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PSYB32 Lec 8 Nov 13 2012.docx

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University of Toronto Scarborough
Konstantine Zakzanis

Lecture 8 - Schizophrenia Wednesday, November 14, 2012 9:21 AM Schizophrenia  Course evaluations available on intranet  Neil's Story (not tested on)  1% of the population will suffer from schizophrenia  One of the most severe psychopathologies  More common in men  Can start in childhood, but more typically late teens  Mens typically have onset earlier than females  Females - mid to late twenties  There is also late onset schizophrenia  A number of acute episodes characterizing early onset  Acute episodes are characterized by the positive/psychotic symptoms - symptoms that bring the patient to the attention of the physician  Between acute episodes are negative symptoms  This illness is very heterogeneous - presents itself in many ways  50% of patients typically have a co-morbid disorder  Paranoid personality disorder  Avoidant personality disorder - missing a lot of social skills  Personality disorders are often imposed on the illness itself  Substance abuse  A lot of patients use cannabis which improves their cognition  Different outcome predictors:  Predictor of positive outcome - early remission, within first three months, must better chance for good outcome  Predictor of poor outcome - cognitive impairment  Schizophrenia is not a one person disorder - family is very involved.(video clip of sister's reaction)  Positive Symptoms :  Psychotic symptom  Characterize acute episode  Too much of a behaviour that is not apparent in most people  Added to the personality  Excesses or distortions  Disorganized speech - incoherence and loose associations - problems in organizing ideas and in speaking so that a listener can understand  Speech may include made up words and repetitions (can get stuck in a set) and echolalia (repeating what is said to them)  Delusions - beliefs that are held contrary to reality  Different kinds - (1) persecutory - someone is after them , (2)thought broadcasting, (3) feel they are being controlled by extraneous forces  Hallucinations - sensory experiences (any of the senses) in the absence of any stimulation from the environment. Most common type is auditory. Examples: hearing voices, hearing your thoughts spoken by a different person, seeing people who are not there  During residual stages, patient will experience Negative Symptoms which can be just as, if not more, debilitating as Positive symptoms:  Parts of personality or cognition that we should have but don't  Strong predictors of one's quality of life  Strongly related to cognitive deficits  Many different types of symptoms :  Behavioural deficits-  Abolition - lack of energy, loss of interest to persist doing routine activities (e.g. getting dress, brushing teeth)  Alogia - poverty of speech, patient is lacking either in the amount of speech or a poverty of content of speech (words are there but don't say something meaningful)  Anhedonia - inability to experience pleasure - if you look at them they show a flat affect, internally it has been shown that these patients can experience please. Also been shown that even if they can't express themselves, internally they do show these emotions  Asociality - lose social skills - may stem from paranoia  Other symptoms (not either positive or negative):  Catatonia - persons demonstrates motor abnormalities in two ways:  (1) hysterical posturing or waving hands and feet (has purpose for patient but does not appear so to others)  (2) catatonic immobility  Waxy Flexibility - person is in a catatonic state and you can put them in bizarre postures and they will stay in those poses for hours and not move (incredibly rare because medications now are highly effective)  Inappropriate affect - may laugh at bad news, cry for good news -> this symptom is highly specific to schizophrenia  How do we diagnose the illness:  Specific criteria  Disturbance has to be present for at least 6 months  Serious disorder  Medications can have profound side effects  Diagnosis can have a lot of negative stigma - not diagnosed quickly  Active phase characterized by positive symptoms  Acute episode of the diagnosis depends on the acute symptoms being present  Remaining time within 6 months - prodromal (before active phase) and resid
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