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PSYC 331
Ariel Fenster

Recent research  Zakzanis; conclusion tha the specific role of deficits in the temporal lobes has been overstated and that more diffuse dysfunction exists  MRI studies found a subtle 4% but significant bilateral hippocampal volume reduction in ppl with s  Regional volume reductions were esp marked in bilateral medial temporal lobe regions  Reported finding reduced hippocampus volume amog twins with s relative to twins without s  They reported that ppl had smaller medial temporal lobe volumes relative to controls but that the volume diff was not specific for either region or hemisphere  Reduced cerebral blood volume accompanies brain size in s and proposed that chronic cerebral blood volume eventually results in neuronal loss and cognitive impairments  The results suggested that violet ppl with s and a history of anti social and or substance use manifest neural dysfunction affecting basal or orbital pats or the prefrontal cortex Psychological stress and s  Data as show that as with other dis increased in life stress increase the likelihood of a relapse  Ppl who take pare in stress mgt program are less likely to be readmitted to the hospital the year following treatment esp if they had attended treatment session regularly  Two stressed have played an imp role in s: social class and family Social class and s  S are found in central city areas inhibited by ppl in the lowest socio economic class  The rate of s was found to be twice as high in the lowest social class as in the 2 lowest class  Found tat ppl with s are downwardly mobile in occupational status. But an equal # of studies have shown that ppl with s are not downwardly mobile  Found evidence for social selection hypothesis: of 26 patients in the lowest social class only 4 had fathers in the lowest class  The data are more supportive of the social selection theory than of the sociogenic theory  The prevalence of s among Africans from the Caribbean who remain in their native country is much lower than among those who have emigrated to London The family and s  Moms found to be rejecting, overprotective, self sacrificing, impervious to the feelings of others, rigid and moralistic about sex, and fearful of intimacy. This blamed the mom for child’s psychiatric disorder. Mother theory had not yielded supporting data  A family communication pattern characterized by hostility and poor communication produced the later onset of s or s related disorders  10% of the ppl returning to the low EE homes has relapse .in marked contrast in the same period 58% of the ppl returning to high EE homes had hone back to the hospital  it has also been fond that negative symp of s are the more likely to elicit critical comments  EE mothers are highly sensitive to excitement and depression in the patient and report a high level of burden associated with their kids illness. These mothers also have a personality characterized by high levels of conscientiousness and lowest levels of neurotism  Research indicates that both interpretations of the operation of EE –the casual and the reactive may be correct.  Two key findings emerged: 1) the expression of unusual thoughts by the patients elicited higher levels of critical comments by family members who had previously been characterized as high in EE 2) in high EE families critical comments by family members led to increased expression of unusual thoughts  Thus the study found a bi-directional relationship: critical comments by members of high EE families elicited increased expression of unusual thoughts by patients and unusual thoughts expressed by patients led to increased critical comments in high EE families  Cortisol is known to increase dopamine activity and may thereby increase the symp of s. thus theory suggest a bi-directional relationship between HPA activation and dopamine activity Developmental /high risk studies of s  Found that kids who later developed s had lower Iqs than did members of various control groups  Teachers described s boys as disagreeable in childhood and pres girls as passive  Both men and women were described as delinquent and withdrawn in childhood  Pres kids showed poorer motor skills and more expressions of negative affect  Negative symp s was preceded by a history of pregnancy and birth complications and by a failure to show elctrodermal response to simple stimuli. Positive symp s was precede by a history pf family instability such as separation from parents and placement in foster care  New York high risk study found that a composite measure of attentional dysfunction predicted beh disturbance at a follow up.  Low IQ was a characteristic of the 1 high risk kids to be hospitalized  In an Israeli study poor neuorbeh functioning predicted s –like outcomes as did earlier interpersonal problems  Participants who developed a psychotic disorder relative to those who didn’t had reduced gray matter volumes suggesting that lower grey matter volume predates the onset of psychotic disorders including s THERAPIES FOR S  Hospital care does little to effect changes in majority of mental disordered ppl  A major problem with any kind of treatment for s is that nay ppl lack insight into their impaired condition and refuse any treatment. They don’t see the need for professorial treatment  This is esp true of those with paranoid s who may regard any therapy as a threatening intrusion by hostile outside forces  Family members therefore face a major challenge in getting their reactive to get help which is one reasons they sometimes turn to involuntary hospitzlaitzioan via civil commitment as a last resort to lobby for community treatment disorders  Clinicians who treat s also face challenges including: risk of patient suicce, and the possibility of violent beh, nonadherence of the preferred tretamemy regimen, relapse of symp, and deterioration of functioning over time.  The ultimate goal of treatment is to help the ppl to remain or re -enter and function in the community biological treatments shock and psychosurgery  early 1930s practise of inducing coma with large dosages of insulin was introduced by Sakel who claimed that up to three quarters of s he treated showed significant improvement. Coma and death though and abandoned  electro conclusive therapy was also used after its develop in 1938 by cerletti and bini—it too proved to be only minimally effective  in 1935 moniz a Portuguese psychiatrist introduced the prefrontal lobotomy—a surgical procedure that destroys the tracts connecting the fontal lobes to lower centres of the brain. His initial reports claimed high rates of success.  A related procedure known as a leucotomy is a more circumscribed and specific procedure than a lobotomy. The lobotomy procedure was used especially for those whose beh was violent. Many patients did indeed quiet down after undergoing a lobotomy and could even be discharged from hospitals  After surgery many patients became dull and suffered serious losses in their cognitive capacities. This is not surprising given the destruction of the parts of their brains believed to responsible for thought 
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