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PSYB32H3 (614)
Lecture

Chapter 11 notes.docx

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Department
Psychology
Course Code
PSYB32H3
Professor
Konstantine Zakzanis

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Chapter 11: Schizophrenia Schizophrenia: psychotic disorder characterized by major disturbance in thought, emotion, & behaviour disordered thinking in which ideas are not logically related faulty perception and attention flat or inappropriate affect, bizarre disturbances in motor activity they withdraw from people and reality, often into a fantasy life of delusions and hallucinations Asian populations have the lowest prevalence rates for schizophrenia Male to female ratio of 1:4 Begins in childhood, but appears in late adolescence or early adulthood, somewhat earlier for men than woman PTSD is highly prevalent and underdiagnosed among military veterans with schizophrenia CLINICAL SYMPTOMS OF SCHIZOPHRENIA Symptoms of schizophrenia involve disturbances in several major areas:  Thought  Perception  Attention  Motor behaviour  Affect or emotion  Life functioning People with schizophrenia can differ from each other more than do people with other disorders. Evidence found it is hard to find specific traits or characteristics that are shared by all people with a diagnosis of schizophrenia 2 main symptoms of schizophrenia: Positive symptoms- comprise excesses or distortions (disorganized speech, hallucinations, and delusions), they are what define an acute episode of schizophrenia. The presence of too much of a behaviour that is not apparent in most people  Disorganized speech  Also known as formal thought disorder  Refers to problems in organizing ideas and in speaking so that listener can understand  Incoherence: person makes repeated reference to central ideas or a theme, the images and fragments of thought are not connected, it’s difficult to understand what exactly the person is trying to say  Loose associations or derailment: person may be more successful in communicating with a listener but has difficulty sticking to one topic  Delusions  Beliefs held contrary to reality are common  Person may be the unwilling recipient of bodily sensations or thoughts imposed by an external agency  People may believe that their thoughts are broadcast or transmitted, so that others know what they are thinking  People may think their thoughts are stolen from them, suddenly and unexpectedly by an external force  believe that their feelings and behaviour are controlled by an external force  Some people believe that impulses to behave in certain ways are imposed on them by some external force  Hallucinations  Sensory experiences in the absences in the absence of any stimulation from the environment (more auditory than visual)  The world seems different or unreal to them  A person may mention changes in how his/her body feels, or the body becomes depersonalized that it feels like a machine  Hear their own thoughts spoken by another voice  Hear voices arguing  Hear voices commenting on their behaviour Negative symptoms- behavioural deficits, strong predictor of poor quality of life  Avolition  Lack of energy and seeming absence of interest in or inability to persist in what are usually routine activities  Clients may become inattentive to grooming and personal hygiene (uncombed hair, dirty nails, and dishevelled clothes)  Difficulty persisting at work, school, or household chores, and may spend much of their time sitting around doing nothing  Alogia  Negative thought disorder  Poverty of speech, sheer amount of speech is greatly reduced  Anhedonia  Inability to experience pleasure  Manifested as a lack of interest in recreational activities, failure to develop close relationships with other people, and lack of interest in sex  Clients are aware of this symptom  Flat affect  No stimulus can elicit an emotional response  Client may stare vacantly, muscles of the face drooping, eyes lifeless  Flat and toneless voice  Refers only to the outward expression of emotion and not to the person’s inner experience  Asociality  Severely impaired social relationships  Few friends, poor social skills, and little interest in being with other people, shy  Begins in childhood  Catatonia  Motor abnormalities  Clients gesture repeatedly, using peculiar and sometimes complex sequence of finger, hand and arm movements that often seem to be purposeful  Unusual increase in their overall level of activity (which might include much excitement, wild flailing of the limbs, and great expenditure of energy similar to that seen in mania  Catatonic immobility: clients adopt unusual postures and maintain them for very long periods of time (stand on one leg, with the other tucked up toward the buttocks)  Waxy flexibility: another person can move the person’s limbs into strange positions that they maintain for extended periods  Inappropriate affect  Emotional response of these individuals are out of context (client may laugh when he has heard someone has died, or become enraged when asked a simple question about how a new garment fits) HISTORY OF THE CONCEPT OF SCHIZOPHRENIA Concept of schizophrenia was formulated by Emil Kraeplin and Eugen Bleuler The early term for schizophrenia was dementia praecox Delusional disorder: troubled by persistent persecutory delusions or by delusional jealousy unfounded conviction that spouse or lover is cheating being followed somatic delusions- believing some internal organ is malfunctioning delusions of erotomania- believing that 1 is loved by some other person (usually a complete stranger) Categories of schizophrenia: Disorganized  Speech is disorganized and difficult for a listener to follow  Clients may speak incoherently, stringing together similar-sounding words and even inventing new words, often accompanied by silliness or laughter  May have flat affect or experience constant shifts of emotion, breaking into inexplicable fits of laughter and crying  Behaviour is disorganized and not goal directed  Completely neglect their appearance (never bathing or combing hair) Catatonic  May alternate between catatonic immobility and wild excitement, but one of these symptoms may predominate  Resist instructions and suggestions and often echo the speech of others  This type is rarely seen today Paranoid  Presence of predominant delusions (delusions of torments are most common)  Grandiose delusions: exaggerated sense of their own importance, power, knowledge, or identity  Delusional jealousy: unsubstantiated belief that their partner is unfaithful  Sense of being tormented or spied on  Vivid auditory hallucinations  Ideas of reference: (people with paranoid schizophrenia often develop this) incorporate unimportant events within a delusional framework and read personal significance into the trivial activities of others (see something on the TV and become paranoid someone is watching them)  More alert and verbal than are people with other types of schizophrenia  Language is not disorganized Undifferentiated schizophrenia: people who meet the diagnostic criteria for schizophrenia but not the criteria for any of the 3 subtypes Residual schizophrenia: client no longer meets the full criteria for schizophrenia but still shows some signs of the disorder Heinrichs and Awad conducted a cluster analysis that identified subtypes of schizophrenia:  Normative, intact cognition  Executive subtype- distinguished by impairment on the Wisconsin Card Sorting test  Executive-motor subtype- had deficits in card sorting and motor functioning  Motor subtype- had deficits only in motor functioning  Dementia subtype- had pervasive and generalized cog
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