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PSYB32 - Lecture 08 Notes.docx

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Konstantine Zakzanis

PSYB32 – Lecture 08 (Chapter 11: Schizophrenia) WebOption – Summer 2013 Slide 4 – Schizophrenia  1% of the population suffers from it  One of the most severe psychopathologies o People with anxieties and depressions have an easier time coping than do people with delusions and hallucinations  This is because these delusions and hallucinations can put yourself or those around you at risk for harm o Requires stronger/more medications; it’s more debilitating  More common in men  Male have the onset of the illness earlier than females o Females typically present in their mid-late twenties (but not always) o Late teens for males  Early onset of Schizophrenia can be characterized by a number of acute episodes  Acute episodes are characterized by the Positive symptoms (psychotic symptoms) o These are the symptoms that bring the individual to the attention of a physician/psychiatrist  Negative symptoms are experienced between acute (ie psychotic) episodes  As each acute episode occurs, the person falls more and more away from their baseline (pre- illness) functioning o So you get worse and worse after each psychotic episode  Schizophrenia is incredibly Heterogeneous o The disorder can present itself in many different ways from person to person o There are some commonalities, but an individual’s functional outcome can differ greatly: from homelessness, to permanent institutionalization, to somebody able to complete their education (ie our guest speaker) and start a family  50% of patients have a comorbid disorder o Schizophrenics typically also have to deal with a personality disorder  ie dependent personality disorder – person can’t function on their own. Depends on others for regular daily functions  ie paranoid personality disorder  ie avoidant personality disorder – usually stemming from a lack of social skills, and also from the paranoia brought about by schizophrenia o Another disorder that’s often comorbid with Schizophrenia is substance abuse  Many chronically use cigarettes and cannabis which patients believe aid in easing their symptoms  **There are also different types of predictors of outcomes  For example, a predictor for a positive outcome is when the patient has an early remission from the acute episode  In other words, if the symptoms go away within the first 3 months after the onset of the diagnosis, patients typically have a much better chance for a good outcome  A predictor for poor outcome is cognitive impairment o When the patient shows a great deal of cognitive impairment, it tends to impact their ability to move forward in life (ie go to school, work, etc) Slide 6 – Positive Symptoms  Listed on the slide are the positive (ie psychotic) symptoms of schizophrenia  These are the symptoms that characterize the acute episode of schizophrenia  **They’re called positive symptoms because they’re too much of a behaviour that is not apparent in most people o **They’re added to the personality (hence positive)  Delusions: beliefs that are not based in reality o Contrary to manic disorder in which the patient holds beliefs in their capabilities which are unlikely, but not impossible o So there are qualitative differences in what a patient with mania may experience  The most common delusions are the persecutory delusions o Feeling that someone is after them, that something bad is gonna happen to them\  Another delusion is thought broadcasting o If a patient is watching the news, they may feel that the newscaster is stealing their thoughts and stating them on the television set  Patients also believe that their behaviours occur outside of their own volition o For example (an extreme example), if a schizophrenic commits a violent act, they will tell you how they weren’t in control of what happened  Hallucinations: sensory experiences (can be any of the senses) in the absence of any stimulation from the environment  Most common hallucinations are auditory hallucinations o Ie hearing voices; hearing your thoughts being spoken by a different person  Remember, these (positive) symptoms only occur during the acute episode Slide 8 – Negative Symptoms  Outside of the acute episode, the patient will often experience Negative symptoms which can be just as, maybe even more debilitating than the psychotic symptoms  **Negative symptoms: parts of our personality or cognition that we should have, but we don’t o **So whereas in positive symptoms are added to the personality, negative symptoms indicate a lack (gone from our being)  They are strong predictors of one’s quality of life; of one’s cognitive deficits  Negative symptoms include behavioural deficits such as:  Avolition: the lack of energy, absence of interest, or inability to persist through routine activities o ie these individuals will sometimes start a task, like dressing themselves or cleaning, but they won’t finish the task o Can result in individual’s complete lack of care for themselves (ie hygiene)  Alogia: a poverty of speech where the patient is either a) lacking in the amount of speech (how much they talk), or has b) a poverty of speech content (they talk but it’s more like rambling without a point)  Anhedonia: inability to experience pleasure o Anhedonia is a tough one to diagnose because the patient may sometimes show a flat affect (ie respond without any signs of pleasure or emotions) but they may still feel it internally  Asociality: patient loses social skills o Can lead to severe impairment in terms of forming any sort of social relations o May stem from their delusions if they have a paranoid quality to them  Remember, these symptoms characterize the patient in the time between the acute episode Slide 9 – Other symptoms  Some symptoms of schizophrenia don’t fall into either the positive or negative dichotomy, and are thus characterized as “other” symptoms  Catatonia: patient exhibits motor abnormalities; can come in 2 different ways o Catatonic Immobility: Fixity of posture, maintained for long periods with accompanying muscular rigidity, trancelike state of consciousness  Although it may sound like a malfunction in the patient’s motor abilities, it actually has to do with something cognitive  Ie our guest speaker spoke of standing at his table in a catatonic state (unable to move) because he felt that if he moved to either the left or the right it would dictate his political standing o Waxy Flexibility: when a patient is in a catatonic state and you can put them in an awkward, really weird posture and they’ll stay like that for hours without moving  Next slide has a vid displaying waxy flexibility  *Inappropriate affect: o For ex, if you tell a patient that their mother died, they may start laughing hysterically o For ex, if they won the lottery they may cry and cry and become very depressed o *This symptom is very important to clinicians because it is highly specific to schizophrenia o Many of the other symptoms discussed so far can be experienced by patients with other disorders, but inappropriate affect for the most part only occurs in schizophrenics Slide 11 – Schizophrenia: It’s Diagnosis  What are the diagnostic criteria (requirements) a patient must meet in order to be diagnosed with Schizophrenia?  Disturbance has to be present for at least six months o It’s not diagnosed quickly because diagnosis of schizophrenia has a profound impact on the patient o ie it’s highly debilitating, the meds have huge side effects, the stigma attached to it  At least one month out of the six must include the active phase, which is defined by the presence of at least two of the symptoms listed on the slide o So a diagnosis hinges greatly on acute episode (positive) symptoms being present for at least one month  The remaining time required within the minimum of six months can be either a *prodromal (before the active phase) or a residual (after the active phase) period o During the prodromal or residual phase the person will typi
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