Psychosis

The capacity to perceive, process, and respond to environmental stimuli is impaired Three mental disorders involve psychosis: –Mood Disorders –The Schizophrenias –Delusional Disorder (Paranoia)

Schizophrenia The origin of the concept: –Dementia Praecox (Morel, Kraepelin) –Schizophrenia (Bleuler)

“The integrating mental picture in my personality was taken away and smashed to bits, leaving me like agitated hamburger distributed infinitely throughout the universe” »Quoted by Mendel

Clinical Presentation Positive Symptoms: –Something has been added to normal behaviour e.g. marked emotional turmoil, motor agitation, delusions and hallucinations Negative Symptoms: –Something has been taken away from normal behaviour e.g. emotional expressiveness, communicative speech, and reactivity

Clinical Presentation Type I schizophrenia: –Characterized by positive symptoms and tends to respond to medication Type II schizophrenia: –Characterized by negative symptoms, associated with structural brain abnormalities, and does not respond as well to medication

Clinical Presentation Disorganized: –Characterized by chaotic and seemingly directionless speech and behaviour Non-disorganized: –Less disorganization

Disturbance of Associative Linking Formal Thought Disorder Cognitive slippage, derailment, loosening of associations, or incoherence Blocking Neologisms/clanging/word salad

“My thoughts get all jumbled up. I start thinking or talking about something but I never get there. Instead I wander off in the wrong direction and get caught up with all sorts of different things that may be connected with the things I want to say but in a way I can’t explain. People listening to me get more lost than I do.”

Disturbance of Thought Content Delusions Common Delusions: –Persecution –Control (influence) –Reference –Grandeur –Sin and Guilt –Hypochondriacal –Nihilistic

Disruption of Perception Unable to sort out and process sensory information Breakdown of selective attention Hallucinations

“Schizophrenic behaviour is a special strategy that a person invents in order to live in an unlivable situation.” »R. D. Lang

Emotional Dysfunction Inappropriate emotion Anhedonia, blunting expression – appears to be a deficit of expressiveness rather than experience

Confused Sense of Self Delusional identity Delusional boundaries between self and not self Delusions regarding agency

Disrupted Volition Disrupted goal-directed activity Deterioration from previous daily functioning Frontal lobes and executive functioning

Retreat to an Inner World Disengagement from the external world In extreme cases can be seen as a deliberate attempt to avoid being overwhelmed Rich elaboration of inner world (fantastic ideas, creation of strange beings)

Disturbed Motor Behaviour Excited hyperactivity Marked clumsiness Decrease in movement

Classifying Schizophrenia

Subtypes of Schizophrenia Catatonic Type Disorganized Type Paranoid Type Residual Type Undifferentiated Type

Catatonic Type Pronounced motor signs, either excited or slowed The slowed state can often look like a psychotic mood disorder Echolalia, Echopraxia Maintain postures May swing from hyperactivity to low activity (stupor)

Disorganized Type Usually occurs at an earlier stage More severe personality disintegration Hebephrenic Preoccupation with trivial, moral, philosophical issues Emotional distortion, bizarre, inappropriate expression Incoherent speech

Paranoid Type History of increasing suspiciousness and severe interpersonal difficulties Absurd, illogical, and often changing delusions – typically themes of persecution and grandeur Higher level of adaptive functioning