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PSYCH 257 (141)


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Allison Kelly

S CHIZOPHRENIA &P SYCHOTIC D ISORDERS Today’s Questions 1. How are auditory hallucinations different from the “voices” we all hear in our heads? 2. Can delusions be adaptive and helpful in some way? 3. What is the best possible outcome for someone with schizophrenia? Outline 1. The nature of schizophrenia and psychotic disorders 2. Causes of schizophrenia and psychotic disorders 3. Treatments and outcomes THE NATURE OF SCHIZOPHRENIA AND PSYCHOTIC DISORDERS a) Overview b) Symptoms c) Diagnostic groups Overview of Schizophrenia  Broad spectrum of cognitive, emotional, and behavioural dysfunctions  Different classes of symptoms o Positive o Negative o Disorganized  Different subtypes Symptoms of Schizophrenia Positive Symptoms  Active manifestations of abnormal behaviour, or an excess or distortion of normal behaviour o Delusions o Hallucinations Delusions  Gross misrepresentations of reality  Various types o Bizarre o Non-bizarre Types of Delusions  Of guilt or sin (usually bizarre)  Somatic (bizarre or non) o Belief that ones body or appearance is altered  Persecutory (bizarre or non) o Belief that your being watched and conspired against  Of reference (usually bizarre) o Belief that random events are directed at oneself – meant for oneself  Grandiose (bizarre or non) o Believing that you have great power – something you were meant to do on this world  Of being controlled (usually bizarre) o People feeling that they have been micro chipped Hallucinations  Experience of sensory events without input from surrounding environment  Auditory o Feel like they’re hearing voices  Visual  Tactile: touch  Somatic: in body  Olfactory: smelling Negative Symptoms  Absence or insufficiency of normal behaviour o Avolition: absence of motivation or to start behaviours  Often with everyday things o Alogia: Relative absence of speech o Anhedonia: Absence of pleasure or general interest in pleasurable activities o Affective flattening: People showing subdued emotions – not reacting in correct way o Asociality: Deficit in motivation to form relationships = poor social skills Disorganized Symptoms  Erratic behaviours that affect speech, motor behaviour, and emotions o Inappropriate affect: Laughing or crying when not appropriate o Disorganized behaviour: dressing strangely, inappropriate sexual activity o Catatonia: motor dysfunctions: immobile, or sporadic o Disorganized speech: speech that does not make sense Examples of Disorganized Speech  Cognitive slippage: Speaking in an illogical, incoherent ways  Tangentiality: Response to question shifts … Switch from subject to subject without relation  Clang associations: speaking with words that sound similar without going together o There’s a dog on a frog sitting on the log  Word salad: words combined: no sense  Neologisms: made-up words Schizophrenia DSM-IV Criteria  2 or more of the following, each present for a significant portion of time during a 1 month period: o Delusions o Hallucinations o Disorganized Speech o Disorganized or catatonic behaviour o Negative symptoms  Only one Criterion A symptom required if : o delusions = bizarre OR o hallucinations = voice keeping a running commentary on person’s behaviour or thoughts OR 2 or more voices conversing with each other Subtypes of Schizophrenia  Paranoid type o Most common o Hallucinations and delusions have theme: persecuted etc… o Cognitive skills intact o Best prognosis  Disorganized type o Experience disorganized symptoms, if they have hallucinations and delusions they seem to be fragmented o Poor prognosis  Catatonic type o Marked symptoms: Cattatonic, non responsive to environment. o Rare – Quite severe  Undifferentiated type o Not-Otherwise Specified: doesn’t fit  Residual type o Have at some point met criteria for schizophrenia, but no longer meet Other DSM-IV Psychotic Disorders  Schizophreniform Disorder o People who have symptoms of schizophreni
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