Psychosis con’t

Schizophrenia

1. Diagnosis
   1. Atleast two of the following: Delusions, hallucinations, disorganized speech, grossly disorganized behavior, negative symptoms
   2. Impairment in functioning
   3. Atleast six months of symptoms, but acute symptoms for atleast one month
2. Additional Diagnositic issues
   1. Prodromal phase (before): Eccentric, bizzar, but not schizophrenic
   2. Residual symptoms (after): odd, eccentricity, none of the acute symptoms
3. Schizophreniform -> more than one month, less than six
4. Brief psychotic disorder -> more than a day, less than a month
5. Schizoaffective disorder -> schizophrenia and a mood disorder (take your pick)
   1. Meet criteria for mood disorder
   2. Psychotic symptoms in absence of mood symptoms
6. Prognosis -> not great (repeat hospitalizations), after 5-6 years symptoms decrease
7. Role of genes
   1. Diathesis stress model
   2. Communication deviance -> vague, uninterpratable, fragmented
   3. Expressed emotion
8. Statistics
   1. With one parent: 13%
   2. 63% with have no relatives who have had
9. Dopamine Hypothesis
   1. Initial Clues
      1. Thorazine -> reduces dop, reduce acute symptoms
      2. Amphetamines -> increase dop, cause symptoms
      3. Increasing dopamine for parkinson’s -> can cause pyschosis
   2. Explanation of link
      1. Dopamine seems to regulate your ability to pay attention
      2. too much causes Aberrent salience
   3. Where does it come from?
      1. Over production
      2. too little reuptake
      3. not enough deactivation
      4. increased sensitivity
   4. Did spinal tap to find evidence for excess dopamine, which there wasn’t
   5. Back to sensitivity -> presence of D2 receptor (110% more than non-schizophrenic patients)
      1. Could be due to medication use though…
   6. BRAIN SCANS
      1. No evidence for increased sensitivity
   7. Glutamate
      1. PCP blocks Glutamate receptors and causes psychosis, connection?
      2. ketamine -> same thing, but no psychosis in kids, only adults
      3. Reduced functioning of NDMA receptors? (which are sensitive to glutamate)
      4. Reduced functioning also causes Brain Damage (possibly explaining negative symptoms)
   8. Link?
      1. Dopamine inhibits the release of Glutamate (which is why increase causes psychotic symptoms, but schizophrenics don’t have extra dopamine
10. History
    1. 1st generation neuroleptics -> thorazine, haldal
       1. Not great
       2. Akinesia
       3. Akathesis
    2. 2nd generation -> closopene
       1. fewer side effects
       2. wider than just d2 receptors
       3. help with some negative symptoms
       4. still have fatal side effects

Somatoform and Dissociative Disorders

1. Case study: Vertigo
   1. Attacks of dizzieness -> with slight nausia
   2. Every day at 4pm
   3. Husband -> tyrant
   4. Dreaded his arrival
   5. But she’s not faking it
2. Somatoform is a real physiological symptom, with psychological origin
3. Psychosomatic: psychological factors contribute
4. Malingering: deliberate faking to avoid unpleasantness
5. Factitious: deliberately faking to get medical attention (munchausen’s)
6. Somatoform
   1. Symptoms are real
   2. How do you know?
   3. Conversion Disorder -> loss of function in part of body
      1. Testing for conversion paralysis
         1. Drop hand on face (won’t catch with other hand if paralized)
         2. Muscil atrophy (won’t atrophy with with somatoform)
         3. Pin prick (won’t move, but heart rate will increase with somatoform, but not paralysis)
         4. Blindness (eye will follow mirror)
         5. Aphonia (somatoform will cough, if they really have it they won’t, same for crying)
         6. Symptoms will often breifly disapear as you wake up
      2. Treatment
         1. Find what’s causing them stress
   4. Somatization Disorder
      1. Symptoms
         1. Pain (4 areas)
         2. 2 GastroIntestinal
         3. 1 sexual disorder (medical)
         4. 1 neurological
      2. Cultural Differences (schizophrenia is better in non-industrialized, but Somatization is worse)
         1. We’re more open about saying things like stressed out
      3. Grand parents are more likely to somatizise
         1. Less able to express emoations
      4. Family influences -> runs in families, but not genetic
         1. Parents who somatizise neglect children
         2. causes children to model their behavior as attention seeking
   5. Hypochondriasis
      1. Worrying about having a serious disease
      2. Tend to seek help immediately
      3. Dr. Shopping
      4. Tend to focus on one area of body
      5. Disfunctional beliefs about illness (thinking its more common than it is)
   6. Dissociation
      1. Active consciousness: plans, desires, voluntary
      2. Receptive consciousness: hidden observer