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Schizophrenia (2).docx

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McMaster University
Richard B Day

November 28 , 2012 Psych 2AP3: Abnormal Psychology – Major Disorders Schizophrenia (2) Subtypes of Schizophrenia - paranoid schizophrenia:  delusions, hallucinations on single theme, tend to be delusions of persecution  the delusions and hallucinations tend to be about the same thing all the time, the same set of delusions, consistent, fairly organized delusions, central theme in which a wealth of beliefs are built  characterized primarily by positive symptoms, prognosis is better  based on prominence of particular symptoms - disorganized schizophrenia:  incoherence, flat affect, fragmentary delusions, avolition  thought and expression is very disturbed and difficult to understand  may have delusions but are not organized around a single theme, may change, fragmentary  most debilitating and most disturbed of all the subtyped  dominated by negative symptoms - catatonic schizophrenia:  psychomotor disturbance; stereotypes: stupor or excitement, stereotyped movement or posture patterns  very rare - undifferentiated schizophrenia:  similar to NOS  uncategorizeable psychotic symptoms: involves or reflects a distancing of the individual from reality, can involve not knowing where they are, delusions, hallucinations - residual schizophrenia Course of schizophrenia - has a prognosis that is not all that bad - one episode, full remission: 25% of cases - episodic (still show symptomatology in between episodes), partial remission: 25% of cases - episodic (fine in between episodes), full remission: 20% of cases - episodic, becoming chronic, become longer, period of remission becomes shorter, eventually permanent (chronic): 15% of cases, typically negative symptoms predominate - chronic deterioration: 15% of cases, symptomatology that begins early in life, tends to be dominated by negative symptoms, get more symptomatic, more intense, present all the time and getting worse in number and intensity Epidemiology - point prevalence:  U.S. & Canada: 50-70/10,000 at any one moment - lifetime prevalence:  U.S. & Canada: 100-190/10,000  U.S. & Canada: 150/10,000 - onset in adolescence, early adulthood:  usually diagnosed 18-35 years  symptoms fairly early, diagnosis does not come for few more years - more males than females:  1.0/1.0 – 2.0/1.0 male female ratio Etiology: Psychological - Psychodynamic:  Libido withdrawn, can’t relate to others;  Hallucinations, delusions compensate - schizophrenogenic mother:  mother aloof, rejecting, overprotective or overtly hostile - Bateson’s double-blind:  Parent asks for closeness, but rejects it - Singer & Wynne (1963):  Parental communication vague, incoherent - largely abandon along with sociocultural hypothesis Etiology: Brain structure - enlargement of cerebral ventricles:  fluid filled spaces in the middle of the brain that contain cerebral spinal fluid and connect to spinal cord  fewer cells/loss of cells in the area of cerebral ventricles that leads them to become enlarged  proportion of patients varies widely (6-60%)  perhaps older patients (over 50) only: we can’t tell whether or not the enlargement preceded the symptoms of schizophrenia or not  enlargement associated with:  poor premorbid functioning  associated with older individuals  prior to the diagnosis the individual were not functioning optimally prior to their diagnosis  age and/or chronicity: individuals who show chronic symptoms  negative symptoms  cognitive impairment
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