Psychology: Psychotic Symptoms

Psychotic Symptoms

• Delusions: can be bizarre or non-bizarre, with persecutory delusions being the most common type
• Other types of delusions: referential, grandiose, erotomanic, nihilistic, somatic
• Hallucinations: auditory hallucinations are the most common type, with voices being the most common auditory hallucination
• Disorganised thinking and speech: involves jumps in logic, clanging, tangentiality, flight of ideas, derailment, incoherence, and increased pressure of speech
• Abnormal or disorganised motor behaviour may also be present
• Negative symptoms: a cluster of psychotic symptoms including avolition, alogia, anhedonia, and asociality

Brief Psychotic Disorder (BPD)

• Requires at least one of: delusions, hallucinations, disorganised speech/thinking
• Specifiers for BPD: with or without marked stressors, and with post-partum onset

Delusional Disorder

• Features at least one delusion for at least one month
• Behaviour remains normal aside from delusions

Schizophreniform Disorder

• Presence of delusions, hallucinations, and/or disorganised speech/thinking for at least one month but less than six months

Schizophrenia

• Presence of psychotic symptoms experienced for the majority of a one-month period, with symptoms present for at least six months
• Functioning is impaired compared to pre-onset

Schizoaffective Disorder

• Presence of more than two psychotic symptoms alongside a major mood illness
• Delusions or hallucinations must be experienced for at least two weeks in the absence of a mood disorder episode

Schizophrenia Epidemiology

• Most common in early adulthood or adolescence
• Females tend to have a later age of onset, suspected to be due to hormones
• Onset is very rare under 10
• Increased rate of schizophrenia around menopause
• Higher prevalence rates of schizophrenia in men compared to women (3:2) and in migrants and developing countries

Associated Features of Schizophrenia

• Stigma
• Depression and suicide
• Anxiety
• PTSD, either from psychosis or from treatment
• Substance use
• Poor quality of life
• Earlier death, either from illness or treatment

History of Schizophrenia Research

• 1860: Benedict Augustine Morel developed dementia precoce, a first attempt at classification/description of schizophrenia
• 1898: Emil Kraeplin developed dementia praecox, emphasizing early onset and deteriorating course
• 1911: Eugen Bleuler named schizophrenia and noted that it didn't necessitate early onset and didn't always worsen with time
• 1959: The first DSM was published, including first-rank symptoms
• 1972 and 1974: The US-UK Cross-National Project and WHO Multi-Centre Collaborative Study aimed to address un-standardised criteria of schizophrenia
• 1980: The DSM-3 was published, with updated schizophrenia criteria with exclusion and inclusion rules

Current Research and Genetics

• Patrick McGorry is a current schizophrenia researcher aiming to study first-episode patients
• Need to study psychotic symptoms individually, not just as a whole
• Significant genetic component in the development of schizophrenia
• At least 100 genes involved in schizophrenia
• Dopamine hypothesis of schizophrenia proposes excessive dopamine function, but no evidence for increased levels of dopamine