PSYB32H3 Lecture Notes - Reduced Affect Display, Waxy Flexibility, Alogia

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23 Jun 2011
Chapter 11 Schizophrenia
schizophrenia a group of psychotic disorders characterized by major disturbances in thought, emotion,
and behavior; disordered thinking in which ideas are not logically related; faulty perception and attention;
bizarre disturbances in motor activity’ flat or inappropriate emotions; and reduced tolerance for stress in
interpersonal relations; the patient withdraws from people and reality, often into a fantasy life of delusions
and hallucinations
- estimates in the prevalence in the population vary between 0.2-2%, in part dependent upon the
measurement instrument; however, its lifetime prevalence is about 1%
- the incidence is significantly higher in males than in females (male:female ratio = 1:4)
- although schizophrenia sometimes begins in childhood, it usually appears in late adolescence or early
adulthood, somewhat earlier for men than for women
- people with schizophrenia typically have a number of acute episodes of their symptoms; between
episodes, they often have less severe but still very debilitating symptoms
- most people with schizophrenia are treated in the community, however, hospitalization is sometimes
- in Canada, hospitalization rates are typically much higher among young men relative to young women
- about 10% of people with schizophrenia commit suicide
- 50% of people with schizophrenia have comorbid disorders
Schizophrenia and Comorbidity
- comorbid conditions appear to play a role in the development, severity, and course of schizophrenia
- comorbid substance abuse is a major problem for patients with schizophrenia, occurring in as many as
70% of them
- research suggests that childhood conduct disorder problems are potent risk factors for substance use
disorders in schizophrenia
- there’s comorbidity between schizophrenia and depression
- comorbid anxiety disorders are also common and can impose an additional burden on people with
schizophrenia and result in further decline in their perceived quality of life
- comorbidity with OCD is also related to a previous history of suicidal ideation and suicide attempts
- PTSD is highly prevalent and underdiagnosed among military veterans with schizophrenia
Clinical Symptoms of Schizophrenia
- the symptoms of patients with schizophrenia involve disturbances in several major areas: thought,
perception, and attention; motor behavior; affect or emotion; and life functioning
- no essential symptom must be present for a diagnosis of schizophrenia
Positive Symptoms
positive symptoms in schizophrenia, behavioral excess, such as hallucinations and bizarre behavior
- positive symptoms comprise excess or distortions, such as disorganized speech, hallucinations,
and delusions
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- positive symptoms define an acute episode of schizophrenia
- positive symptoms are the presence of too much of a behavior that is not apparent in most people, while
the negative symptoms are the absence of a behavior that should be evident in most people
Disorganized Speech
disorganized speech (thought disorder) speech found in schizophrenics that is marked by problems
in organization of ideas and in speaking so that others can understand
- this refers to problems in organizing ideas and speaking so that a listener can understand
incoherence in schizophrenia, an aspect of thought disorder wherein verbal expression is marked by
disconnectedness, fragmented thoughts, and jumbled phrases
- people with schizophrenia, although they may make repeated references to central ideas or a theme,
the images and fragments of thought are not connected; its difficult to understand exactly what the
patient is trying to tell the interviewer
loose associations (derailment) in schizophrenia, an aspect of thought disorder wherein the patient
has difficulty sticking to one topic and drifts off on a train of associations evoked by an idea from the past
- with loose associations (derailment), the patient may be more successful in communicating with a
listener but has difficulty sticking to one topic
- evidence indicates that the speech of many patients with schizophrenia is not disorganized and that the
presence of disorganized speech doesnt discriminate well between schizophrenia and other psychoses,
such as some mood disorders
delusions beliefs contrary to reality, firmly held in spite of evidence to the contrary, common in
paranoid disorders
- delusions, which are common beliefs contrary to reality, are common positive symptoms of
- please see page 327-328 for examples of delusions
- although delusions are found among more than half of people with schizophrenia, as with speech
disorganization, they’re also found among patients with other diagnoses notably, mania and delusional
- the delusions of patients with schizophrenia are often more bizarre than those of patients in other
diagnostic categories; their delusions are highly implausible
Hallucinations and Other Disorders of Perception
- patients with schizophrenia often report that the world seems somehow different or even unreal to them
hallucinations perceptions in any sensory modality without relevant and adequate external stimuli
- the most dramatic distortions of perception are hallucinations, sensory experiences in the absence of
any stimulation from the environment; they’re more often auditory than visual
- some hallucinations are thought to be particularly important diagnostically because they occur more
often in patients with schizophrenia than in other psychotic patients; these types of hallucinations include:
some patients of schizophrenia report hearing their own thoughts spoken by another voice
some patients claim that they hear voices arguing
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some patients hear voices commenting on their behavior
Negative Symptoms
negative symptoms behavioral deficits in schizophrenia, such as flat affect and apathy
- the negative symptoms of schizophrenia consist of behavioral deficits, such as avolition, alogia,
anhedonia, flat affect, and asociality
- these symptoms tend to endure beyond an acute episode and have profound effects on the lives of
patients with schizophrenia
- the presence of many negative symptoms is a strong predictor of a poor quality of life (eg: occupational
impairment, few friends), 2 years following hospitalization
- in addition to prognosis, there is also some evidence that negative symptoms are associated with earlier
onset brain damage (eg: enlarged ventricles) and progressive loss of cognitive skills (eg: IQ decline)
- when assessing negative symptoms, its important to distinguish among those that are truly symptoms of
schizophrenia and those that are due to some other factor; observing patients over extended periods of
probably the only way to address this issue
avolition a negative symptom in schizophrenia in which the individual lacks interest and drive
- apathy or avolition refers to a lack of energy and a seeming absence of interest in or an inability
to persist in what are usually routine activities
- for example, they may have difficulty persisting at work, school, or household chores and may spend
much of their time sitting around doing nothing
alogia a negative symptom in schizophrenia marked by poverty of speech and of speech content
- alogia can take several forms
- in poverty of speech, the sheer amount of speech is greatly reduced
- in poverty of content of speech, the amount of discourse is adequate, but it conveys little information
and tends to be vague and repetitive
anhedonia a negative symptom in schizophrenia in which the individual in unable to feel pleasure
- this is an inability to experience pleasure
- it is manifested as a lack of interest in recreational activities, failure to develop close relationships with
other people, and lack of interest in sex
- patients are aware of this symptoms and report that normally pleasurable activities are not enjoyable for
Flat Affect
flat affect a deviation in emotional response wherein virtually no emotion is expressed whatever the
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