Download Psychosis - Santa Barbara Therapist

Psychosis
Schizophrenia and Related
Disorders
Schizophrenia
• A hx of acute psychosis with
delusions, hallucinations,
disorganized speech, catatonia,
grossly disorganized behavior, or flat
affect
• Chronic deterioration of functioning
• Duration more than 6 months
• Absence of concurrent mood
disorder, substance abuse, or
medical condition
Schizophrenia Criteria
• Two or more for most of at least 1 months time
• Delusions-often bizarre and mood-incongruent
• Hallucinations
• Disorganized speech-incoherence, frequent
derailment, loose arrangements, tangentiality,
circumstantiality, illogical thinking, poverty of
content, unable to filter relevant from irrelevant
material, punning without humor, making up words
(neologisms)
• Disorganized or catatonic behavior
• Negative symptoms- what is missing (flat affect or
inappropriate, alogia-few or no words or avolition-lack
of ability to initiate and persist in goal acted activity)
Schizophrenic
Presentation
• Have difficulties separating
what is internal vs. what is
external
• Magical thinking
Course
• Manifests in adolescents or early
adulthood-abruptly or slowly
• Promodal- symptoms prior to acute
episode
• Residual- symptoms following the episode
• During both patients seem flat and burnt
out
• Early on: active symptoms and
hospitalizations. Later, less psychotic
symptoms, but more apathy, low energy,
social withdrawal, and low tolerence for
stress
Course
• Can function in the community
• May have depression after psychotic
episode and this is the most
dangerous time for suicide
• Decreased sleep, energy and mood
tend to precipitate a psychotic break
• Recovery is NOT related to severity
of psychosis
Subtypes
• Disorganized-marked incoherence with flat, silly or
inappropriate affect. Early onset, poor premorbid
functioning, severe social impairment, and chronic
course
• Catatonic-psychomotor disturbances. Sudden
onset, better prognosis, respond to ECT
• Paranoid- persecutory or grandiose delusions or
hallucinations. Unfocused, angry, argumentative,
violent, anxious. Onset later in life, interferes less
with social functioning, more stable course. Can
be contained delusions
Subtypes
• Undifferentiated- Don’t fit the
other subtypes and are actively
psychotic
• Residual type-No longer an
active episode, but some
symptoms continue
Specifiers
• Episodic with interepisode residual
symptoms. Can add with prominent
negattive symptoms
• Episodic with no interepisode
residual symptoms
• Continuous. Can add with prominent
negative symptoms
• Single episode in partial remission
• Single episode in full remission
• Other or unspecified pattern
Etiology
• Brain chemistry- Dopamine
• Biology produces schizophrenia,
environment determines if it is
expressed and how
• Is Genetic
Schizophrenic vs Other
Disorders
• Between psychotic episodes,
schizophrenics do not completely
recover form the psychosis (may still
hear voices) with other conditions
like mood disorders people usually
have remissions
• Anxiety and obsessives know their
“delusions” are silly
Treatment
• Not to cure, but to improve quality of
life
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Minimize symptoms
Prevent suicide
Avert relapse
Improve self-esteem
Improve functioning
Reduce pain of relatives
Educate family
Treatment
• Antipsychotics
• Tardive Dyskinesia
Therapy
Support only, stressing reality testing and
reassurance: since poor reality testing,
overwhelmed by too much stimuli, and short
attention span.
Identify stressors and help avoid and cope better
with them
Involve family
Treatment
• Medication Compliance
• Aftercare compliance
• Resources (housing, income,
self-care
• Increase socialization and
support
• Help family to provide more
supportive environment
Schizophreniform
• Same as Schizophrenia EXCEPT:
• Time Frame (at least one month,
less than 6 months)
• Functional Impairment is not
required
Schizophreniform
Specifiers
• With good Prognostic Features
• (2) Onset of Psychosis w/in 4 wks of
change in B or Func
• Confusion at peak of episode
• Good premorbid functioning
• Absence of flat affect
• Without good Prognostic Features
• Provisional-If under 6 months and
active
Schizoaffective Disorder
• Schizophrenia with mood disorder
(MD-2wks, Mania, or Mixed 1 wk)
and
• 2 wks of psychosis w/out prominent
mood disorder symptoms
and
• Mood is present during most of
disorder
Schizoaffective Disorder
• Bipolar Type
• Depressive Type
• Prognosis: Better than
Schizophrenia, worse than
mood disorder (precipitating
stress = better prognosis)
Delusional Disorder
• At least one nonbizarre delusion
lasting at least 1 month
• Not dx if cl has ever met criteria for
Schizophrenia
• Hallucinations are not prominent and
relate to delusion
• Apart from delusions, Psychological
functioning is intact
• Not due to as mood disorder
Delusional Disorder
Subtypes-Based on
Delusional Theme
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Erotomanic- YOU LOVE ME
Grandiose- I’M GREAT
Jealous- YOU’RE CHEATING
Persecutory- YOU’RE OUT TO GET
ME
• Somatic- I STINK (or other body
functions)
• Mixed
• Unspecified
Brief Psychotic Disorder
• One day to one month w/ at
least one positive psychotic
symptom
• Subtypes
• With Marked Stressors
• W/out Marked stressors
• With Postpartum Onset (w/in 4
wks)
Shared Psychotic
Disorder
• Catch a delusion (in whole or in
part) from another person with
a Psychotic Disorder
Other Psychotic
Disorders
• Due to a general medical
condition
• Substance Induced
• NOS