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Joe Kim

Module 1 – Schizophrenia Introduction Holds much public attention, research, and fascinations There is no “main symptom” of schizophrenia: hard to find specific traits or characteristics that are shared by all persons with this diagnosis. Instead, patients often have a combination of different types of symptoms. Symptoms of Schizophrenia Positive symptoms: behaviours that increase in someone with schizophrenia Negative symptoms: behaviours that decrease in someone with schizophrenia Catatonic behaviours: consist of movement behaviours that an individual exhibits which are not in response to any event in the environment. Any given patient may experience only some of these symptoms, and the severity of symptoms varies widely from one case to another. Positive Symptoms Disorders of thought: schizophrenic thinking is characterized by loose associations; the individual’s train of thought may consist of ideas that are often only loosely related to each other. Speech may be vague and abstract, ex.: “I wish you a happy, joyful, healthy, blessed and fruitiful year, and many good wine-years to come as well as a healthy and good apple-year, and sauerkraut and cabbage and squash and seed year.” Patient started making associations with the word fruit and trailed off from his original intent. Delusions: The content of schizophrenic thought is often unusual. May contain fragmentary or bizarre delusions. A delusion is a belief that is irrational, or unsupported by external evidence. Common delusions involve the idea that the individual is being persecuted by others, or that events or objects have special significance for the individual. Ex.: may think that a character on television is speaking to or about them directly. Very often delusions are about thought or thinking itself: these may include the delusion of thought broadcast – the belief that others can hear one’s thoughts, or thought withdrawal, the belief that thoughts are being removed from his head before he can think them, or thought insertion, the belief that thoughts are being place in the individual’s head by others. Hallucinations: perceptions of things that are not really there. Auditory hallucinations are more common than visual hallucinations. The individual may report that she hears voices in her head, or speaking to her from parts of her body. These voices are usually saying negative things, commenting on the individual’s behaviour, or giving orders. Negative Symptoms Decrease in the individual’s engagement with the outside world. Individual may become less and less interested in people and events in the outside world, and more concerned with internal ideas or fantasies. Lead to growing estrangement from family and coworkers, and an increasing neglect of one’s personal appearance. Emotional responses may also change. Affect: refers to emotional responsiveness. A person with a flat or blunted affect shows very little emotional response. A patient with inappropriate affect shows emotional reactions that are inappropriate to the situation. Ex.: laugh when speaking about the loss of a family member. Catatonic Behaviour Unrelated to stimuli from the outside world. May involve a dramatic reduction in movement, sometimes to the point of ceasing to move at all = cationic rigidity, or catatonic stupor. Individual may maintain a single posture for very long periods of time, and resist being moved. In other cases, catatonia involves a kind of “waxy flexibility’. A patients arms and legs can be moved into a variety of positions – like a wax figure – and then very slowly move back to the original position. May be repeated or stereotyped motor movement that seem to have no purpose at all, and are unrelated to what is going on around the person. Sometimes involve very active or even frantic movements, a state called catatonic excitement. Subtypes of Schizophrenia DSM recognizes several subtypes of schizophrenia which are based on the pattern of symptoms that dominate the clinical presentation. Paranoid schizophrenia: dominant symptom is delusions or auditory hallucinations with a single theme. Apart from the delusion, the individual’s thinking may be relatively coherent, with no disturbed affect, or psychomotor disturbances. Shows anger or anxiety related to the disturbing content of the delusions. Catatonic schizophrenia: dominant symptoms are psychomotor disturbances. These may include catatonic stupor, catatonic excitement, or alternation between the two. There may be stereotyped postures or mannerisms, together with waxy flexibility. Disorganized schizophrenia: considered to be the most severe and disruptive of all types of schizophrenia. Thought and speech are markedly incoherent, with very loose associations, and disorganized behaviour. Shows flat or inappropriate affect, and any delusions present are incoherent ad fragmentary. May be marked psychomotor disturbance, and profound social withdrawal. Some cases of schizophrenia do not neatly fit into one of the established subtypes. Researchers can disagree about the appropriate characteristics that define a specific subtype. Undifferentiated schizophrenia is used to categorize cases which do not fit into any of the other three categories. Causes of Schizophrenia Thought to develop when there is a genetic predisposition for the disorder and some environmental stress that triggers the symptoms (diathesis-stress hypothesis). Epidemeological evidence for genetic predisposition is very consistent. Ex.: probability that an individual will develop the symptoms of schizophrenia increases the more closely he or she is related to someone who has the disorder and identical twins are more likely than fraternal twins to both have schizophrenia. Adoption studies: schizophrenia is more common in biological relatives of adoptees than in non- related members from their adoptive families. Not clear what this inherited disposition is. Some researchers believe that it is abnormalities in brain structure or changes in levels of neurotransmitters. Not sure what environmental events trigger schizophrenic symptoms. Stress and problems, with relationships with others, especially immediate family, are possible causes. Evidence of higher levels of dysfunction in the families of schizophrenics, but it’s difficult to tell whether it was there before the disorder appeared, or occurred as the family tried to deal with the individual’s symptoms. Treatments of Schizophrenia For many years, the only ‘treatment’ for schizophrenic symptoms was chronic care. Left untreated, it is among the most debilitating of all disorders. 1960’s: effective drug treatments became widely available. Now the most common therapy. Drugs are not equally successful with all patients, or with all types of symptoms. Most drugs that are effective against the symptoms have unpleasant side effects of their own. Some patients would rather experience symptoms of schizophrenia than the side effects of the drug which can affect compliance rates. Psychotherapy alone does not help very much in treating the major symptoms of schizophrenia. But may help the patient develop new coping strategies once drugs have relieved their symptoms. CBT, patient is taught how to think about the psychosis in ways that allows him to better cope. Learn to identify and avoid triggers or learn positive ways to react to these triggers. Often used to encourage patients to comply with medicinal instructions though rewarding adherence. CBT also addresses environmental factors that may have triggered the illness and continue to contribute to it. Some studies show that many of the families of people with schizophrenia have environments of conflict and stress that can act as a trigger for psychotic episodes, or make it harder for patients to cope with their symptoms. Family therapy aims to teach families how to interact in positive and supportive manner. Family therapy also helps to educate the family about schizophrenia and teach them how to react to episodes and best support the patient. Module 2 – Dissociative Disorders Introduction Category of disorders that was historically confused with schizophrenia. Symptoms that distance the individual, either physically or psychologically, from anxiety- producing events or memories. Dissociative Identity Disorder
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