Transcript Document
Psychotic Disorders Eszter BarraJohnson, Ph.D. Remedios Varo: To be Reborn (1960) What Are Psychotic Disorders? Psychotic disorders are mental disorders in which the personality is seriously disorganized, and a person's contact with reality becomes impaired. During a psychotic episode a person is confused about reality and often experiences delusions and / or hallucinations. (Miller, J.L., 2000, AtHealth.com). Characteristics of Psychotic Disorders Delusions [inaccurate beliefs the person holds, even after being presented with accurate information; 2 kinds: Grandiose, and Persecutory]; hallucinations [internal sensory perceptions, sights or sounds, that are not really present], bizarre behavior, incoherent or disorganized speech, and/or disorganized behavior (Miller, J.L., 2000, AtHealth.com). Types of Delusions Grandiose delusion: This occurs when a person’s belief about his/her own importance or status in life is grossly out of proportion. For example, a person might believe that he / she is Jesus Christ, the Pope, or the President of the USA. Persecutory delusion: This means that a person believes there is some form of a conspiracy to harass, punish, or attack him / her (typical example: “The FBI is following me”). The person also might believe that the group to which he / she belongs is being harassed or singled out for punishment by the government or other entities. (Miller, J.L., 2000, AtHealth.com). Rare Types of Delusional D/O More rare types of delusions include Capgras syndrome, in which the person believes someone they know had been replaced by a clone; and Cotard’s syndrome, in which the person believes a part of his or her body (e.g., the brain, or some body parts) has changed in some impossible way. Types of Psychotic Disorders There are 9 main types of Psychotic Disorders, such as: (1) Brief Psychotic Episode [Psychotic symptoms last 30 days or less] (2) Schizoaffective Disorder [Psychotic episodes with mood disturbances] (3) Schizopherniform Disorder [Same criteria as Schizophrenia, but episode lasts from 16 months, and there is no deterioration of social status]. (4) Schizophrenias [Psychotic symptoms last longer than 6 months, and deterioration of occupational and social functioning is prominent. See types of Schizophrenias on the next slide] (Miller, J.L., 2000, AtHealth.com). Major Subtypes of Schizophrenias Paranoid Disorganized Catatonic Residual Undifferentiated For detailed diagnostic criteria please read the DSM-IV-TR and review the Durand & Barlow text book pp.504-505. Types of Psychotic Disorders ctd. 5. Delusional Disorder [non-bizarre delusions, situations that could occur in real life, such as being followed, poisoned, deceived, conspired against, or loved from a distance; can lead a normal social life] 6. Shared psychotic disorder (Folie a Deux or Psychosis by association) [a rare delusional disorder shared by 2 or, occasionally, more people with close emotional ties as explained here: http://www.emedicine.com/med/topic33 52.htm Types of Psychotic D/O ctd. 7. Substance induced psychosis [certain drugs and chemical substances may induce temporary delusions and psychosis] 8. Psychosis due to a general medical condition [see next 2 slides] Psychotic State / Medical Cause One or more medical conditions causing brain changes, leading to psychotic symptoms (e.g., hallucinations, delusions), A large variety of medical conditions can create psychosis, amng them neurological conditions like brain tumors, cerebro-vascular disease, Huntington's disease, multiple sclerosis (MS), epilepsy, auditory or visual nerve injury or impairment, deafness, migraine, and infections of the central nervous system. [MentalHelp.net] Psychotic state / Medical Cause II. Endocrine disturbances include increase (Hyper -,) or decrease (Hypo-) in the activity of the thyroid, parathyroid, or adrenocortical system. A decrease in blood gases such as oxygen or carbon dioxide, or imbalances in blood sugar or electrolytes are some metabolic causes of psychosis. Autoimmune disorders with central nervous system involvement such as systemic lupus erythematosus may also cause psychosis. [MentalHelp.net] Possibles-Bag 9. Psychosis - Not otherwise specified [Everything that doesn’t meet the criteria for other types of Psychotic Disorders; patient exhibits some or mixed symptoms of various Psychotic D/O] [APA, DSM-IV-TR] So, are surrealistic paintings… …created in psychotic episodes? What do you think? Remedios Varo: Vampiros Vegetarianos (1962) Or how about this one: Remedios Varo: Exploracion de las Fuentes del Rio Orinoco [The origination of the Orinoco river] (1959) …and this one? Remedios Varo: The Escape Mental Health Services USA Legal and ethical issues: Review Chapter 14 pp. 563-583. Insanity as Criminal Defense The insanity defense has been a source of intense debate among attorneys, mental health professionals and the public. The average American believes defendants are abusing this defense to avoid the consequences of their actions including capital punishment. Do you agree or disagree; and why? The Case of Andrea Yates A Houston jury found Andrea Yates not guilty by reason of insanity for admittedly killing her 5 children in 2001 by systematically drowning them in a bathtub. In her delusional state while in a psychotic episode, she thought Satan was inside her she was trying to save the kids from hell. The 42-year-old will be committed to a state mental hospital, with periodic hearings before a judge to determine whether she should be released. If convicted of murder, she would have faced life in prison. http://www.cbsnews.com/stories/2006/07/26/national/main1 837248.shtml What are your thoughts about this tragedy? This is the END I enjoyed spending time with you this evening. Have a safe and happy evening! Dr. E. René François Ghislain Magritte (1898 – 1967)