PSYC10004 Lecture Notes - Lecture 30: Stimulant Psychosis, Schizoaffective Disorder, Delusional Disorder
4. Psychosis – Schizophrenia
psychosis: a uella te eaig out of touh ith ealit
Can refer to variety of clusters of symptoms:
• Organic presentations like dementia
• Substance use: amphetamine psychosis
At the disorder level, psychosis refers to a group of disorders distinguished from one another in
terms of:
• Symptom configuration: (eg. delusional disorder vs schizophrenia)
o Non-bizarre vs bizarre delusion
• Duration:
o < or > than 6 months
• Relative pervasiveness: in terms of both duration and clinical picture of psychotic symptoms
vs affective symptoms (eg. bipolar disorder and schizoaffective disorder). What is the core?
Schizophrenia
Schizophrenia: efes to split idedess o a id tued asude
• Involves disruption in various aspects of perceiving, thinking, feeling and behaviour
• Phenomena associated with schizophrenia classified into two major groups: positive
symptoms & negative symptoms
Positive symptoms: additive to normal experience
• Hallucinations: a percept in the absence of environmental stimuli.
o Hallucinations can occur any sensory modality, auditory most common, then visual
• Delusions: a false elief, oth izae ad o-izae
o Persecutory (people are out to get you, eg. CIA), ideas (delusions) of reference,
grandiose (plus religious), somatic delusions, passivity phenomena (thought
insertion, thought withdrawal, thought broadcasting, delusions of control, mind
reading)
• Positive though disorder: involves of a range of a abnormalities in cognition largely
expressed through speech
o Clanging: speech pattern based on phonological association rather than semantic or
syntactic
o Circumstantiality: speech that includes unnecessary or irrelevant detail. Goal is
eventually reached
o Flight of ideas: sequence of loosely associated concepts are articulated. Sometimes
rapidly changing from topic to topic.
o Derailment: speech train steers off-topic to unrelated things.
o Incoherence: word salad. Incomprehensible speech.
o Pressure of speech: excessive spontaneous speech production and rapid rate.
Difficult to interrupt.
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Negative symptoms: deficit in normal function
• avolition: lack of motivation to achieve goals
• alogia (negative thought disorder): includes poverty of speech; less speech than normal,
poverty of content of speech, vague
• anhedonia: inability to experience pleasure
• affective flattening: dulled emotional expression
• inattention: disturbance in selective attention
• Other symptoms:
o Catatonia: immobility, waxy flexibility, excitement
o Incongruent or inappropriate affect: display incongruent ith pesos eotio o
inappropriate to context
o Bizarre behaviour: no rational basis
Diagnostic Criteria for Schizophrenia
A. Two or more of the following for a
significant portion of time for a 1-month
period:
• Delusion
• Hallucination
• Disorganised speech
• Grossly disorganised or catatonic
behaviour
• Negative symptoms
B. For a significant proportion of time since
onset, disturbance in functioning
C. Continuous signs of disturbance for at least
6 months, with at least one month of active
symptoms
D. Schizoaffective disorder/Bipolar disorder
No mania/mood disturbance or only
briefly
E. rule out substance or medical condition
Specify if:
• First episode, currently in:
o Acute episode, partial or full remission
• Multiple episodes, currently in:
o Acute episode, partial or full remission
• Continuous
• Also, severity of primary symptoms
Facts and Figures
• Prevalee of shizopheia ≈% oldwide with some variations in certain regions
• Sex ratio 1:1, males have earlier onset in later teens to eal s
• Carries significant disability and handicap in many domains of functioning
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History of Schizophrenia
• Morel thought schizophrenia was early onset deetia deee peoe
• Kaepeli deetia paeo, refined and more formal, emphasised early onset and
deteriorating course, differentiated from bipolar disorder/etc.
• Bleule shizopheia, oade defiitio, disageed ith Kaepelin that it was an early
deterioration course of early onset dementia, emphasised fracturing of thoughts, changed
the name to decrease stigma
• “heide ephasised fist ak sptos and made the diagnosis on cross section
(deemed duration criteria unecessary)
o 11 first rank symptoms: heaig oes oie aloud, halluiato oies talkig,
uig oeta, soati halluiatios, thought ithdaal, though
insertion, though broadcasting, delusional perception (ideas of reference), made
feelings, made actions, made impulses
o probles with Scheider’s approach: symptoms not specific to schizophrenia,
found in bipolar disorder too
• DSM-III (1980) and successors emphasise narrow (Neo-Kraepelinian) view of schizophrenia
o Exclusion and inclusion rules and duration criteria
o Must interfere with life domain functioning
• Patik MGo late s – present)
o Over-focus on chronic samples who are only representative of poor outcome
patients and are contaminated by institutionalisation, medication side-effects, etc.
o Perhaps we have biased view of disorder as a result, especially in terms of outcome
o Need to prospectively study first-episode patients and prodromal patiens
• ‘ihad Betall s – present)
o Need to study psychotic symptoms individually, not schizophrenia as a conduct
Outcomes of Schizophrenia
• Associated with very poor prognosis
o Partly because chronic populations have been studied
• Kapelis oigial ok foused o hospitalised populatios
o Know that he misdiagnosed and included patients with organic disorders
• Eugen Bleuler later noted that members with good prognosis were often lost to follow-up or
discharged leaving chronic unremitted patients in hospital
• Cliicia’s illusio: that who clinicians see in hospital are representative of patients with
that diagnosis
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Document Summary
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