clinical psychology hc’s part 2
Lecture 1: psychotic disorders
metacognitive psychotherapy for psychosis
TED talk: Sachs → see slides
learning goals:
● what the symptoms are and recognize these cases
● explain how the various different diagnoses relate to one another; differentiate these
form psychotic symptoms in other disorders
● provide a general picture of how biological. psychological and social factors all seem
to contribute to the risk of psychosis
● interventions
what is psychosis?
● formally; disruption in the experience of reality/reality testing
● DSM does not enter the debate on what is ‘psychotic’ but explicitly chooses to define
psychosis in terms of symptoms
○ this is significantly broader than ‘reality testing’
● symptoms can be subdivided in different ways
○ in all models positive (adding something to reality) and negative (distract from
life)
■ positive: hearing voices
■ negative: fled emotions
● some models add domains for example
○ disorganized (DSM)
○ thought disorder
● trauma is a huge factor; a experience before or the experience of the first psychosis
hallucinations (Positive symptom)
● are perception-like experiences which occur without an external stimulus
○ lifelike
○ full force and impact of normal perception
○ can occur in all modalities
○ most common: auditory (voices)
● In some (sub) cultures, hallucinations are considered normal (religious) experience.
Are psychotic symptoms unusual?
● audiovisual hallucination
○ children around 8; +/- 9%
○ general population: 5%-28%
● imaginary friends
1
, ○ children 5-12 year: 46%
Delusions (positive symptom)
● beliefs/convictions which conflict with reality
● DSM-IV: are erroneous beliefs that usually involve a misinterpretation of perceptions
and experiences
● belief —> delusion where do you draw the line
● DSM-5 are fixed beliefs that are not amenable to change in light of conflicting
evidence
● DSM 5: are fixed beliefs that are not amenable to change in light of conflicting
evidence
● types
○ most common:
■ persecutory: they are after me.. → fear
■ referential: things that are not related to you, feel related to you
○ less often
■ somatic; body experiences, belief that you have bugs under the skin
■ grandiosity: Believe that you will become president
■ erotomanic; celebrity X is in love with me → can induce action
■ nihilistic; impending catastrophe; the world is gonna end
● bizarre vs. non bizarre
○ DSM IV; clearly implausible and not understandable and not derived form
ordinary life experiences
○ DSM 5: delusions are deemed bizarre if they are clearly implausible and not
understandable to same culture peers and do not derive from experiences
■ → are not used anymore since they are so hard to distinguish
sometimes, it needs context
negative symptoms
● common:
○ reduced expressivity
○ avolition: reduces self-motivated, goal oriented activities
● less common:
○ alogia: reduced speech production
○ anhedonia: reduced enjoyment
○ a-sociality: reduced interest in social activities
disorganized symptoms
● disorganized speech: waterfall speech
● catatonic behavior; motor disruption
other symptoms
● anosognosia: believe that you are not ill; reduced insight in illness
2
, ● disrupted self experience → their self has shattered not splitted (DID)
● social cognition/metacognition/mentalizing
○ abilities to understand others and the social world
● different constructs all point to structural and important, deficits in social cognition
Clinical profile:
Delusional disorder: differential diagnosis (thesis suggestion; very complex field)
● with oCD or BDD: even if the belief of catastrophe/body experience is extremely
solidified and there is anosognosia OCD or BDD fits better than delusional disorder
● with mood disorders: similar to schizoaffective disorder, symptoms of mood have to
be relatively short compared to symptoms of delusional disorder
epidemiology
● schizophrenia
○ incidence (how many per year); around 15 new cases per 100 000 persons
○ prevalence (how many people have the disorder currently): 0.7-1%
3
, Diagnostic: classification
● praecox gefuhl: feeling that you cannot reach each other
● careful: differentiate psychotic episode (or psychosis from psychotic disorder)
● (semi) structured interviews
Other symptoms
● Jumping to conclusions
● neurocognition: digit span test
Etiology
● biological/neurological perspective: dopamine hypothesis
○ strong genetic component
○ slightly more men than women
■ woman have a little more symptoms, but social functioning remains a
bit better
● Medication implies that dopamine is at the foundation of (positive) symptoms
○ but don’t barely work on negative symptoms
● Aberrant Salience model
Social factors
● being a migrant is a risk factor for development of schizophrenia
● urbanicity is a risk factor
Psychological factors
● trauma (50-98% of patients)
● 80% of patients experience their psychotic episodes as traumatic too
● prevalence PTSD comorbid 16%
● 90% of case files do not mention PTSD, though it is present
● example of development of mentalizing abilities
○ develops in early childhood, environment-driven
■ deafness/deprivation impedes development
■ association found between hearing difficulties, trauma in development
and later psychotic symptoms/disorders
■ differences were found on social responsiveness between children who
later develop schizophrenia vs. bipolar vs. controls
Explanatory models
● cognitive model for example
Etiology - so what’s the deal?
● take home message: biopsychosocial model and diathesis-stress model are the shared
foundation of most models
● neurobiological and cognitive models support one another in most cases
● on great example: social defeat hypothesis
4
Lecture 1: psychotic disorders
metacognitive psychotherapy for psychosis
TED talk: Sachs → see slides
learning goals:
● what the symptoms are and recognize these cases
● explain how the various different diagnoses relate to one another; differentiate these
form psychotic symptoms in other disorders
● provide a general picture of how biological. psychological and social factors all seem
to contribute to the risk of psychosis
● interventions
what is psychosis?
● formally; disruption in the experience of reality/reality testing
● DSM does not enter the debate on what is ‘psychotic’ but explicitly chooses to define
psychosis in terms of symptoms
○ this is significantly broader than ‘reality testing’
● symptoms can be subdivided in different ways
○ in all models positive (adding something to reality) and negative (distract from
life)
■ positive: hearing voices
■ negative: fled emotions
● some models add domains for example
○ disorganized (DSM)
○ thought disorder
● trauma is a huge factor; a experience before or the experience of the first psychosis
hallucinations (Positive symptom)
● are perception-like experiences which occur without an external stimulus
○ lifelike
○ full force and impact of normal perception
○ can occur in all modalities
○ most common: auditory (voices)
● In some (sub) cultures, hallucinations are considered normal (religious) experience.
Are psychotic symptoms unusual?
● audiovisual hallucination
○ children around 8; +/- 9%
○ general population: 5%-28%
● imaginary friends
1
, ○ children 5-12 year: 46%
Delusions (positive symptom)
● beliefs/convictions which conflict with reality
● DSM-IV: are erroneous beliefs that usually involve a misinterpretation of perceptions
and experiences
● belief —> delusion where do you draw the line
● DSM-5 are fixed beliefs that are not amenable to change in light of conflicting
evidence
● DSM 5: are fixed beliefs that are not amenable to change in light of conflicting
evidence
● types
○ most common:
■ persecutory: they are after me.. → fear
■ referential: things that are not related to you, feel related to you
○ less often
■ somatic; body experiences, belief that you have bugs under the skin
■ grandiosity: Believe that you will become president
■ erotomanic; celebrity X is in love with me → can induce action
■ nihilistic; impending catastrophe; the world is gonna end
● bizarre vs. non bizarre
○ DSM IV; clearly implausible and not understandable and not derived form
ordinary life experiences
○ DSM 5: delusions are deemed bizarre if they are clearly implausible and not
understandable to same culture peers and do not derive from experiences
■ → are not used anymore since they are so hard to distinguish
sometimes, it needs context
negative symptoms
● common:
○ reduced expressivity
○ avolition: reduces self-motivated, goal oriented activities
● less common:
○ alogia: reduced speech production
○ anhedonia: reduced enjoyment
○ a-sociality: reduced interest in social activities
disorganized symptoms
● disorganized speech: waterfall speech
● catatonic behavior; motor disruption
other symptoms
● anosognosia: believe that you are not ill; reduced insight in illness
2
, ● disrupted self experience → their self has shattered not splitted (DID)
● social cognition/metacognition/mentalizing
○ abilities to understand others and the social world
● different constructs all point to structural and important, deficits in social cognition
Clinical profile:
Delusional disorder: differential diagnosis (thesis suggestion; very complex field)
● with oCD or BDD: even if the belief of catastrophe/body experience is extremely
solidified and there is anosognosia OCD or BDD fits better than delusional disorder
● with mood disorders: similar to schizoaffective disorder, symptoms of mood have to
be relatively short compared to symptoms of delusional disorder
epidemiology
● schizophrenia
○ incidence (how many per year); around 15 new cases per 100 000 persons
○ prevalence (how many people have the disorder currently): 0.7-1%
3
, Diagnostic: classification
● praecox gefuhl: feeling that you cannot reach each other
● careful: differentiate psychotic episode (or psychosis from psychotic disorder)
● (semi) structured interviews
Other symptoms
● Jumping to conclusions
● neurocognition: digit span test
Etiology
● biological/neurological perspective: dopamine hypothesis
○ strong genetic component
○ slightly more men than women
■ woman have a little more symptoms, but social functioning remains a
bit better
● Medication implies that dopamine is at the foundation of (positive) symptoms
○ but don’t barely work on negative symptoms
● Aberrant Salience model
Social factors
● being a migrant is a risk factor for development of schizophrenia
● urbanicity is a risk factor
Psychological factors
● trauma (50-98% of patients)
● 80% of patients experience their psychotic episodes as traumatic too
● prevalence PTSD comorbid 16%
● 90% of case files do not mention PTSD, though it is present
● example of development of mentalizing abilities
○ develops in early childhood, environment-driven
■ deafness/deprivation impedes development
■ association found between hearing difficulties, trauma in development
and later psychotic symptoms/disorders
■ differences were found on social responsiveness between children who
later develop schizophrenia vs. bipolar vs. controls
Explanatory models
● cognitive model for example
Etiology - so what’s the deal?
● take home message: biopsychosocial model and diathesis-stress model are the shared
foundation of most models
● neurobiological and cognitive models support one another in most cases
● on great example: social defeat hypothesis
4
