Psychosis – Life in the shadow of madness

Delusional thinking

 1-depressive, I’ve done something horrible
 2-somatic – something’s wrong with my body
 3-grandeur – self-importance
 4-influence – controlled by someone
 5-persecution – they’re after me
 6-reference – msg for you on television

Hallucinations – voices, skin, taste,

Disturbed emotions – flat or reversed affect –

Disturbed communication – speech is like “word salad”

Personality disintegration – lack of coordination between thoughts, actions, emotions

Very disturbing behavior normally occurs in brief episodes, rather than continuous

People can usually tell an episode is about to occur – insomnia, emotional changes, feeling “high”

Brief Reactive Psychosis – psychotic symptoms occur after an extremely stressful event

Organic psychosis – brain pathology
Functional psychosis – unknown causes

Organic psychosis

– general paresis – syphilis attacks brain cells
– lead or mercury poisoning
– senile dimentia (e.g., Alzheimer’s disease)

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3 Major types of functional psychosis are

delusional disorders
schizophrenia
psychotic mood disorders

1.  Delusional disorders – presence of deeply held false beliefs

Grandiosity, jealousy, persecution, bodily complaints, romantic attraction

Most common – paranoid psychosis – delusions of persecution

2. Schizophrenia

Delusions, hallucinations, apathy, split between thought and emotions

Blunted or inappropriate emotions

Similar to schizotypal personality disorder – withdrawal, social isolation, and odd behavior, but no break with reality

Types of schizophrenia

- disorganized – madness – emotions, speech, and behavior are highly disorganized
- develops in early adolescence or young adulthood
- often preceded by serious personality disorganization in earlier years
- Catatonic – panic – stupor –
- Paranoid – delusions of grandeur and prosecution
- Undifferentiated – shift from one pattern to another

Causes –

prenatal problems (exposure to influenza, malnutrition, birth complications),

early psychological trauma (violence, sexual abuse, death, divorce, separation),

deviant communication within families, double-blind communication

Heredity – 48% chance that both identical twins will become schizophrenic if one develops the disorder

46% chance if BOTH natural parents are schiz

17% for fraternal twins

9% for brothers and sisters

Brain chemistry – dopamine – overactivity in levels – antipsychotic meds block dopamine –

Double the amount of dopamine receptors in the brain – in the limbic system

Drug treatment:  Clozapine – blocks action of dopamine in the brain (old drug was Thorazine)

Brain fissures – Hinckley’s brain

MRI – enlarged ventricles

PET – measures metabolism of sugar (glucose) in the brain - abnormally low activity in the frontal lobes

Stress-vulnerability hypothesis – combination of stress and inherited potential brings about mind-altering changes in brain chemicals

 This applies to other disorders as well

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Mood disorders – depressive and bipolar

Moderate mood disorders –

Dysthymic disorder (moderate depression for two years)

Cyclothymic (up and down in affect, like manic-depression)

Reactive depression – despondency after an identifiable event

 Major mood disorders

Bipolar I  - mostly loud, elated, hyperactive, energetic – but with some bouts of depression

Bipolar II – mostly sad and guilt-ridden, but with brief manic episodes

 High risk for suicide

Major Depressive Disorder – only the depressive side

Can suffer Affective Psychosis

 Manic episodes, rapid shifts in ideas, constant talking,
 Restless movement, eating and sleeping ignored

Major mood disorders more often appear to be ENDOGENOUS or produced from within

No known external cause or stressor – and they respond to medication

Causes:

 Looking at serotonin, noradrenaline, dopamine levels

 Repressed anger

 Learned helplessness

 Self-criticism, self-defeating thoughts

 Women are twice as likely to experience depression

Genetics – identical twins 80%

Non-twin siblings 35%

Treatment – major mental disorders now primarily treated with drugs

Organic psychosis cannot be “cured” – but controlled with drugs and other techniques

Psychotherapy is used for behavioral and emotional problems

Biological treatment – pharmacotherapy, ECT, and Psychosurgery

Minor tranquilizers (valium), antidepressants (prozac), antipsychotics (clozaril)

TDK (tardive dyskinesia) caused by major tranquilizers - tremors, resembles Parkinson's Disease

ECT – usually temporary

Lobotomy - no longer used

Deep lesioning - for specific disorders, like OCD

Hospitalization

Deinstitutionalization

Community Mental Health