Psychosis: Schizophrenia, Schizoaffective Disorder, Delusional Disorder, Hallucinations

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SKIP AHEAD:
0:25 – Psychosis Symptoms (Hallucinations, Delusions, Catatonia & Disorganized Speech)
3:21 – Psychosis in mood disorders
3:54 – Schizophrenia
6:06 – Schizophreniform & Brief Psychotic Disorder
6:34 – Schizoaffective
7:29 – Delusional Disorder
8:08 – “Schizo Spectrum” Mnemonic

Psychosis = disorganized thoughts and distorted perception of reality. Psychotic individuals will usually have a loss of function and a lack of insight (they don’t realize their perception of reality is distorted).
• Hallucinations – hearing, seeing, feeling, tasting or smelling something that isn’t really there. This sensation has no external stimuli. Due to the lack of insight these individuals think that what they perceive is real. Schizophrenia is usually associated with auditory hallucinations where the individual hears voices. Tactile Hallucinations like the sensation of bugs crawling on their skin is usually related to street drugs. Olfactory (smell) hallucinations are more commonly seen in the aura before seizures.
• Delusions – strongly held beliefs that are not based on fact. Due to the lack of insight trying to convince a psychotic person that their delusions are false is almost impossible no matter of how much evidence you present. Delusions of Persecution are the most common type and involve paranoia. These individuals think others are “out to get them” and are trying to follow them, spy on them, poison them, steal from them or otherwise harm them. Delusions of Grandeur are when an individual believes that have special powers, talents or intellect. They may think they are famous, have supernatural abilities or have religious prominence. Other common themes in delusion are guilt, thought control, thought broadcasting (belief that others can hear your thoughts) and ideas of reference (belief that people on TV/radio/print media are talking about you).
• Disorganized Speech (Thought Disorder) is random, incoherent speech that may involve repeating phrases or words that sound similar. The patient likely is not aware that their speech makes no sense to others. This is sometimes referred to as “Word Salad.”
• Catatonia –motor hyperactivity with repetitive purposeless motions or motor hypoactivity that leads to complete motor immobility & waxy flexibility (you can move the patient into an odd position and they will stay in that position for hours). It can include a complete disconnect from reality. This should not be confused with Cataplexy which is a type of narcolepsy where people have motor immobility while remaining completely aware of their surroundings.

In the previous video in the Psychiatry section we covered mood disorders. There we briefly discussed Mania with psychosis and depression with psychosis. The key difference between schizophrenia and a mood disorder with psychosis is that the psychosis in mood disorders is “Mood Congruent.” This means that the psychosis is only present during mood “episodes” and that the psychosis is in line with their mood. So a manic individual may have delusions of grandeur and a depressed person might have delusions of guilt.

Schizophrenia – a chronic progressive psychiatric condition characterized by psychosis and an abnormal interpretation of reality. They have a difficult time functioning in society due to progressive loss of function. Symptoms are categorized into 2 groups, Negative and Positive Symptoms.
• Positive symptoms = behaviors or sensations that are not normally present. These symptoms are may be related to an excess of dopamine. Examples include hallucinations, delusions, catatonia & disorganized speech/behavior
• Negative symptoms = The absence of normal behavior. Examples include a lack of initiative, diminished speech, disheveled appearance & flat affect.

There used to be specific subtypes of Schizophrenia based on what types of psychosis were predominate, but the difference between those types was low yield and in the most recent version of the DSM those subtypes have been removed.

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Picture Used:
Derivative of “Flexibilitas cerea” available at http://en.wikipedia.org/wiki/Waxy_flexibility via Public Domain

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