Schizophrenia Spectrum and Other Psychotic Disorders

ABNORMAL PSYCHOLOGY C-PSYM311A 1ST SEMESTER – FINALS ●​ M7: SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDERS A A1 ●​ KEY FEATURES THAT DEFINE THE PSYCHOTICS DISORDERS DELUSIONS Delusions are strong beliefs that a person holds even when there’s clear proof they’re not true. These beliefs don’t change, even when others try to correct them. ★​ There are different types of delusions: ➢​ Persecutory: Believing someone or a group wants to harm or harass you (most common type) ➢​ Referential: Thinking that random things—like gestures or comments—are secretly aimed at you ➢​ Grandiose: Believing you have amazing talents, wealth, or fame ➢​ Erotomanic: Believing someone is in love with you, even if it’s clearly not true ➢​ Thought withdrawal: Believing that someone or something is taking thoughts out of your head ➢​ Thought insertion: Believing that foreign thoughts are being placed into your mind ➢​ Delusions of control: Believing that your body or actions are being controlled by an outside force ★​ Individuals with schizophrenia spectrum disorders experience a variety of delusional themes: 1.​ 2.​ 3.​ 4.​ 5.​ 6.​ A2 ●​ ➢​ Nihilistic: Believing a huge disaster is about to happen ➢​ Somatic: Being overly worried about your health or body functions ●​ Bizarre delusions are strange beliefs that are clearly impossible and don’t make sense to others from the same culture. ➔​ Example: Believing someone secretly took out your organs and replaced them with someone else’s—without leaving any scars. ●​ PAGE 1 CREATED BY JEMS Delusions of Grandeur Delusions of Control Delusions of Thought Broadcasting Delusions of Persecution Delusions of Reference Delusions of Thought Withdrawal HALLUCINATIONS Hallucinations are experiences that feel real—like seeing, hearing, or feeling something—but there’s no actual thing causing them. They’re: ★​ Very clear and strong, just like normal senses ★​ Not something the person can control ★​ Can happen in any sense (hearing, seeing, smelling, etc.) ★​ But hearing voices or sounds (auditory hallucinations) is the most common type in schizophrenia. ●​ So it’s like the brain is creating a real-feeling experience without anything actually being there. ●​ According to Sue et al. (2016), hallucinations are experiences where a person senses something that isn’t really there. Nonbizarre delusions are false beliefs that could possibly happen in real life, but still aren’t true. ➔​ Example: Believing the police are watching you, even though there’s no real proof. Some bizarre delusions involve feeling like you’ve lost control over your own mind or body. These include: ABNORMAL PSYCHOLOGY C-PSYM311A ●​ 1ST SEMESTER – FINALS These can affect one sense or several senses at the same time, such as: ★​ Hearing sounds or voices (auditory) ★​ Seeing things that aren’t there (visual) ★​ Possession trance: Acting as if taken over by another identity or spirit ●​ These can look like disorganized speech, but they aren’t signs of psychosis unless the person also shows other clear symptoms, like hallucinations or delusions. ★​ Smelling strange odors (olfactory) ●​ Also, mild disorganized thinking or speech can happen in the early (prodromal) or recovery (residual) stages of schizophrenia. ●​ Cognitive symptoms in schizophrenia affect how a person thinks and processes information. These include: ★​ Feeling things on the skin (tactile) ★​ Tasting things without eating (gustatory) A3 ●​ DISORGANIZED THINKING (SPEECH) Disorganized thinking means a person’s thoughts are jumbled or hard to follow, and this shows up in how they talk. Examples include: ★​ Derailment or loose associations: Jumping from one topic to another without clear connection ★​ Tangentiality: Giving answers that are only slightly related—or not related at all—to the question ★​ Incoherence or “word salad”: Speaking in a way that’s so mixed up it’s almost impossible to understand, like random words thrown together ●​ It’s like their speech doesn’t follow a clear path, making it hard for others to keep up. ●​ Mildly disorganized speech is pretty common and doesn’t always mean there’s a mental disorder. ●​ For it to count as a symptom, it has to be so severe that it seriously affects the person’s ability to communicate clearly. ●​ Also, it can be hard to judge how bad the speech problem is if the person diagnosing it comes from a different language or culture than the person being examined—because what sounds “disorganized” might just be a difference in how people speak. ➢​ Some religious practices involve unusual speech, like: ★​ Glossolalia: Speaking in tongues—sounding like random or unknown words PAGE 2 CREATED BY JEMS ★​ Disorganized thinking, speech, and communication: Thoughts may be jumbled or hard to follow. ★​ Loosening of associations (cognitive slippage): Jumping from one idea to another without clear or logical connection. ★​ Trouble with attention and memory: Finding it hard to focus or remember things. ★​ Difficulty making decisions: Struggling to think clearly and choose between options. ●​ People with schizophrenia often have moderate to severe problems with thinking skills, especially when compared to those without the condition. This includes: ★​ Trouble focusing attention ★​ Difficulty understanding and processing information ★​ Struggling to make decisions based on new things they’ve learned ●​ A4 ●​ These thinking problems are part of what’s called poor executive functioning, which affects how someone plans, organizes, and responds to everyday situations. GROSSLY DISORGANIZED OR ABNORMAL MOTOR BEHAVIOR Grossly disorganized or abnormal motor behavior means a person moves or acts in ways that are unusual or hard to understand. This can look like: ABNORMAL PSYCHOLOGY C-PSYM311A 1ST SEMESTER – FINALS ★​ Childlike silliness (acting playful or goofy in inappropriate situations) ★​ Unpredictable agitation (sudden restlessness or anger) ●​ These behaviors can interfere with normal daily tasks, like getting dressed, cooking, or going to work—because the person struggles with goal-directed actions (doing things with a clear purpose). A.​ Catatonic behavior means a person shows very little response to their surroundings. It can include: ★​ Negativism: Refusing to follow instructions or do what’s asked ★​ Rigid or bizarre posture: Staying in strange positions for a long time ★​ Mutism and stupor: Not speaking or moving at all ●​ It’s like the person is frozen or shut off from the outside world, and it can be a serious symptom in some mental health conditions. B.​ Catatonic excitement is a type of catatonia where a person shows excessive, purposeless movement without a clear reason. ●​ 2.​ Withdrawn Catatonia is when a person becomes extremely unresponsive, even though they’re still aware of what’s happening around them. They may: ➔​ Stay in a stupor (not moving or reacting) ➔​ Show mutism (not speaking at all) ➔​ Hold strange or rigid postures for a long time ➔​ Refuse to move or change position, even when asked ●​ A5 Negative symptoms are a major reason why schizophrenia causes long-term problems in daily life. ●​ These symptoms involve a loss or reduction of normal functions, such as: ★​ ★​ ★​ ★​ Lack of motivation Reduced emotional expression Social withdrawal Poor speech or communication ●​ They’re called “negative” because something is missing—not added—compared to typical behavior. These symptoms are less common or less severe in other psychotic disorders, but in schizophrenia, they can seriously affect a person’s ability to work, connect with others, and live independently. 1.​ ➔​ Act silly, laugh loudly, or behave inappropriately ➔​ Sleep very little and seem like they’re always in motion ➔​ Lose control of their actions, which can sometimes lead to dangerous or violent behavior ●​ It’s a serious condition that needs medical attention because the person may be unable to keep themselves or others safe. PAGE 3 CREATED BY JEMS NEGATIVE SYMPTOMS ●​ It may include: Repetitive movements, staring, grimacing, or echoing others’ speech. Excited Catatonia is a severe form of catatonia where a person becomes extremely hyperactive and agitated. They may: ➔​ Talk or shout nonstop ➔​ Run or move constantly, sometimes until they collapse from exhaustion It’s like the person is frozen in place—silent, still, and disconnected from their surroundings. ➢​ Two negative symptoms prominent in schizophrenia: 1.​ are particularly Diminished Emotional Expression ➔​ The person shows less emotion in their face and voice. ➔​ They may avoid eye contact. ➔​ Their speech might sound flat or monotone. ➔​ They move less—especially their hands, head, or face—when talking. 2.​ Avolition ABNORMAL PSYCHOLOGY C-PSYM311A 1ST SEMESTER – FINALS ➔​ The person has low motivation to start or do things ➔​ They might sit for hours without doing much ➔​ They show little interest in work, hobbies, or social activities ●​ Negative symptoms in schizophrenia mean the person has trouble doing things that most people do naturally. This includes: ★​ Starting actions or conversations ★​ Showing emotions through facial expressions, voice, or gestures ★​ Feeling pleasure from things they used to enjoy ●​ These symptoms reflect a loss of normal abilities, making it harder for the person to connect with others or stay motivated in daily life. ★​ Jealous type: They believe their partner is cheating, even without real proof—often based on small, unrelated details (like messy clothes). ★​ Persecutory type: They feel targeted or attacked, believing others are spying, plotting, poisoning, or trying to ruin their goals. ★​ Somatic type: They’re convinced something is wrong with their body. ●​ Women are more likely to have erotomanic delusions—believing someone is secretly in love with them. ●​ Men tend to develop paranoid delusions, especially involving persecution (feeling targeted or conspired against). ➢​ Other than diminished emotional expression and avolition, the following are negative symptoms also: ★​ Shared Psychotic Delusion: This rare condition happens when someone close to a person with delusions starts to believe those delusions too. It’s more common in people who are socially isolated. ★​ Alogia: A lack of meaningful speech. ●​ The pattern generally involves a family member or partner acquiring the delusional belief from the dominant individual (with delusions). ●​ The dominant individual is often younger, highly suggestible, more passive, and has lower self-esteem ●​ The person who adopted the delusion often stops believing it once they’re no longer around the dominant individual. ★​ Asociality: Minimal relationships. interest ★​ Anhedonia: Reduced ability pleasure from positive events. to in social experience B DISORDERS IN THE SPECTRUM B1 DELUSIONAL DISORDER B.​ PREVALENCE OF DELUSIONAL DISORDER Delusional disorder means a person has strong, ongoing beliefs that aren’t true—but they don’t show other strange or unusual behaviors, except those directly tied to the delusion. ●​ Delusional disorder is rare, affecting about 0.2% of people over their lifetime (based on a Finnish study). ●​ The most common subtype is persecutory delusion—feeling targeted or conspired against. ●​ The jealous type (believing a partner is unfaithful) seems to happen more often in men. ●​ However, there are no major differences between men and women in how often delusional disorder occurs overall, or in the types of delusions they experience. ●​ A.​ SUBTYPES ★​ Erotomanic type: The person believes that someone is secretly in love with them—often someone famous or of higher status. ★​ Grandiose type: They’re convinced they have special talents, insights, or discoveries that make them important or superior. PAGE 4 CREATED BY JEMS ABNORMAL PSYCHOLOGY C-PSYM311A 1ST SEMESTER – FINALS C.​ DEVELOPMENT AND COURSE OF DELUSIONAL DISORDER ●​ The symptoms last at least one full day, but less than one month. ●​ People with delusional disorder usually have better overall functioning than those with schizophrenia. ●​ After the episode, the person usually goes back to normal and functions well again. ●​ ●​ The diagnosis is often stable, but in some cases, especially early on, it can develop into schizophrenia. Because the symptoms can be sudden and intense, doctors may: ➔​ About 1 in 3 people diagnosed within the first 1–3 months may later be diagnosed with schizophrenia. ➔​ If the delusional disorder lasts more than 6–12 months, it’s less likely to change into another diagnosis. ●​ Delusional disorder tends to run in families, especially those with a history of: ★​ Schizophrenia ★​ Schizotypal personality disorder ●​ B2 This means that genetics may play a role in increasing the risk of developing delusional disorder, especially if close relatives have related mental health conditions. ●​ Most people fully recover and return to their usual selves. ●​ If the symptoms don’t go away or last longer than a month, doctors may consider a different diagnosis, like schizophrenia. B.​ DEVELOPMENT AND COURSE ●​ It's a short-term mental health condition where a person suddenly experiences psychotic symptoms. These symptoms can include: ★​ Delusions: Believing things that aren’t true (e.g., thinking someone is out to get them) ★​ Hallucinations: Seeing or hearing things that aren’t really there ★​ Disorganized speech: Talking in a confused or jumbled way PAGE 5 CREATED BY JEMS It can begin in the teen years or early adulthood, but it can also happen at any age. On average, people experience it around their mid-30s. ➔​ Must go away completely within 1 month ➔​ The person should return to how they were before the episode ➔​ Sometimes, the symptoms only last a few days ●​ Even though people recover within a month, more than half may have another episode later (relapse) ●​ Still, most people do well in the long run, especially in terms of: BRIEF PSYCHOTIC DISORDER A.​ INTRODUCTION ●​ ➔​ Use antipsychotic medication to help reduce symptoms While it can affect younger people, it seems to be more common in older adults. D.​ RISK AND PROGNOSTIC FACTORS ●​ ➔​ Recommend hospital care to keep the person safe ★​ Social life (relationships, work, daily activities). ★​ Symptomatalogy B3 SCHIZOPHRENIFORM DISORDER A.​ INTRODUCTION ●​ Schizophreniform Disorder is a mental health condition where a person experiences psychotic symptoms (like hallucinations, delusions, or disorganized thinking). ABNORMAL PSYCHOLOGY C-PSYM311A 1ST SEMESTER – FINALS ●​ ●​ These symptoms last more than 1 month but less than 6 months. ●​ If the symptoms go away within 6 months, the person is officially diagnosed with schizophreniform disorder. ●​ ●​ But if the symptoms continue beyond 6 months, the diagnosis may change to schizophrenia. ➢​ People tend to recover better if: In lower-income countries, it may happen more often, especially in cases with better chances of recovery (called “good prognostic features”). In some of these places, it might be just as common as schizophrenia. C.​ DEVELOPMENT AND COURSE ●​ The way schizophreniform disorder develops is similar to schizophrenia. ➢​ When someone is first diagnosed (provisional), there are two possible outcomes: ★​ The symptoms start suddenly. 1.​ ★​ They were functioning well before the episode (e.g., socially, at work or school). ★​ They don’t show negative symptoms like lack of motivation, flat emotions, or social withdrawal. ●​ Like schizophrenia, this disorder can come with a high risk of suicide, especially if the person also feels depressed. ➢​ The diagnosis of schizophreniform disorder is made under two conditions: 1.​ Recovered within 1–6 months: If the person had psychotic symptoms for more than 1 month but less than 6 months, and they’ve already recovered, the diagnosis is schizophreniform disorder. 2.​ Still sick but not past 6 months yet: If the person still has symptoms but it’s been less than 6 months, doctors call it “schizophreniform disorder (provisional)” — meaning it’s temporary and not yet final. ●​ ●​ If the person gets better before 6 months, the diagnosis stays as schizophreniform disorder. ➔​ Their final diagnosis stays as schizophreniform disorder 2.​ The other two-thirds continue to have symptoms ➔​ Their diagnosis usually changes to schizophrenia or schizoaffective disorder B4 SCHIZOAFFECTIVE DISORDER A.​ INTRODUCTION ●​ Schizoaffective Disorder is a mental condition that combines two types of symptoms. symptoms (like hallucinations, ★​ Psychotic delusions, or disorganized thinking) — similar to schizophrenia. ★​ Mood symptoms — either depression or mania (extreme energy, mood, or behavior). ●​ These mood symptoms must be present for most of the time that the psychotic symptoms are happening. ●​ If the person has manic episodes, it’s called the bipolar subtype. If the symptoms continue beyond 6 months, the diagnosis is changed to schizophrenia. B.​ PREVALENCE About one-third of people recover within 6 months ●​ The number of people who get this disorder is similar across different cultures. ●​ If the person only has depressive episodes, it’s called the depressive subtype. ●​ In wealthy countries like the U.S., it’s rare—about five times less common than schizophrenia. ●​ People with depression or bipolar disorder can also have hallucinations or delusions, but: PAGE 6 CREATED BY JEMS ABNORMAL PSYCHOLOGY C-PSYM311A 1ST SEMESTER – FINALS ➔​ In mood disorders, psychotic symptoms only happen during mood episodes. ➔​ In schizoaffective disorder, psychotic symptoms can also appear when mood symptoms are not present. ➔​ Mood symptoms must be present for most of the illness, not just a “substantial” part like in older DSM-IV rules. ●​ B.​ PREVALENCE People with schizoaffective disorder tend to do better than those with schizophrenia, but not as well as those with mood disorders like depression or bipolar disorder. ●​ It’s less common than schizophrenia — only about one-third as frequent. D.​ RISK AND PROGNOSTIC ●​ In one study from Finland, about 0.3% of people were found to have it during their lifetime. ●​ It was more common in women than in men (based on older DSM-IV criteria). ➢​ The risk is also higher if a close relative has: The rate is expected to be lower now because the newer DSM-5 rules are stricter: ★​ Bipolar disorder, or ★​ Schizoaffective disorder itself ●​ ●​ If someone has schizophrenia, their close relatives (like parents or siblings) may have a higher chance of developing schizoaffective disorder. ➔​ Mood symptoms (like depression or mania) must be present for most of the illness, not just briefly. ●​ C.​ DEVELOPMENT AND COURSE ➢​ People with schizoaffective disorder often show higher scores for: ●​ Schizoaffective disorder usually begins in early adulthood, but it can start anytime — from teen years to old age. ●​ Some people are first diagnosed with another psychotic disorder, but later get diagnosed with schizoaffective disorder once their mood symptoms (like depression or mania) become clearer. ●​ Others are first diagnosed with a mood disorder, and only later show psychotic symptoms that lead to a schizoaffective diagnosis. ➢​ Over time, the diagnosis can shift again: ★​ Some people move from schizoaffective disorder to schizophrenia ★​ Fewer shift from schizoaffective disorder to a mood disorder ●​ This shift to schizophrenia is more common now because the DSM-5 rules are stricter: PAGE 7 CREATED BY JEMS Scientists use something called polygenic risk scores — these are like genetic “risk fingerprints.” ★​ Schizophrenia ★​ Bipolar disorder