptomsType 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

SchizophreniaSchizophrenia can develop in children.

Drug and/or alcohol abuse is common among schizophrenics.

Psychotherapy can help them cope with life events such as losinga 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.

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% chanceof 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.

SchizophreniaPeople born between February and April are more likely to developschizophrenia.

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 ifthey are in treatment. Research in Germany showed that 62% startedbefore or in the month of onset.

Schizophrenics show less prefrontal cortex activity than normals. They also have less grey matter.

SchizophreniaPeople with schizophrenia have less grey matter than normals.

Schizoaffective DisorderHas 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 orMixed and/or a Depressive episode with his/her psychotic sx.

Depressive type is where the patient has only the symptoms of aMajor 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

Delusional (Paranoid) DisorderNonbizarre 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 meGrandiose: inflated self worth, power, knowledge, identy

or special relationship with God or a famous person.

Jealous: belief that one’s sexual partner is unfaithfulPersecutory: 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

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

Dissociative Disorders

Depersonalization Disorder

Dissociative Amnesia

Dissociative Fugue

Dissociative Identity Disorder (formerly Multiple Personality DO)

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

Dissociative Amnesia

Inability to recall important personal information

Information is frequently traumatic in nature

Sub categories:

Generalized amnesia

Localized amnesia

Selective amnesia

Dissociative Fugue

Sudden, unexpected travel away from usual surroundingscoupled with amnesia of former life

Usually time-limited

Person suddenly remembers who they are and becomes amnesicfor the time away

Also follows traumatic event (?)

Dissociative Identity Disorder

Splitting of personality into two or more separate anddistinct 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