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Lecture 7

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PSYC 3604
Connie Kristiansen

PSYC3604 March 3 & 10, 2014 Goals for today’s class… - have the rest of the notes in my tablet • Chapter 11: Schizophrenia – How do we understand and classify Schizophrenia and the other Psychotic Disorders? – What do we know about possible causes and treatments? From the text… • Chapter 11: Schizophrenia – What are the characteristics of Schizophrenia and the other Psychotic Disorders? – What are the various symptoms? – What are the different types of Schizophrenia? – What is happening in the brain of someone with Schizophrenia? – What might be the cause of Schizophrenia (various theoretical approaches)? – What treatments are available for Schizophrenia? How do these work? The Psychotic Disorders • Psychoses: A class of psychological disorders where reality contact (the ability to successfully interact with one’s environment) is impaired. – when you loses the contact with reality – when you experience what ppl does not experience • Psychotic – delusions or prominent hallucinations, with the hallucinations occurring in the absence of insight into their pathological nature. Or, could also include prominent hallucinations that the individual realizes are hallucinatory experiences. An even broader definition would also include other positive symptoms of Schizophrenia (i.e. disorganized speech, grossly disorganized or catatonic behaviour). – psychotic when you experience delusions or hallucinations. The client may recognized that their delusions/hallucinations are wrong but some have poor insight and might be resistant to accepting evidence and continue to hold on their delusions/hallucinations DSM: Schizophrenia Spectrum & Other Psychotic Disorders • Schizotypal Personality Disorder • Delusional Disorder, Brief Psychotic Disorder, Schizophreniform Disorder, Schizophrenia, Schizoaffective Disorder, Substance/Medication-Induced Psychotic Disorder, Psychotic Disorder due to another medical condition • Catatonia associated with another mental disorder, or another medical condition, or unspecified catatonia • Other specified, or unspecified, schizophrenia spectrum and other psychotic disorders Key Features • Positive symptoms – appear to reflect an excess or distortion of normal functions. – when symptoms are exaggerated, it includes delusions and hallucinations, disorganized speech/behaviour ( or catatonic – when you’re not responsive to external cues) – Including distortions in thought content (delusions), perception (hallucinations), language and thought processes (disorganized speech), and self-monitoring of behaviour (grossly disorganized or catatonic behaviour). – Two dimensions of positive symptoms • “psychotic dimension” includes delusions and hallucinations • “disorganized dimension” includes disorganized speech and behaviour • Negative symptoms – appear to reflect a diminution or loss of normal functions. Key Features: Delusions • Delusions: erroneous beliefs that usually involve a misrepresentation of perceptions or experience, and are resistant to change even in the face of conflicting evidence. Content may include a variety of themes. – they are irrational beliefs, when you misinterpret stimulus they are resistant to change despite when ppl they them this is not correct but other do know that this is not correct – Persecutory delusions are the most common – the person believes they are being tormented, followed, tricked, spied on, or ridiculed. – when you believed that ppl are after you, that ppl are tormented you, spying on you, can be that government is spying on my sister – Referential delusions – believes that certain gestures, comments, passages from books/newspapers, song lyrics (etc.) are directed at them. – belief that everything is directed to you – that news papers are talking about, they collect news paper thinking that their a code in there for them Key Features: Delusions • Delusions: – Grandiose delusions – believes they have exceptional abilities, wealth, or fame – when - you believe that you’re someone important, believe that youre Jesus, belied that their are special they have some kind of ability, fastet person in the planet, believed that they are rich, famous – Erotomanic delusions – believes that another person is in love with him/her- believe that someone of high status is in love with you – Nihilistic delusions – believes that a major catastrophe will occur –ex: tornado will happen, like the end of the near – Somatic delusions – believes that health or organ function is at risk- believe that ex: foreign heart as being inserted in them, that they had heart surgery without the operational scar, they are worried about their health – these are bizarre delusions Key Features: Delusions • Delusions: – Delusions can be bizarre if they are clearly implausible, do not derive from ordinary experience, and are not understandable to peers. • Bizarre (things that cannot happen) – belief that an outside force has removed my internal organs and replaced them with someone else’s organs (without leaving scars).which are: – Thoughts withdrawal: when believe that the government by example is removing your thoughts – Thoughts insertion : things are being inserted in my body – Delusion of control : outside force that is manipulating my body • Nonbizarre (things that can be plausible) – belief that I am being watched by the police or government. Key Features: Hallucinations • Hallucinations: Perception-like experiences that occur without an external stimulus. – See things without actually being there, and there are Vivid and clear. Not under voluntary control. Can occur in any sensory modality (auditory, visual, olfactory, gustatory, tactile). – Can see, taste, hear, smell, sense – Auditory are most common – usually experienced as voices (familiar or unfamiliar) that are perceived as distinct from the person’s own thoughts.- these auditory are different from your thoughts Key Features: Disorganized Thinking (Speech) • Disorganized thinking/thoughts (“thought disorder”) - due to difficulty in diagnosing “thought disorder” and because this is usually based on the individual’s speech, the emphasis here is on disorganized speech. – hard to diagnose because cannot access your thoughts, but the speech pretty derails ( sometimes called loose associations) do not follow one concept, tangibility ( when answers are not related at all to the question) and severe level when its incoherent “ word salad” when you get bits and bits but are not in logical order – Derailment or loose associations – Tangentiality – Incoherence or “word salad” Key Features: Grossly Disorganized or Abnormal Motor Behaviour • Grossly Disorganized Behaviour – may manifest in a variety of ways, including childlike silliness to unpredictable agitation. – hard to perform and complete goal directed behaviours, can like run around act like a kid, move in repetitive pattern – May involve difficulties in performing goal-directed behaviours. - Key Features: Catatonia • Catatonic Motor Behaviours – include a marked decrease in reactivity to the environment – when you pretty do not react to the environment – Negativism – resistance to instructions – Catatonic mutism and stupor – complete unawareness- standing there emotionless – Catatonic rigidity – rigid posture- be a posture can;t move them they stay in their posture for a long time – Catatonic posturing – assuming bizarre postures- when stay long time in an uncomfortable pause – Catatonic excitement – purposeless excessive motor activity – movement are really exaggerated and done in purpose Key Features: Negative Symptoms • Diminished emotional expression- their tone of voice is monotone, and do not have facial expression, will have no eye contact • Avolition – lack of motivated/self initatited behaviour ex: go pee, they will just sit and do nothing • Alogia- refer as cognitive speech they replies are short and brief, they do nit communicate anything useful • Anhedonia- lack of ability to experience of pleasure • Asociality- lack of any pleasure in social activity/social interactions Schizophrenia- full diagnose of schizorphrenia is that it must last for up to 1 month and some symptoms must persist for atleast 6 months usually on the negative side, must have atleast 2 must one must be delusions or hallucinations or disorganized speech • Schizophrenia: essential features are a range of cognitive, behavioural, and emotional dysfunctions that have been present for a significant portion of time during a 1-month period, with some signs of the disorder persisting for at least 6 months. • Two (or more) of the following, present for a period of at least 1 month. At least one of these must be 1, 2, or 3. 1. Delusions 2. Hallucinations 3. Disorganized speech (e.g. Frequent derailment or incoherence) 4. Grossly disorganized or catatonic behaviour 5. Negative symptoms Schizophrenia • Since onset, level of functioning in one or more areas (self-care, work, interpersonal relations, etc.) must be markedly below the level achieved prior to onset. • Continuous signs of disturbance must be present for at least 6 months. • Not better accounted for by Schizoaffective Disorder or a Mood Disorder with psychotic features, and is not due to a general medical condition or substance- induced. • Resuming this bullet pt: • their level of functioning must be impaired (firt bullet point) • the signs last for atleast 6 months (some lingering symptoms)- but before 6 months can;t do the office diagnose • 3rd bullet pt: schizophrenia does not meet schizoaffective disorder or mood disorder with psychotic features • its not due to medical or subtance abuse Schizophrenia Subtypes • Schizophrenia Subtypes: Paranoid, Disorganized, Catatonic, Undifferentiated, Residual 6. Often symptoms of more than one subtype are present. 7. how we differentiate the subtypes follow the order of classification 8. order of classification: 1. Catatonic (whenever prominent catatonic symptoms are present)- if they dont have catatonice move on to the next one and so on, but must write the catatonic symptoms 2. Disorganized - in terms of speech and behaviour , 3. Paranoid - in order for the client to be given the paranoid subtype the client cannot have disorganized or catatonic symptoms same goes for all, to be diagnose with the subtypes they must ont exhibit the symptoms of that subtype 4. Undifferentiated (a "catch-all" category describing presentations that include prominent active-phase symptoms not meeting criteria for the first 3) - this is when client does not fit well with the previous subtypes 5. Residual (for presentations in which there is continuing evidence of the disturbance, but the criteria for the active-phase symptoms are no longer met).- when full on symptoms are nor rlly present anymore but are left with lingering symptoms Schizophrenia Subtypes • Paranoid - preoccupation with one or more delusions or frequent auditory hallucinations (but not disorganized speech, disorganized or catatonic behaviour, flat/inappropriate affect) - delusion are present, or auditory hallucinations it is possible to experience minor hallucions but they are connected to delusions • Disorganized - all of the following are prominent: disorganized speech, disorganized behaviour, flat or inappropriate affect (criteria are not met for catatonic type)- the big one is disorganized speech, behaviour, • Catatonic - at least two of the following: motor immobility, excessive motor activity, extreme negativism (motiveless resistance to all instruction or attempts to be moved), peculiarities of voluntary movement (posturing)- cliet must have atleast 2 of the: cannot sit still, their movement is extreme, relly negative • Undifferentiated - some of the characteristic symptoms are present (i.e. delusions, hallucinations, etc.) but does not meet the criteria for the first three subtypes • Residual - absence of prominent delusions, hallucinations, disorganized speech/behaviour. Continuing evidence of the disturbance as indicated by the presence of negative symptoms (or limited characteristic symptoms - e.g. odd beliefs)- so when you only experience negative symptoms last for 6 months Videos: - john nash- beautiful mind ( the real guy): they experience the paranoid subtype Paronoid subtypes: can either be highly functional or no when they derale - disorganized subtype: often their speech are incorate, incoprehensive and disorganized behaviour, he also shows inappropriate affect Schizophrenia Course- the development of schizophrenia starts with 3 mains phases • Prodromal phase - In some cases, onset may be sudden ("reactive" or "good premorbid"). However, in other cases the onset may be protracted over years ("process" or "poor premorbid"). - the begining of the symptoms are prodomal phase: onset might be due to traumatic, stressful stimulus and the person experience symptoms and then leave and then come back fully, here their is a strong stressful, said to be good premordid because all we have to do is to deal with the stressor for the symptoms to subtue or go away. In some cases ppl the symptoms might be reative/good premorbid when the symptoms are sudde, while others the symptoms come take years to actually start: this call process or poor premorbid: no clear stressor which makes hard to access what we should deal for the symptoms to go away, it associated with worse outcome because client is stuck with this active.residual phase : john nash and his son have this process phase, • Active phase - patient shows prominent symptoms of schizophrenia- it the full onset of symptoms, • Residual phase - (active phase is usually followed by residual phase) patient shows symptoms similar to prodromal phase (i.e. blunted affect)- the full onset (active phase) kinda takes a break: this is the residual phase, here the person has the symptoms that the had during the prodromal phase • Typical pattern is to fluctuate between Residual phase and Active phase. ( normal pattern active-residual-active-residual) onset: ppl are most likely to suffer from schizophrenia from the age of 16-25 but see less ppl suffering as the age : less ppl from the age 75 or more. Males are most likely to be attain of schizophrenia at the age of 16-25,26-35, b
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