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Lecture 5

PSY240_Review_Notes_lec5_8.docx


Department
Psychology
Course Code
PSY240H1
Professor
Martha Mc Kay
Lecture
5

Page:
of 22
PSY240 Review Notes
LECTURE 5
1. Schizophrenia
Diagnostic
Criteria
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
symptoms
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
behaviour
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
hallucintions/delusions
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
coherent
-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
years)
Prevalence
-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
Cause
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
events
-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