Schizophrenia Spectrum and other Psychotic Disorders – Psychological Disorders (PSY)

by Tarry Ahuja, MD

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    00:01 Okay. Now, let’s talk about schizophrenia.

    00:03 Schizophrenia is a mental disorder that’s characterized by abnormal social behavior and failure to understand reality.

    00:09 So, this is one of those disorders that is fairly, I don’t want to say that it’s, you know, more important than others, but it’s more I would say traumatic from the others.

    00:21 Because when you’re expressing with schizophrenic symptoms, it’s a removal from reality.

    00:27 So you don’t know what’s real and you don’t know what’s fake and that can be very, you know, for a, you know, a non-schizophrenic individual to experience that and see that, it’s kind of scary.

    00:37 So, symptoms of this are classified in two bins.

    00:41 We can have positive symptoms and negative symptoms.

    00:43 Positive is where your adding something to the equation.

    00:46 So you’re seeing something that wasn’t -- that’s not there versus negative which is a removal or a deficit of something.

    00:52 So, we’ll take a look at this in a little bit more detail here.

    00:54 So, positive symptoms can include things like delusions.

    00:58 So now you’re adding sort of mysterious things that you’re seeing.

    01:02 Disorder thoughts in the speech, hallucinations, these are all things that are considered positive symptoms.

    01:09 Now, positive symptoms respond quite well in medication and treatment, so that’s a good thing obviously.

    01:16 And it’s a good thing because some of these things can be quite dramatic and can really impact your ability to function.

    01:23 So it’s kind of hard to do your job when you’re seeing, you know, flying unicorns and you’re seeing, you know, you’re seeing odd things and also delusions where you have this disconnect between what’s really actually happening and what you think is happening in your mind.

    01:41 So, in this image that you’re seeing here, you see a cat.

    01:44 The cat has delusions of we’ll say grandeur or things that, “I am a cat. I am a wild cat. I’m a lion.” When reality is it’s actually just a good old cat, but in its mind, it believes that it is a powerful lion.

    01:59 It’s Simba walking around in the jungle, okay? Now, the flipside or negative symptoms, and these are a little bit less responsive to medication and psychotherapy -- sorry, pharmacotherapy.

    02:09 And things like removal of normal emotional response.

    02:13 So you have a flat affect.

    02:15 So normally, me and you are having a discussion, and if I’m worked up about something, you’ll know that I’m worked up because you can see that emotional -- expression of emotion attached to the conversation we’re having.

    02:27 And sadness and all the different things that you would express as opposed to an individual who has lack of affect or flat affect might be quite monotone.

    02:37 It might say things like, “Yeah, I may have killed a man yesterday and I also then won a $50 million lottery.” And there’s no emotion there and you don’t know, you know, are you being sarcastic or this is for real or do you know what you’re saying.

    02:49 And then also the reduced quantity or fluency of speech.

    02:52 So, they might not be saying a lot, maybe just a few keywords.

    02:56 They might be mumbling a little bit more.

    02:59 It seems very forced in the way that they’re speaking, and these all are then, again, classified as negative symptoms.

    03:08 So, schizophrenia refers to a split and mental function or reality and is not a split in identity.

    03:17 So do not get those two confused.

    03:18 So, you having trouble discriminating between reality and delusions or hallucinations, it doesn’t mean that you have a dual identity.

    03:28 That’s its own -- that its own situation.

    03:30 Schizophrenia is just an inability to differentiate between reality and non-reality.

    03:38 Now, five main types of schizophrenia.

    03:40 Again, I’m not going to spend lots of time going through each one.

    03:44 I think you need to appreciate the fact that there are different types of schizophrenia.

    03:48 This is just some sampling of some.

    03:50 But for the MCAT, I think you would need to know probably at least understand that these fall under types of schizophrenia.

    03:57 So paranoid-type schizophrenia is mostly hallucinations, delusions, and usually you’re relating to a theme.

    04:03 So, there’s some consistency in the positive symptoms that you’re experiencing.

    04:10 Disorganized-type is flat or inappropriate affect, disorganized speech, and behavior.

    04:15 And like the descriptor implies, it’s quite disorganized as opposed to the paranoid-type or just some consistency.

    04:22 And the Catatonic-type, immobility or hyperexcited motor activity and it’s not influenced by external stimulus.

    04:29 So, if you have ever seen a schizophrenic patient that seems highly exaggerated in how they’re moving, and I’m flashing my arms around, or even to the point where they’re seem almost frozen, that would be catatonic-type.

    04:45 Undifferentiated-type is the basic criteria for schizophrenia.

    04:49 The basic criteria are met but they don’t fit in any of the other.

    04:53 So this is a sort of catch all of those who don’t fit in the obvious other types.

    04:58 And there’s residual-type or previously met criteria for schizophrenia symptoms and they’re now a little bit milder.

    05:04 So, this could either be that you’re transitioning out of the disease.

    05:07 It could be that some of the treatment that you have is starting to take shape.

    05:11 Sometimes schizophrenia slightly environmentally based and that what surround you is impacting it.

    05:18 It’s not going to completely absolve your schizophrenia but you might be in a better place when you have more support around you and that might transition you from being full-blown schizophrenic to residual type.

    05:29 Brief psychotic disorder is at least one psychotic symptom for less than one month.

    05:35 And then the last two, we’re going to have our schizophreniform disorder.

    05:40 And this is where you display the symptoms of schizophrenia for one to six months and it usually transitions to schizophrenia.

    05:45 So this might be schizophrenia light.

    05:48 So it’s kind of like you start with the SPD and then you can transition to schizophrenia.

    05:54 And then there’s also schizoaffective disorder where symptoms of schizophrenia and you also have a major depressive, manic or mixed episode.

    06:02 So this is a combination actually of two disorders of schizophrenia and then affective disorder.

    06:08 So the last two are probably the most removed from your typical schizophrenia with schizophreniform disorder being one that your -- it’s a gate way you’re going to transition to schizophrenia, and that usually happens in at least half of the time.

    About the Lecture

    The lecture Schizophrenia Spectrum and other Psychotic Disorders – Psychological Disorders (PSY) by Tarry Ahuja, MD is from the course Individual Influences on Behavior.

    Included Quiz Questions

    1. Apathy.
    2. Disordered speech.
    3. Visual hallucinations.
    4. Grandiose delusions.
    5. Racing thoughts.
    1. Paranoid delusion.
    2. Broken speech.
    3. Flat affect.
    4. Loss of emotion.
    5. Loss of interest.
    1. Residual schizophrenia.
    2. Disorganized schizophrenia.
    3. Untreatable schizophrenia.
    4. Treatment-resistant schizophrenia.
    5. Undifferentiated schizophrenia.
    1. Schizophreniform disorder.
    2. Paranoid schizophrenia.
    3. Acute psychotic disorder.
    4. Schizotypal disorder.

    Author of lecture Schizophrenia Spectrum and other Psychotic Disorders – Psychological Disorders (PSY)

     Tarry Ahuja, MD

    Tarry Ahuja, MD

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