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Lecture 5


Course Code
Martha Mc Kay

of 22
PSY240 Review Notes
1. Schizophrenia
Presence of severe symptoms for at least one month and the presence
of some symptoms for at least six months.
A. Core symptoms: two or more of the following present for at least a
one- month period: 1. Delusions 2. Hallucinations 3. Disorganized
speech 4. Grossly disorganized or catatonic behavior 5. Negative
B. Social/ occupational functioning: signifi cant impairment in work,
academic performance, interpersonal relationships, and/ or self- care
C. Duration: continuous signs of the disturbance for at least six
months; at least one month of this period must include symptoms that
meet Criterion A above
Positive Symptoms: excess or distortion in normal repertoire of
Delusions: persecutory, reference, grandiose, being controlled,
thought broadcasting, thought insertion, thought withdrawal,
guilt/sin, somatic
Hallucinations (auditory, visual, tactile, or somatic)
Tactile= feel things outside body; Somatic= feel things inside body
Disorganized Thought and Speech (e.g., word salad)
-“Formal thought disorder”
-Loose associations/derailment move from one topic to an
unrelated one with little coherent transition
-Word Salad speech so disorganized, incoherent to listener
-Neologisms made up words
-Clangs associations between words made up based on sound. E.g.
Dog is Spog
-Perseveration repeating same word or saying over and over again
Disorganized or Catatonic Behaviour (e.g., disheveled appearance,
inappropriate clothing, agitated, repetitive behaviours)
-Behaviour that is highly unpredictable, bizarre or shows complete
lack of responsiveness for long periods of time
-Catatonia complete lack of responsiveness to outside world
-Disorganzed Examples: untriggered agitation (shouting, swearing,
pacing); Dishevelled and dirty inappropriately dressed for weather
-Catatonic Examples: holding strange poses for hours; catatonic
excitement wild agitation, no response, difficult to subdue, may be
infused with angry outbursts; may reveal nature of
Negative Symptoms
Affective Flattening (or Blunted Affect) Severe reduction or
complete absence of affective responses to the environment
Alogia- Severe reduction or absence of speech
Avolition Inability to persist at common, goal-oriented tasks
Inappropriate Affect- Laughing at sad things, crying at happy things
Anhedonia Loss of interest in and across all realms of life
Impaired Social Skills- More often caused by negative symptoms
Prodromal Symptoms: present before acute phase
Residual Symptoms: present after pt come out of acute phase
-May express unusual beliefs but are not delusional
-Have strange perceptual experiences not full-blown hallucinations
-May speak in tangential and disorganized manner yet remain
-Negative symptoms are especially prominent: withdrawal from
others, work or school; “gradually slipping away”
Types of Schizophrenia
Paranoid- Prominent delusions and hallucinations involving
persecution and grandiosity (best known, better prognosis, onset
later in life)
Disorganized- thoughts and behaviours are severely disorganized
(word salads, cant bathe, disturbed emotional expression, early onset,
most disabled by disorder)
Catatonic- rare subtype; very distinctive features (e.g., catatonic
stupor or excitement)
-Show variety of motor behaviours and ways of speaking - complete
lack of responsiveness to their environment
-Two of the following symptoms: Catatonic Stupor (motionless),
Catatonic Excitement, Maintenance of rigid posture or complete
mutism, Odd mannerisms (grimacing or hand flapping), Echolalia
(word repetition) or echopraxia (repeated movements)
Undifferentiated- some symptoms but not enough to meet complete
diagnosis of any subtype (early onset, chronic, difficult to treat)
Residual- at least one acute episode in the past with lingering Type II
and mild Type I symptoms (may have symptoms chronically for many
-In Canada, 0.5 2% of the population has been diagnosed with a
schizophrenia-spectrum disorder
-Immigrants to Canada (and to other countries) seem to be at
increased risk
-Schizophrenia may be relatively culture free, however, in that
worldwide prevalence appears to be uniformly around 1% (with
varying estimates likely reflecting diagnostic discrepancies rather
than real differences)
Age and Gender Factors
-Life-span development and stabilization
-Women who develop schizophrenia have a more favorable course of
the disorder than do men who develop schizophrenia
Sociocultural Factors
-Although the prevalence of schizophrenia seems not to vary much
across culture, its course seems to be more favorable in developing,
collectivist cultures as compared to industrialized countries
-Those diagnosed in developing countries can expect a wider network
of social support beginning with the extended family and extending to
the community
Genetic Theories
-Disordered genes seem to make one vulnerable to schizophrenia,
likely best understood via a polygenic, additive model
-Considerable evidence drawn from family and adoption studies
-Genes do not tell the whole story, however, as observed in studies
examining risk and genetic relatedness
Structural Brain Abnormalities
-Enlarged ventricles;
-reduced volume and neuron density in frontal cortex, temporal lobe,
thalamus, and limbic system
Birth Complications & Prenatal Viral Exposure
-Particularly those involving loss of oxygen that could damage brain
Perinatal Hypoxia
Neurotransmitter Theories= Imbalances in levels of or receptors for
dopamine; serotonin, GABA, and glutamate may also play roles
Psychosocial Perspectives
-Social selection (aka social drift): Urban birth and chronically
stressful circumstances
-Stress and relapse: Although stress may not cause schizophrenia,
relapses into psychotic episodes are often precipitated by stressful
-Communication patterns: Strange patterns within families:
vagueness; misperceptions and misinterpretations; odd word usage;
poor integration
-Expressed emotion: Families are over-involved with each other and
overprotective of the member who has schizophrenia while
attributing more control for symptoms than the individual possesses
(but, what is cause and what is effect?).
-Cognitive theories: Neurological abnormalities underlie problems
with attention, inhibition, and communication
-Behavioural; Symptoms have developed via operant conditioning;
Although behavioural theories of etiology are not well accepted,
behavioural interventions are helpful in learning more socially
appropriate methods of interaction
-Cross-Cultural Perspectives: Need to accommodate differing cultural
views about the genesis of schizophrenia