Key Insights on Psychosis and Schizophrenia

Aug 30, 2024

Lecture Notes on Psychosis and Schizophrenia

Understanding Psychosis

  • Definition: An abnormal mental state where one cannot distinguish reality from unreality.
  • Broader Meaning: Includes delirium, dementia, etc.
  • Primary Psychosis: Not tied to any other condition; key in identifying schizophrenia.

Focus on Schizophrenia

Symptoms of Schizophrenia

  • Positive Symptoms: Present in schizophrenia, absent in most people.
  • Negative Symptoms: Absent in schizophrenia but present in most people.

Diagnostic Criteria (DSM)

Use mnemonic HDBS Network:

  • H: Hallucinations
  • D: Delusions
  • B: Disorganized Behavior
  • S: Disorganized Speech
  • N: Negative Symptoms

Positive Symptoms Explained

  • Hallucinations: Perceptions without a stimulus, mostly auditory in schizophrenia.
    • Auditory hallucinations: Vivid, critical voices perceived as external.
  • Delusions: Fixed false beliefs, often paranoid or persecutory.
    • Common delusions: Ideas of reference, thought broadcasting, insertion, withdrawal, control.
  • Disorganized Thought: Inferred from behavior and speech.
    • Speech: Clang associations, neologisms, echolalia, perseveration, word salad.
    • Behavior: Purposelessness, unpredictable actions.

Negative Symptoms (Five A's)

  • Affect: Blunted or flat emotional expression.
  • Ambivalence: Difficulty in decision making.
  • Alogia: Reduced speech communication.
  • Anhedonia: Inability to feel pleasure.
  • Asociality: Lack of social interest.

Diagnosis Criteria

  • 2 or more symptoms for at least 6 months.
  • Mnemonic: 2-4-6-afrenia

Epidemiology

  • Prevalence: 0.5% to 1%, more in men.
  • Onset: Early adulthood, earlier in men.
  • Outcomes: Poor, with high recurrence and reduced life expectancy.

Risk Factors

  • Prodrome State: Early signs include social withdrawal, poor school performance.
  • First Break: Triggers lifelong pattern of exacerbations and functional deterioration.

Treatment

  • Medications: Antipsychotics block dopamine; effective for positive symptoms.
  • Psychotherapy: CBT for controlling symptoms, not enough alone.
  • Hospitalization: May be needed for severe cases.

Related Disorders

  • Brief Psychotic Disorder: Symptoms <1 month.
  • Schizophreniform Disorder: Symptoms 1-6 months.
  • Delusional Disorder: Delusions without other schizophrenia symptoms; impacts life.

Conclusion

  • Further learning resources: Videos and books available for deeper understanding.

Additional Resources

  • Videos: Psychopharmacology series, patient perspective.
  • Book: "Memorable Psychiatry" available on Amazon.