This is a summary of 4.3 Severe Mental Illness in Urban Context. I added tables to summarise the main points which really helped me for the exam, I hope it helps you too! This includes a summary of the literature and some brief answers to the reading questions to help you with revision :)
• BRIEF PSYCHOTIC DISORDER:
o Prevalence = 9% of cases of first onset psychosis
3
,• DELUSIONAL DISORDER:
o Prevalence = 0.2%
• SCHIZOTYPAL PERSONALITY DISORDER:
4
,Reading 1: Nolen-Hoeksema – Psychopathology Chap 8 (2020):
• INTRO:
o Schizophrenia (S) = hallucinations + delusions are common
§ Beliefs & experiences out of touch with reality = psychotic
o Psychoticism -> speak incoherently + act in unpredictable manner
§ Can be put in a continuum – people meet more or less criteria for
schizophrenia
§ Family members of those with S often show problems in attention &
memory – similar abnormalities to those with S but less severe
o DSM lists S & other psychotic disorders in order of severity:
§ 1) Schizotypal PD = moderate symptoms of S – but retained reality testing
• Odd & eccentric speaking + unusual beliefs/perceptions + difficulty
relating to other people
§ 2) Delusional disorder = persistent beliefs contrary to reality
• Lack other symptoms of S + not impaired in functioning
• Delusions about things that are possible but untrue
§ 3) Brief psychotic disorder = symptoms of S for 1 month or less
§ 4) Schizophreniform = symptoms of S for 1-6 months
§ 5) Schizoaffective disorder = mixture of S & MDD or mania
§ 6) Schizophrenia (0.5-2% of general population develop it)
• à All have similarities with S but not as severe or persistent
§ Also have psychoses caused by medication/drugs or medical condition
o Psychosis = unable to tell difference between what is real or not
§ Schizophrenia -> one of the most puzzling & severe psychotic disorders
§ Varies from accurate to false view of reality + levels of functioning
§ Often develops in late teens/early adulthood
o These disorders -> high medical cost + health care use
§ In need of care when they could be contributing to society – often forever
(S tends to be chronic)
§ S = often live independently or with family + prisons + homeless shelters
• SYMPTOMS, DIAGNOSIS, AND COURSE:
o Schizophrenia = psychosis is core symptom
§ Schizophrenia spectrum -> 5 symptoms to define psychotic disorders
5
, § Number; severity; duration distinguish psychotic features from each other
o Different combo of symptoms possible -> different types of S
§ Positive symptoms (delusion; hallucination; disorganized thought;
disorganized/abnormal motor behavior)
§ Negative symptoms (e.g., restricted emotional expression or affect)
§ Cognitive deficits – decline in functioning
• Positive symptoms:
o = Overt expressions of unusual perceptions, thoughts, behaviors
o Delusions -> ideas one believes are true but are v unlikely/impossible
§ = “fixed beliefs that are not amenable to change in light of conflicting evidence”
§ ≠ Self-deception (at least possible; not preoccupied with them;
acknowledge their beliefs may be wrong)
§ Look for evidence in support of their beliefs to convince others
§ Persecutory delusion – belief people are following/after you
§ Delusion of reference – belief random events/comments are directed at them
• E.g., red neckties with John Nash
§ Grandiose delusion – belief one is a special being/possesses special powers
§ Delusions of thought insertion – belief one’s thoughts are being controlled
§ à Also seen in severe depression & bipolar
§ Effect of culture on content of delusions
• UK = controlled by computer – Pakistani = controlled by black magic
• Also changes with time -> focus on Germans in WW2 in US
§ Beliefs that are part of culture’s belief system aren’t delusions
o Hallucinations -> see or hear (any sense) something that isn’t actually there
§ Mentally healthy people can also experience these sometimes
• In S = more frequent; persistent; complex; linked to delusions
• Also common in severe depression & bipolar
§ Auditory hallucinations – most common (voices, music)
• Can come from in or out of someone’s head – might talk back to them
§ Visual hallucinations (often with auditory) – see something
§ Tactile hallucinations – something out of one’s body (e.g., bugs on back)
§ Somatic hallucinations – something in one’s body (e.g., warm eating intestine)
§ Different types across cultures again
• E.g., religious visions in Puerto Ricans
6
, o Disorganized thought & speech -> often referred to as formal thought disorder
§ Loose association/derailment – slip from one topic to unrelated other topic
• Common to answer Qs with unrelated answers
§ “Word salad” – when speech is totally incoherent
§ Neologism – make up words only known to them
§ Clangs – make associations between words based on sounds > content
§ !! More language deficits in M > F (F use both hemispheres of brain for it)
o Disorganized or catatonic behavior -> unpredictable agitation
§ Shouting, swearing, pacing rapidly out of nowhere
• Likely in response to hallucinations & delusions :/
§ Takes them a lot of effort to do simple tasks (e.g., get ready, brush teeth)
§ Catatonia = disorganized behavior that reflects unresponsiveness to env
• Negativism – lack of response to instructions
• Rigid/inappropriate posture
• Lack of verbal/motor responses (e.g., mute)
• Catatonic excitement – excessive motor activity for no apparent reason
Positive symptoms - Added unusual behavior/thoughts/perceptions
- Delusions (ideas thought to be true but are v unlikely/impossible) –
persecutory; reference; grandiose; thought insertion…
- Hallucinations (perceiving something that isn’t there) – auditory; visual;
tactile; somatic
- Disorganized thought & speech (more in M) – loose association/
derailment; word salad; neologism; clang
- Disorganized or catatonic behavior (unpredictable agitation) – catatonia
• Negative symptoms:
o = Loss of certain qualities of the person (restricted affect; asocial)
§ Strong neg symptoms = more linked to poor outcome > strong pos symptoms
§ Harder to treat + persistent
o Restricted affect -> severe reduction or absence in emotional expression
§ Fewer facial expressions, avoid eye contact, less gestures, flat voice tone…
§ Those with S show anhedonia + lower pleasure
• BUT proof they may experience lots of emotions that they can’t express
§ Troubles with predicting future emotional experience (L for decisions)
o Avolition/asociality -> can’t initiate/persist at common goal-directed activities
§ Physically slowed down in movement + seems unmotivated
• Poor hygiene – lack of desire to socialize
§ !! Only diagnose if they have access to friends/family but shows no interest
Negative symptoms - Loss of qualities in person (can be more severe than pos symptoms)
- Restricted affect (reduced/absent emotional expression) – does not
mean they experience less emotions!!
- Avolition/asociality (physically slowed down; low desire to socialize)
• Cognitive deficits:
o Deficits in attention, memory, processing speed
o Poor working memory (hold info to manipulate it) ->hard to pay attention to
relevant info + suppress irrelevant info
§ May contribute to pos & neg symptoms
o -> Impact on daily functioning L (work, social relationships)
o This is also seen in immediate relatives of those with S even if they don’t have S
7
, § Also common to see this prior development of S + don’t get better with
treatment -> early marker
Cognitive deficits - Deficits in attention; memory; processing speed
- Impact on daily functioning (work; social relationships) L
- Also seen in immediate relatives + prior full development of S
+ stays after S (don’t go with treatment)
• Diagnosis:
o Schizophrenia recognized as a psych disorder since early 1800s
§ Originally believed to be a premature deterioration of brain/dementia
§ Seen as progressive; irreversible; chronic
o Schizein (split) + phren (mind) => split mind (≠ split personalities)
§ Break in association between thoughts, language, memory, problem solving
§ Inability to maintain a train of thoughts
o DSM-5 = S -> 2+/5 symptoms of psychosis (at least 1 hallucination, delusion,
disorganized speech)
§ Symptoms present for at least 1 month (severe) + some symptoms for at
least 6 months (impairment in social/occupational functioning)
§ Need to specify if with catatonia
§ Prodromal symptoms (before acute phase) + residual (after)
• Withdrawn/uninterested in others here – “gradually slipping away”
• Beliefs that are unusual but not delusional
§ Chronic residual symptoms + relapse in acute episodes
o ≠ Autism -> S = delusions/hallucinations must be present
§ Social deficits in ASD begin v early in life (≠ S)
o Big neg impact on their lives -> longitudinal study: 40% employed/school
§ 37% recovered
§ Lower levels of education + less success in holding jobs L
o Neg symptoms less responsive to meds than pos
§ (Easier to get rid of hallucinations > restricted affect)
o DSM-IV = used to have subtypes of S (e.g., paranoid schizophrenia) – low evidence
Diagnosis - 2+/5 psychosis (hallucination, delusion, disorganized speech,
disorganized behavior, neg symptoms) for 1 month | At least 1,2, or 3
- Impairment for 6 months | Neg effect on career & social life L
- Prodromal & residual symptoms | Chronic residual + episodic acute
• Prognosis:
o S = one of the most severe & debilitating disorders
§ 50-80% of those hospitalized for one episode will come back at one point
in their life
§ Life expectancy is 10-20 years shorter
§ Higher rates of infectious and circulatory diseases
§ 5-10% of people with schizophrenia commit suicide
• Highest rate in 1st psychotic episode or recently diagnosed
o Many stabilize (≠ degression) in functioning J
§ 41% had at 1+ period of complete recovery for at least 1 year
o Gender & age factors -> F tend to do better (more periods of recovery; less hospitalization;
milder neg symptoms; better social adjustment; fewer cog deficits)
§ Onset in F is more in late 20s/early 30s + estrogen may help regulation of
dopamine – show less brain abnormalities (≠ M)
§ Functioning improves with age in both M & F (maybe find right treatment,
brain aging helps somehow, reduced dopamine levels…)
8
, o Sociocultural factors -> developing S in developed countries is
more debilitating than developing it in developing countries
§ Better social environment helps (no one person is
solely responsible for the care of someone with S)
Prognosis - Many end up hospitalized multiple times + shorter life expectancy
(10-20 years) + commit suicide + develop/catch diseases
- Many also stabilize in functioning > degression
- F tend to do better + functioning improved with age
- More debilitating to have S in developed countries
• Other psychotic disorders:
o These fall on continuum of severity
§ S = worst long-term outcome
§ Schizophrenia > schizoaffective > schizophreniform…
o Schizoaffective = mix of schizophrenia & mood disorder (psychotic + mood
symptoms) – mainly mood symptoms
§ At least 2 weeks of hallucination or delusion without mood symptoms
o Schizophreniform = meet criteria A, D, and E for S but only for 1-6 months
§ Functional impairments not necessary
§ Good (quick onset, good prior functioning, confusion but not blunted
affect) vs not prognosis
§ Majority eventually develop schizophrenia or schizoaffective disorder
o Brief psychotic disorder = sudden onset of delusions, hallucinations, disorganized
speech/behavior – but only for 1 day to 1 month
§ Sometimes caused by major stressor (e.g., giving birth 1/10,000)
§ High relapse but commonly good outcomes
o Delusional disorder = delusions for at least 1 month – but not other symptoms
§ Just behaviors that follow delusions | Rare (prevalence of 0.2%) | more in
F > M | later onset than other disorders (40-49 years)
o Schizotypal PD = odd self-concept + ways of relating to others + thinking/behavior
§ Trouble setting realistic/clear goals | Restricted emotional expressions
§ Suspicious of others -> social isolation
§ Distorted perception | Deficits in WM, learning, recall…
§ Similar genetic traits to S -> some develop it
§ Falls below psychotic disorder threshold – DSM still sees it as part of S spectrum
• BIOLOGICAL THEORIES:
o Some evidence for genetic transmission
§ Possible structural & functional abnormalities in brain
§ Common birth complication or exposure to prenatal virus
§ Neurotransmitters (dopamine in excess)
• Genetic contributors to schizophrenia:
o No single genetic abnormality (different genes responsible for different symptoms
of the disorder?)
o Family studies -> greatest risk in children from 2 S parents + in monozygotic twins
§ Lower genetic similarity = lower risk
§ 1st degree relative sharing 50% of genes has 10% chance of developing it
§ (General population = 1-2%) – doesn’t mean it always happens though
§ Also higher risk of developing bipolar L
o Adoption studies -> nature vs nurture (may be a role of the environment)
9
, § Exposure to illogical thought, mood swings, chaotic behavior
§ Negative symptoms can also impair child-care
§ Still found sig impact of genetics (10% risk in biological S in adoptees)
• Adoptees -> 10% of mom with S + 1% of mom without developed S
o Twin studies -> 46% in monozygotic (identical) + 14% in dizygotic (fraternal)
§ Carrying risk of S doesn’t mean they will develop it (can show different types)
§ DNA can be modified by different environmental conditions?
Genetics - Higher risk of S in 1st degree relatives (10%) also higher risk of bipolar
- Exposure to env with psychosis leads to higher risk (but genes > env)
- Different genetics lead to dif symptoms
• Structural and functional brain abnormalities:
o Major structural & functional deficits in brains of those with S
§ Some see S as neurodevelopmental disorder
o Reduction in grey matter + small/inactive PFC (develops a lot in ado)
§ Hippocampus (LTM) unusual activity to encode/retrieve memories :/
• Seen in 1st degree relatives
§ Reduced white matter (early signs of S > consequences)
• Impairs ability of different brain areas to work together
§ Enlarged ventricles (more severe symptoms)
o Damage to developing brain -> higher risk of S
§ Birth complication = prenatal & birth difficulties more common in S
• Perinatal hypoxia (oxygen) v common in S (30%)
§ Prenatal viral exposure = higher risk if mother exposed to viral infections
when pregnant (2nd trimester – development of CNS)
• S more likely to be born in spring months
• Cause system is more active
Structural & - Change in grey & white matter + PFC + hippocampus
functional - Damage to developing brain (birth complication; viral exp) link to S
• Neurotransmitters:
o Dopamine = too much (in PFC, limbic system) of it leads to S symptoms (og theory)
§ Drugs that lower dopamine help reduce S symptoms
§ Drugs that increase dopamine increase pos symptoms
§ More dopamine seen in people with S
§ !!! Too simple – not the only factors + mainly effect on pos symptoms
o 1) Excess dopamine in mesolimbic pathway (processing salience & reward)
§ Atypical antipsychotics -> bind to specific dopamine receptor
o 2) Low dopamine in PFC (attention, motivation, organization of behavior)
§ Link to neg symptoms of S
o Serotonin (regulate dopamine in mesolimbic) -> interaction between them is key
§ Lower GABA can explain hallucinations & delusions (e.g., ket)
Neurotransmitters - High dopamine in mesolimbic pathway (salience & reward) + low in PFC
(neg symptoms)
- Serotonin helps regulate dopamine (meds can target this) + low GABA
can explain hallucination & delusions
• PSYCHOSOCIAL PERSPECTIVES:
o Social factors can influence its onset, course, and outcome
• Social drift & urban birth:
10
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller eurpsychology. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $11.45. You're not tied to anything after your purchase.
