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Lecture 8

PSYB32 - Lecture 8.docx

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Mark Schmuckler

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PSYB32 – Lecture 7 Prof’s Speech - Purple Slide 4 – Schizophrenia - Psychotic disorder characterized by major disturbances in thought, emotion, and behavior - One of the most severe psychopathologies covered o People cope with anxiety, depression easier than schiz. – dealing with hallucinations is difficult for patient, as well as family members - Can start in childhood (but rare), typically – late teens is when you see the onset o Men have earlier onset than females - Late onset schizophrenia – even seniors can develop schizophrenia, but rare - Acute episodes – characterized by the positive symptoms, aka psychotic symptoms o Symptoms that bring patient to attention of psychiatrist o Between acute episodes – patients have negative symptoms o With each acute episode, the person falls farther and farther away from their baseline functioning/pre-onset functioning - Incredibly heterogeneous – all sorts of different presentation of the illness, with some commonalities o But functional outcome can vary greatly - 50% typically have a comorbid disorder o Typically personality disorder (dependent p.d. – because can’t meet the demands of their daily living, paranoid p.d., avoidant p.d. – stems from their lack of social skills), substance abuse (often cigarettes (for calming symptoms and anxiety), cannabis (to improve their cognition)) - Predictor of positive outcome – when patient has an early remission from acute episode; if within the first 3 months after the onset of the diagnosis, the symptoms go away – they typically have a much chance for a good outcome - Predictor of poor outcome – cognitive impairment (great deal tends to impact their ability to maintain a job, family, etc.) - Disordered thinking in which ideas are not logically related, faulty perception and attention, flat or inappropriate affect, and bizarre disturbances in motor activity - Schizophrenia is not a one person disorder – having a family member who hears voices involves a great deal more care o Depression or anxiety doesn’t touch the family in the same way - Video 1 o The term schizophrenia was first used in the 1800s to describe a condition that was initially conceptualized as a problem in thought, emotion, and behavior o Affects 1% of the population worldwide  Although there is variance – some studies suggest 0.2%, others suggest as much as 2% o Both men and women are equally at risk, however men tend to show symptoms earlier than women  Textbook: more common in men o Onset symptoms typically appear in the early 20s for men, and late 20s for women o Classic course of schizophrenia is one of exacerbation and remission of symptoms, with exacerbation, the patient usually fails to return to the previous level of functioning o Majority of lives - characterized by aimlessness, social isolation, poverty, homelessness and frequent hospitalizations o During exacerbations, patients experience psychotic symptoms, like hallucinations and delusions o Hallucinations are usually auditory, where patients hear voices, sometimes telling them to do things to hurt themselves o Delusions usually take on a grandiose, paranoid, personatory, or sematic theme o Patients are usually socially isolated, lack motivation, and are blunted in emotional response o About half of schizophrenics attempt suicide and about 1/10 succeed - Video 2 – Slide 6 – Clinical Symptoms of Schizophrenia - Positive symptoms; psychotic symptoms  Typically characterize the acute episodes of schizophrenia  Called positive because they are too much of a behavior that is not apparent in most people – added to the personality o Excesses or distortions o Disorganized speech (thought disorder)  Incoherence  Loose associations  Problems in organizing ideas and in speaking so that the listener can understand o Difficult time sequencing thoughts, organizing them  Speech can include neologisms – made-up words, not real  Perseverative speech – repeating speech, get stuck and it gets hard to shift attention from what it is they are saying  Engage in echolalia – when they repeat what is said to them o Delusions  Have beliefs that are held contrary to reality  Different types – most common: persecutory delusions – feeling that someone is after them, something bad is going to happen to them  Thought broadcasting – think that someone is stealing their thoughts and repeating them (i.e. on TV)  Can feel that they are being controlled by extraneous forces – others are forcing them to do what they are doing  Extreme example: someone who commits a violent act o Hallucinations  Sensory experiences – any of the senses, in the absence of any stimulation from the environment  Most common type – auditory  Examples: hearing voices, hearing thoughts spoken by different person, seeing others when no one is there Slide 7 – Hallucinations - Video o Deep thoughts of suicide o Never know what it’s going to happen (hallucinations) Slide 9 – Clinical Symptoms of Schizophrenia - Negative symptoms – experienced during residual periods of acute episodes, can be just as, if not more, debilitating than positive symptoms o These symptoms are part of our personality that we should have, but that we don’t – taken away from our personality o Strong predictor of quality of life, strongly related to cognitive deficits o Behavioural deficits  Avolition  Lack of energy, absence of interest, or inability to persist a routine activity; won’t finish tasks, which can escalate to dishevelment, etc.  Alogia  Poverty of speech where patient lacks in amount of speech (sheer quantity of speech is missing), can also have lack of content; either direction, sometimes both  Anhedonia  Inability to experience pleasure  Even though someone might show a flat affect, this is shown externally, might look like they are not experiencing pleasure, but internally they are  Even though they may not be able to express themselves in terms of joy, sadness, etc., they are able to feel these emotions  Flat affect  Asociality  Loss of social skills, have few friends, may be shy, may stem from being paranoid which is what leads them to be asocial - Other symptoms (not positive or negative) o Catatonia  Exhibits motor abnormality  Hysterical posturing – i.e. hands and feet flailing all over, which may have a purpose for them, but not to an external observer  Catatonic immobility  Understood to be a motor problem, but there is cognitive thought behind it, as with Neil – he was scared if he turned left or right, it would determine his political preference  Waxy flexibility  When a person is in a catatonic state and you can put them in a very bizarre posture and they’ll stay like that for hours and not move o Inappropriate affect  Ex. If you tell someone their mom died, they may start laughing hysterical  Symptom is important to clinicians because it is highly specific to schizophrenia Slide 10 – Schizophrenia - Catatonia o Waxy Flexibility  Incredibly rare today because medications are highly effective in treating people with this symptom Slide 11 – Schizophrenia: Diagnosis - DSM-IV-TR requires at least six months of disturbance for the diagnosis. o Medication could have profound side effects, diagnosis could have profound stigma, so it is not something that is diagnosed quickly - The six month period must include at least one month of the active phase, characterized by the presence of positive symptoms; which is defined by the presence of at least two of the following: o Delusions, hallucination, disorganized speech, grossly disorganized or catatonic behavior and negative symptoms (only one of these symptoms is required if the delusions are
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