Pya5
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PYA5 – PSYCHOPATHOLOGY – REVISION SUMMARY
Clinical Characteristics Schizophrenia Physical/behavioural:
Depression Physical/behavioural:
→
Psychomotor poverty, catatonia – awkward postures assumed, remain motionless in this position for hours
→
Changes in appetite – tends to be reduced but can increase (comfort eating). Generally unhealthy though.
→
‘Waxy flexibility’ – body can be manipulated into different positions
→
→
Catatonic stupor – lie motionless, unware of surroundings but fully conscious
Sleep disturbances – most common is insomnia but also hypersomnia which is excessive sleeping, most likely to escape reality
→
Or increased motor activity – e.g. purposeless & repetitive movement
Lethargy & tiredness (due to sleep disturbance?) or restlessness
→
Sex drive usually reduced
→
Apathy – in appearance, work, home, others. Reduced activity due to lack of interest and energy.
→
→
Disorganised/chaotic/bizarre behaviour can be linked to other symptoms e.g. cover windows with black paper -> cognitive disturbance.
Perceptual:
Perceptual:
Auditory hallucinations – most common – abusive voices, critical running commentary on behaviour → Visual, smell & taste hallucinations too, but less common
→
Cognitive:
Cognitive:
→
→
→
→
Slow, muddled thinking –> difficulty in making decisions
→
Pessimistic/negative thinking, suicidal in severe cases
these all develop into
→
complex web of delusion Thought interference symptoms thought insertion thought withdrawal (belief
thoughts are being extracted from mind) broadcasting (belief ppl can ‘tune in’ to your thoughts)
→
Cognitive impairments intellectual deficits in learning
Physical/behavioural: →
Immediate physical symptoms are the body’s response to stress
→
But it is heightened – can result in breathlessness, tightness in the chest, hyperventilation, palpitations
→
Hyperventilation increases CO2 , leading to light-headedness, ‘pins and needles’ & even painful muscle contractions
→
Muscle tension -> headaches, aching, stiffness, particularly in back, neck, shoulders
→
Avoidance behaviour shown – avoiding feared object – sometimes greatly restricting everyday behaviour
→
Restless, ‘jumpy’ behaviour – difficulty in relaxing – startle response is often common
Auditory hallucinations may occur – extreme forms of selfcritical delusions
Delusions of grandeur persecutory paranoia ‘alien control symptoms’
(belief behaviour’s under external control)
Anxiety Disorders
Negative self-concept = faulty thinking -> individual overly critical of him/herself – can develop into delusions.
Cognitive: →
Anxiety can decrease concentration – decrease ability to perform complex tasks
→
Reduced cognitive capacity can inhibit workplace functioning
PYA5 – PSYCHOPATHOLOGY – REVISION SUMMARY
→
& memory Language impairments neologisms (inventing words) echololia (repeating sounds) word salad (jumbled speech) clang associations (nonsensical rhyming)
incoherent & abrupt topic
changes due to cognitive distractibility (inability to maintain train of thought)
Social:
Social:
social withdrawal is usual may always have lacked social skills → little interest in social interactions – no pleasure from them → may appear aloof, reclusive & emotionally distant even before onset of schiz.
→
Emotional:
Emotional:
Emotional:
Low mood, unhappiness, anguish, often on verge of tears → May experience anhedonia – loss of pleasure in activities previously enjoyed → Diurnal mood variations may occur – mood changes throughout the day, being particularly low in the morning but improving a little as day progresses.
→
Feeling of dread
→
Individual is frightened & distressed
→
May feel they’re about to die or lose control of bodily functions!
→ →
→ →
→ →
→
emotional blunting (lack of emotion) inappropriate affect e.g. laughing when told someone’s died 1/3 of schiz. patients suffer depressive symptoms 1/8 meet the criteria for a mood disorder as well as schiz., therefore tend to be diagnosed with schizo-affective disorder Apathy & lack of drive, interest, personal care, hygiene – all are common & can be linked to depressed state
Social:
Social withdrawal – no pleasure from social interaction – feel they have nothing valuable to contribute – do not want others to witness their depressed state.
→
→
Anxiety may reduce ability to cope w/ social settings, inhibiting personal and social functioning
Types & Diagnosis Schizophrenia →
DSM-IV identifies 5 types of schizophrenia:
→
Depression →
Disorganised Catatonic Paranoid Undifferentiated Residual
Unipolar (major depression) Bipolar (manic depression) Premenstrual syndrome
(PMS)
Postpartum depression (PPD) Seasonal affective disorder
But a more recent typology is Liddle’s core symptoms of schizophrenia: Reality distortion: Hallucinations Delusions
Depression is the main symptom of a range of mood disorders, including:
(SAD) →
Major depression can be divided into two different
Anxiety Disorders →
→
Phobias Main categories of phobias are: specific phobia, social phobia and agoraphobia. Specific phobia (prevalence: 47% of pop.) – phobia of specific object – five types: animal environmental danger blood-injection-injury, situational (planes, lifts, enclosed spaces) ‘other’
PYA5 – PSYCHOPATHOLOGY – REVISION SUMMARY types:
Thought interference Disorganisation: Thought disorder Language disturbances Psychomotor disturbances Inappropriate affect Poverty: Lack of emotion Apathy, lack of motivation Cognitive impairments Psychomotor poverty Social withdrawal →
Endogenous – caused by
factors within the sufferer Reactive – caused by external factors e.g. stressful life events; this is the most common type wary of this distinction because the depression may be due to internal AND external factors between minor, neurotic illness and major, psychotic illness; the former is mood disturbance only, & latter when there are severe cognitive & perceptual distortions e.g. delusions, hallucinations
Negative: lack of interest, emotion, motivation and social withdrawal But schizophrenia is an episodic illness usually, consisting of periods of acute positive symptoms interspersed with periods of better functioning (negative symptoms), and schiz patients may show both, which contradicts this reductionist typology.
DSM-IV diagnostic critera: 2 or more symptoms identified above for a period of 1 month+. One symptom only is needed if delusions are bizarre or if the hallucination is critical/abusive of their behaviour
Disturbance must be evident over significant period of time, 6 months+, including 1 month of pronounced symptoms
Symptoms must have led to a failure to function in social & occupational roles
→
Agoraphobia (prevalence: 2-3% of population) – fear of open/public places, public transport, crowds etc. – very rare on its own as it is comorbid with panic disorder.
A distinction is often made
Positive: hallucinations, delusions, thought disturbances
→
Social phobia (prevalence: 1-2% of pop.) – fear of social situations due to selfconsciousness of behaviour & fear of others reactions; can be generalised (most situations) or specific (e.g. public speaking)
However, it is important to be
Another way of classifying is by positive (Type 1) and negative symptoms (Type 2):
But it is true that the acute phrase tends to resemble Type 1 and the chronic phase often resembles Type 2.
→
Dysthymia is a type of
depression that persists over months or years – less severe though. Major depression tends to be
Panic disorder tends to occur first, then individual avoids public places to avoid panic attack, thus agoraphobia develops. →
DSM-IV diagnostic criteria: Marked and persistent fear
of a specific object or situation
Exposure to fear-provoking
stimulus produces rapid anxiety response
episodic Individual recognises the fear →
DSM-IV: diagnosis of depression requires 5 of the physical, perceptual, behavioural, cognitive, social and emotional symptoms to persist over 2 weeks+
experienced is excessive Phobic stimulus is either
avoided or responded to with great anxiety Phobic reactions interfere
significantly with individual’s working or social life/there is marked distress about the phobia
PYA5 – PSYCHOPATHOLOGY – REVISION SUMMARY
Clinical Characteristics Schizophrenia Physical/behavioural:
Depression Physical/behavioural:
→
Psychomotor poverty, catatonia – awkward postures assumed, remain motionless in this position for hours
→
Changes in appetite – tends to be reduced but can increase (comfort eating). Generally unhealthy though.
→
‘Waxy flexibility’ – body can be manipulated into different positions
→
→
Catatonic stupor – lie motionless, unware of surroundings but fully conscious
Sleep disturbances – most common is insomnia but also hypersomnia which is excessive sleeping, most likely to escape reality
→
Or increased motor activity – e.g. purposeless & repetitive movement
Lethargy & tiredness (due to sleep disturbance?) or restlessness
→
Sex drive usually reduced
→
Apathy – in appearance, work, home, others. Reduced activity due to lack of interest and energy.
→
→
Disorganised/chaotic/bizarre behaviour can be linked to other symptoms e.g. cover windows with black paper -> cognitive disturbance.
Perceptual:
Perceptual:
Auditory hallucinations – most common – abusive voices, critical running commentary on behaviour → Visual, smell & taste hallucinations too, but less common
→
Cognitive:
Cognitive:
→
→
→
→
Slow, muddled thinking –> difficulty in making decisions
→
Pessimistic/negative thinking, suicidal in severe cases
these all develop into
→
complex web of delusion Thought interference symptoms thought insertion thought withdrawal (belief
thoughts are being extracted from mind) broadcasting (belief ppl can ‘tune in’ to your thoughts)
→
Cognitive impairments intellectual deficits in learning
Physical/behavioural: →
Immediate physical symptoms are the body’s response to stress
→
But it is heightened – can result in breathlessness, tightness in the chest, hyperventilation, palpitations
→
Hyperventilation increases CO2 , leading to light-headedness, ‘pins and needles’ & even painful muscle contractions
→
Muscle tension -> headaches, aching, stiffness, particularly in back, neck, shoulders
→
Avoidance behaviour shown – avoiding feared object – sometimes greatly restricting everyday behaviour
→
Restless, ‘jumpy’ behaviour – difficulty in relaxing – startle response is often common
Auditory hallucinations may occur – extreme forms of selfcritical delusions
Delusions of grandeur persecutory paranoia ‘alien control symptoms’
(belief behaviour’s under external control)
Anxiety Disorders
Negative self-concept = faulty thinking -> individual overly critical of him/herself – can develop into delusions.
Cognitive: →
Anxiety can decrease concentration – decrease ability to perform complex tasks
→
Reduced cognitive capacity can inhibit workplace functioning
PYA5 – PSYCHOPATHOLOGY – REVISION SUMMARY
→
& memory Language impairments neologisms (inventing words) echololia (repeating sounds) word salad (jumbled speech) clang associations (nonsensical rhyming)
incoherent & abrupt topic
changes due to cognitive distractibility (inability to maintain train of thought)
Social:
Social:
social withdrawal is usual may always have lacked social skills → little interest in social interactions – no pleasure from them → may appear aloof, reclusive & emotionally distant even before onset of schiz.
→
Emotional:
Emotional:
Emotional:
Low mood, unhappiness, anguish, often on verge of tears → May experience anhedonia – loss of pleasure in activities previously enjoyed → Diurnal mood variations may occur – mood changes throughout the day, being particularly low in the morning but improving a little as day progresses.
→
Feeling of dread
→
Individual is frightened & distressed
→
May feel they’re about to die or lose control of bodily functions!
→ →
→ →
→ →
→
emotional blunting (lack of emotion) inappropriate affect e.g. laughing when told someone’s died 1/3 of schiz. patients suffer depressive symptoms 1/8 meet the criteria for a mood disorder as well as schiz., therefore tend to be diagnosed with schizo-affective disorder Apathy & lack of drive, interest, personal care, hygiene – all are common & can be linked to depressed state
Social:
Social withdrawal – no pleasure from social interaction – feel they have nothing valuable to contribute – do not want others to witness their depressed state.
→
→
Anxiety may reduce ability to cope w/ social settings, inhibiting personal and social functioning
Types & Diagnosis Schizophrenia →
DSM-IV identifies 5 types of schizophrenia:
→
Depression →
Disorganised Catatonic Paranoid Undifferentiated Residual
Unipolar (major depression) Bipolar (manic depression) Premenstrual syndrome
(PMS)
Postpartum depression (PPD) Seasonal affective disorder
But a more recent typology is Liddle’s core symptoms of schizophrenia: Reality distortion: Hallucinations Delusions
Depression is the main symptom of a range of mood disorders, including:
(SAD) →
Major depression can be divided into two different
Anxiety Disorders →
→
Phobias Main categories of phobias are: specific phobia, social phobia and agoraphobia. Specific phobia (prevalence: 47% of pop.) – phobia of specific object – five types: animal environmental danger blood-injection-injury, situational (planes, lifts, enclosed spaces) ‘other’
PYA5 – PSYCHOPATHOLOGY – REVISION SUMMARY types:
Thought interference Disorganisation: Thought disorder Language disturbances Psychomotor disturbances Inappropriate affect Poverty: Lack of emotion Apathy, lack of motivation Cognitive impairments Psychomotor poverty Social withdrawal →
Endogenous – caused by
factors within the sufferer Reactive – caused by external factors e.g. stressful life events; this is the most common type wary of this distinction because the depression may be due to internal AND external factors between minor, neurotic illness and major, psychotic illness; the former is mood disturbance only, & latter when there are severe cognitive & perceptual distortions e.g. delusions, hallucinations
Negative: lack of interest, emotion, motivation and social withdrawal But schizophrenia is an episodic illness usually, consisting of periods of acute positive symptoms interspersed with periods of better functioning (negative symptoms), and schiz patients may show both, which contradicts this reductionist typology.
DSM-IV diagnostic critera: 2 or more symptoms identified above for a period of 1 month+. One symptom only is needed if delusions are bizarre or if the hallucination is critical/abusive of their behaviour
Disturbance must be evident over significant period of time, 6 months+, including 1 month of pronounced symptoms
Symptoms must have led to a failure to function in social & occupational roles
→
Agoraphobia (prevalence: 2-3% of population) – fear of open/public places, public transport, crowds etc. – very rare on its own as it is comorbid with panic disorder.
A distinction is often made
Positive: hallucinations, delusions, thought disturbances
→
Social phobia (prevalence: 1-2% of pop.) – fear of social situations due to selfconsciousness of behaviour & fear of others reactions; can be generalised (most situations) or specific (e.g. public speaking)
However, it is important to be
Another way of classifying is by positive (Type 1) and negative symptoms (Type 2):
But it is true that the acute phrase tends to resemble Type 1 and the chronic phase often resembles Type 2.
→
Dysthymia is a type of
depression that persists over months or years – less severe though. Major depression tends to be
Panic disorder tends to occur first, then individual avoids public places to avoid panic attack, thus agoraphobia develops. →
DSM-IV diagnostic criteria: Marked and persistent fear
of a specific object or situation
Exposure to fear-provoking
stimulus produces rapid anxiety response
episodic Individual recognises the fear →
DSM-IV: diagnosis of depression requires 5 of the physical, perceptual, behavioural, cognitive, social and emotional symptoms to persist over 2 weeks+
experienced is excessive Phobic stimulus is either
avoided or responded to with great anxiety Phobic reactions interfere
significantly with individual’s working or social life/there is marked distress about the phobia
PYA5 – PSYCHOPATHOLOGY – REVISION SUMMARY
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