PSYC30014 Lecture Notes - Lecture 2: Emil Kraepelin, Clanging, Waxy Flexibility
10 May 2018
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Lecture 2
- Louis Wain - a visual artist; subject matter often included cats; continued to produce
art as he developed schizophrenia
- Art changed in characteristic ways as his experience of the world changed -
repeating patterns, fractal patterns
- Louis’ experience of the world esp his visual world, and how he represented his
visual world internally and how he expressed it through his art, was changing in
profound ways (Louis’ experience of reality was becoming very different to that which
is generally agreed upon)
- Hallmark of psychosis - experience of reality different to that which is generally
agreed upon
- Experience can manifest in terms of visual perception (perceptual abnormalities,
hallucinations) or any perception (beliefs about what’s happening in the world that is
inconsistent with what everybody else believes [false beliefs]), can also be expressed
in terms of behaviour and cognition (thought disorder)
- Myth: individuals with psychotic disorders all have the same symptoms [psychosis is
a uniform experience]
- Generally manifests in terms of: individuals with psychotic disorders are violent and
hear voices
- Term ‘psychosis’ is an umbrella terms meaning ‘out of touch with reality’ [intending to
suggest that there is a fracturing from a generally agreed upon reality ]
- Not necessarily hear voices, very unlikely that violence is expressed by people with
psychotic disorders [someone with psychotic disorder diagnosis is more likely to be a
victim of violence]
- Can refer to a variety of clusters of symptoms - psychotic symptoms can occur in a
range of disorders including: organic presentations like dementia, substance use -
amphetamine psychosis and so on, range of medical experiences as well
- Within each disorder can be a completely heterogenous experience [experience in
terms of signs and symptoms of psychosis can vary considerably]
- When considering potential diagnosis for client around psychosis → also working with
medical professional and getting a range of necessary tests done to check for
medical illnesses (rule those out)
- At the disorder level, psychosis refers to a group of disorders distinguished from one
another in terms of:
- → symptom configuration (e.g. delusional disorder versus schizophrenia) ⇒ non-
bizarre [delusional disorder, someone is in love with you but no evidence of this and
they’re not in love with you, may have evidence of contrary but sustain false belief] vs
bizarre delusion [schizophrenia, not likely to be true based on our agreed upon
generally take on reality, unlikely that someone is psychically controlling me and
making me do and feel things, not possible based on how we scientifically
understand the world]
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- → duration (e.g. schizophrenia versus schizophreniform disorder) ⇒ less or more than
6 months [similar based on symptom profile but distinguished based upon length of
time that disturbances are present; 1-6 months ⇒ schizophreniform disorder, longer
than 6 months with exact same symptoms ⇒ schizophrenia]
- → relative pervasiveness [of symptom profile, when collect info from new client and
corroborating sources and trying to formulate what is going on and what is the core of
the disturbance, what symptoms and signs are driving the disturbance → if psychotic
features + mood component ⇒ schizoaffective disorder; but if mood component
driving the disturbance and also psychotic features that tend to co-occur with mood
component ⇒ bipolar disorder] - in terms of both duration and the clinical picture - of
psychotic symptoms versus affective symptoms (e.g. bipolar disorder and
schizoaffective disorder) Which is the core?
- The term ‘schizophrenia’ refers to ‘split mindedness’ or ‘a mind torn asunder’
(Bleuler) - schizophrenia is not a multiple personalities as commonly perceived (DID -
dissociative identity disorder)
- Involves disruption in various aspects of perceiving, thinking, feeling, and behaviour
- Symptoms involve a fracturing of associative threads in terms of cognition,
perception, behaviour
- Phenomena associated with schizophrenia can be classified into two major groups of
symptoms - positive symptoms and negative symptoms
- Positive symptoms - additive to normal experience
- Negative symptoms - deficit in normal function
- Positive symptoms:
- → Hallucinations - a percept in the absence of corresponding environmental stimuli,
hallucinations occur in any sensory modality [olfactory - smell, tactile - touch,
gustatory - taste, auditory - can be ringing phone or bells or whistles (most
common)], of which auditory is the most common then visual; one can have a
perceptual experience in the absence of the corresponding environmental stimulus;
may co-occur across senses (see a visual hallucination at the same time experience
an auditory hallucination)
- → Delusions - a false belief (both bizarre and non-bizarre, both primary [not attached
to another symptom] and secondary [might manifest in response to hallucination,
hear a voice talking to you ⇒ might form explanation for that experience in the form of
a delusion; delusion attached to hallucination experience but it’s secondary to that]),
persecutory (someone has ill intent for you), ideas (delusions) of reference (believe
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that something you see or hear in daily life has got a special meaning just for you
[sign on street, tv, lecture slides has got a special meaning just for you]), grandiose
[believe you’ve got some special type of attribute that others do not have] (plus
religious [believe you’re a deity]), somatic delusions [beliefs about body, arm is not
yours], passivity phenomena (e.g. thought insertion [thoughts have been planted
there by external agent], thought withdrawal [blocking moment, mind goes blank,
thoughts taken away from you by external agent], thought broadcasting, delusions of
control [made actions, made feelings, made impulses], mind reading)
- Positive formal thought disorder: (predominantly observable through speech,
cognitive disorganisation here that is expressed through speech)
- → Clanging: speech pattern based on phonological association rather than semantic
or syntactic, someone speaking to you → utterance doesn’t make sense (not formed
on the basis of the syntactic rules govern the way we put language and sentences
together), words and sounds that are coming out are based in sequence of
phonological association (sound similar, a lot of rhyming sort of sounds)
- → Circumstantiality: speech including unnecessary or irrelevant detail. Goal is
eventually reached
- → Flight of ideas: sequence of loosely associated concepts are articulated.
Sometimes rapidly changing from topic to topic (influenced by distractibility, person is
trying to tell you something but then gets distracted by something else present, might
be speaking in terms of a range of things that just pop into awareness because there
are other things that are present through perception)
- → Derailment: speech train steers off-topic to unrelated things
- → Incoherence: word salad. Incomprehensible speech
- → Pressure of speech: excessive spontaneous speech production and rapid rate.
Difficult to interrupt (very common when dealing with thought disorders and psychotic
disorders, person can’t get all the speech out to you → speaking rapidly, seemingly
endless stream, very difficult to interrupt; very challenging when working in a time-
limited situation such as assessment, therapy session → certain ways to work with it
and contain pressured speech, requires skill acquisition)
- Negative symptoms: (impairments, deficits)
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