We are going to start off our series with an introduction to psychotic spectrum disorders. This is obviously a very large topic, but we will focus on providing a good overview and subsequent lessons will cover this topic in more depth. Let’s jump right into it.
Today's Content Level: Beginner
Remember that all readers are encouraged to read through each post regardless of their level of training as it is helpful to periodically return to the basics.
Clinical Features
The core features of psychotic disorders include: (must have at least one of 1, 2, or 3)
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Disorganized or catatonic behavior
5. “Negative symptoms”
Definitions
•Delusions = A firmly held false belief based on incorrect inference about external reality despite apparent incontrovertible evidence to the contrary. This belief is also not ordinarily accepted by other members of the person’s culture. There are many different types of delusions which we will get into in tomorrows lesson.
•Hallucinations = A sensory perception in the absence of external stimulus that has qualities of real perception. Auditory (hearing) hallucinations are the most common in psychiatric disorders, however, other hallucinations can occur which include visual (seeing), olfactory (smelling), gustatory (tasting), and tactile (touch or movement in the body).
•Disorganized speech = After a certain developmental stage, speech is often described as “linear, logical, and goal directed”. Linear = normal sequence of thought. Logical = rational connections between thoughts. Goal directed = speaking or answering questions with a sense of purpose without straying off-topic. In psychotic disorders, a persons speech may lose this sense of connectedness and purpose. It can become random, disjointed, disorganized, and lack the flow of normal conversation we are accustomed to. In severe cases there may be no speech at all. We will explore specific examples in a future lesson.
•Disorganized or catatonic behavior = This may manifest in several ways and may range from “childlike silliness to unpredictable agitation.” 1 There may be severe limitations in performing goal directed activities of daily living. We will get into catatonia in much more depth later, but it is essentially a significant decrease in reactivity to the environment such as lack of motor/verbal response, maintaining fixed and sometimes bizarre postures, or purposeless motor activities.
•“Negative symptoms” = I like this term for this cluster of symptoms. When you hear negative in this context, think “negative, down, slow, etc..." These symptoms get less attention, because they are less exciting than hallucinations and disorganized behavior, however they account for a substantial portion of the morbidity associated with schizophrenia. They are less prominent in other psychotic disorders.
**Memory Aid**
The 5 A’s of Negative symptoms in psychotic disorders
1. Anhedonia (decreased interest/pleasure)
2. Affect (flat) - absence or near absence of any sign of affective expression
3. Alogia (poverty of speech) - lack of unprompted content of speech
4. Avolition (apathy)
5. Attention (poor attention)
Conclusion
You did it! You finished the first day of your daily Bullet Psych readings. I hope you found it helpful. Please provide specific feedback if you feel that the readings can be improved, but remember that we are just scratching the surface. We are starting out very basic, but each day will build and more advanced learners will find the coming lessons useful as well. Next lesson will be an overview of the various diagnoses on the psychotic spectrum and then after that we will dig a bit deeper and provide some clinical pearls when it comes to assessment and clinical interviews with patients suffering from psychosis.
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Resources used for this lesson include:
Kaplan and Saddock's Synopsis of Psychiatry
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