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PSYB32H3 (614)
Lecture 8

PSYB32-Lecture 8.docx

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Konstantine Zakzanis

PSYB32-lecture 8  Schizophrenia  Course of the disorder is probably one of the most disabling (onset is fairly early on in life as opposed to Alzheimer’s disease)  Prevalence is about 1% of the population; a little more common in males than in females (historically this wasn’t the case); males age of onset is typically in the early 20s while females age of onset is latter 20s  Great deal of comorbidity with persons with the illness; about 10% of patients commit suicide due to several reasons including delusional ideations; personality disorders are also quite comorbid with schizophrenia; substance abuse is also comorbid (alcohol and cannabis); depression and anxiety are also comorbid with the illness  Disorder is not person specific, the disease affects all family members  In schizophrenia, unlike other disorders in the class, there is no marker, no one symptom that all patients share  Acute stage of the disease is characterized by positive symptoms (sometimes referred to as type 1 symptoms)  Positive symptoms means excesses or distortions of a behaviour that is apparent in most persons; there are different types of positive symptoms: 1) disorganized speech or thought disorder- loose association or derailment, incoherent, speech is often characterized by neologisms (made up words), word salad; 2) delusions- beliefs that are held contrary to reality, implausible and not just improbable, persecutory delusions are the most common (being chased etc.), thought broadcasting, thought insertion; 3) hallucinations- sensory experiences in the absence of any stimulation from the environment, can come by way of any of the senses (auditory is the most common), three types of hallucinations that are important to be listening for when patient describes experiences (1. Hearing own thoughts spoken by other voices 2. Arguing voices 3. Person’s voice is commenting on your own behaviour)  Negative symptoms (type 2 symptoms) are seen during the remission stages of the disorder usually after the antipsychotics have worked; the absence of a behaviour that should be evident in most people; negative symptoms typically endure so often also present during the acute states of the disorder; predict disability- the more negative symptoms they are experiencing, the more adjustment difficulties they will have with respect to independent living, working, having a family;  Negative symptoms: avolition- lack of energy, or the absence of any sort of interest in the ability to persist at a task; alogia- a poverty of speech, two kinds of alogia and the other kind is poverty of content of speech (person might be vague or repetitive); anhedonia- the inability to experience pleasure; flat affect- no expression in voice, specific to person’s outward expression, inward expression is not flat in presence of something that should excite/depress them; asociality- patients will have profoundly impaired social relationships, difficulty initiating/ maintaining relationships  Other symptoms of schizophrenia that do not neatly fall into positive or negative categories: catatonia- catatonic immobility- motor abnormalities, inability for physical movement, patients may stand in odd postures for hours(with one foot up in the air); waxy flexibility- can put person into odd postures and they will stay that way which is not conscious; catatonia is incredibly rare because the medications that are available work well in alleviating catatonic symptoms ; inappropriate affect- patient’s inappropriate reaction to stimuli (laughing when told of the passing of a parent)  Diagnosis can be very tricky because you have to let the disorder evolve over six months; symptoms of schizophrenia are not specific with respect to causation (drugs, epilepsy can cause schizophrenia like symptoms)  Read slide for diagnosis of disorder  Negative symptoms are always there against the background of the positive symptoms that come and go which are the acute or active phase of the illness  Prodromal: before the onset of the acute phase  Residual: after the acute phase  Problems during the prodromal and residual phases include mostly the negative symptoms as well as Schizotypal symptoms which are odd beliefs, magical thinking, unusual perceptual experiences, not quite detached from reality  When the person has these symptoms but lasts only from one to six months, we call this schizophreniform disorder  Brief psychotic disorder: someone will have symptoms of schizophrenia that will last from one day to one month at the most; caused by stressor and it is reversible  Schizophrenia can be incredibly difficult to diagnose and other disorders make this so- mood disorders (some patients with depression will experience hallucinations), schizoaffective disorder is when the patient has symptoms of schizophrenia but also meets diagnosis for a major mood disorder, personality disorders typically lo
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