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Lecture 6

PSY240H1 Lecture Notes - Lecture 6: Thought Disorder, Waxy Flexibility, Stimulus Modality

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Theone Patterson

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Lecture 6: Psychotic Disorders
Inability to differentiate between what is real and what is unreal
o Psychotic disorders include symptoms divided into two groups: positive and negative;
+ve: delusions, hallucinations, disorganized speech
-ve = lack of emotions/motivation
Schizophrenia is a type of psychosis that consists of the aforementioned symptoms
o SZ can be defined as a thought disorder characterized by abnormal thoughts, behaviors, cognitions, and
o Extremely heterogenous disorder with a # of symptoms and behaviors
The DSM-5 criteria for SZ includes 2 or more active phase symptoms for 1 months or longer
o At least one of the following: should be present for diagnosis: delusions, hallucinations, or disorganized
o Other symptoms: catatonic behaviors, negative symptoms
Symptoms are presented in 3 different phases:
o Acute: significant symptoms are present and cause marked impairment in functioning
o Prodromal: : milder symptoms present before an acute disorder
o Residual: milder symptoms present after an acute episode
Positive Symptoms
Positive symptoms is when anything is presented in excesses or distortions
Hallucinations: sensory event w/o input from the env
o There are 5 types of hallucinations each specific to a sensory modality (e.g. auditory would be hearing voices,
while visual is seeing something not present)
o Interestingly, the Broca's area rather than the Wernicke's seems to be active during hallucinations
Delusions: strange ideas or beliefs that the patient holds strongly without any logical basis
o There are 7 types of delusions;
1. Broadcasting: person believes thoughts are being transmitted to the external world for everyone to hear
2. Insertion: somebody implanted their thoughts in you
3. Withdrawal: believing thoughts have been removed from ones mind
4. Persecution: think you are being plotted against
5. Grandeur: you are a famous person or have special forces/powers (e.g. you are Jesus)
6. Reference: believing irrelevant agents are related to the self (e.g. people on the news are secretly
making fun of you)
7. Being controlled: either your body, mind, or thoughts are being controlled
Disorganization of thoughts and speech: this can be in the form of loosening associations, world salad,
neologisms (i.e. making up new words), or clanging
Disorganized Symptoms
Present in three forms;
1. Disorganized speech → formal thought disorder
2. Disorganized affect → inappropriate emotional behavior
3. Disorganized behavior → unusual behaviors (e.g. waxy flexibility, forced grasping, opposition, etc.)
Catatonic immobility: lack of behavior
Catatonic excitement: uncontrolled excitation
Negative Symptoms
Negative symptoms present as behavioral deficits
Affective flattening = Little expressed emotion
Alogia: Reduction in speech amount/content
Avolition: Lack of initiation/persistence (apathy)
Anhedonia = Lack of pleasure; indifference
Asociality =Severe relationship impairment
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