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Lecture 8

Lecture 8 - Schizophrenia and Psychotic Disorders. In two columns per page, printing two pages (in total four columns) per page side works well =)

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PSY240 Lecture 8 Psychotic Disorders
Alterations in perceptions, thoughts, or
Rarely diagnosed in children
DSM-IV categories:
Schizophreniform disorder
Schizoaffective disorder
Delusional disorder
Brief psychotic disorder
Shared psychotic disorder
Psychotic disorder due to general medical
Substance-induced psychotic disorder
History of Schizophrenia
Ppl described as crazy
Kraeplin dementia praecox , chronic
intellectual deterioration, didnt get into
subtypes and variations
Bleuler schizophrenia = fragmented
mind, split head, used to think multiple
identity disorder was schizophrenia, didnt
think course was always deteriorating
oHis son did longitudinal study in USA:
only 10% chronic symptoms, 25%
improved, 50% fluctuated btwn
unstable and normal
One of the most studied mental illnesses
oWhy so much heterogeneity
Group of schizophrenias
Schizophrenia Diagnosis
At least 2 of the following, each present for
a significant portion of time during 1
oDelusions firmly held distortions in
thought content
Misinterpretations of experiences
Strong beliefs
Important to ask background
questions for evidence
Bizarre (cannot possibly happen,
ex. Organ replacement w/o scars,
thoughts telecasted) vs. non-
bizarre (in theory could happen
but no evidence)
Persecutory: typically to self,
spied on or ridiculed, most
often non-bizarre
Referential: believes random
things directed at him/her
Grandiose: special/magical
powers, special relationships to
Somatic: organs removed but
no scars, insects crawling
inside body
Being controlled: thoughts
withdrawn from external
forces, thoughts broadcasted,
thoughts planted into head
oHallucinations distortions in perception
May occur in any sensory modality:
Auditory by far most
common, usually experienced
as voices distinct from ones
own thoughts/voice
oOrders, including to kill
self + others
Visual often accompanied by
Tactile something crawling
on skin or inside skin
Somatic electricity in veins
Make sure not considered part of
religious/cultural ceremonies
Make sure cause
distress/impairment in some way
Louis Wain cats paintings
progressively more abstract as
disease progresses
oDisorganized speech distortions in
thought process
Some think is most significant
feature of schizophrenia
Incoherence of train of thought:
Derailment some thread of
thought but must pay close
Tangentiality might sound
completely coherent but
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answers to questions are
Word salad completely
nonsensical jumble of words,
no explanation for why words
Neologisms make up new
Clang associations
speak/answer in rhymes to
connect thoughts together
Perseveration repeat words
or sentences over and over
oDisorganized behaviour:
Grossly disorganized
distortions, self-monitoring of bhvr
(ex. Not dressed appropriately for
weather/occasion, inappropriate
sexual bhvr), unpredictable
Doesnt fit context of what is
going on
or Catatonic bhvr really
marked decrease in responsivity to
environment (ex. Pose and not
move for extended period of time,
face not showing emotions), waxy
flexibility (remain in pose until
moved, than remains in that pose),
dont see spontaneous movement
oNegative (Type II) symptoms loss of
normal functions, usually appear
during the later stages
Flattened affect no range in
emotions, restriction, monotone,
low eye contact, not engaged or
interacting w/ environment
eventually in 60% of
Alogia restriction in either
efficiently or productivity of
thoughts spoken, might have to do
w/ thought blocking (self-sensoring
of hallucinations)
Avolition absence of goal-
directed bhvr, unmotivated, apathy,
loss of energy; very difficult to
Anhedonia inability to
experience pleasure from normal
Note: only 1 symptom is required in
certain circumstances (bizarre
delusions; multiple voices conversing,
running commentary since characteristic of
Must cause significant dysfunction
Must last more than 6 months (acute
symptoms + regular symptoms) seeing
prodromal and residual symptoms
Prevalence : 1% of population, more common
in lower socio-economical status, equally in
males (15-24 years) in females (25-34
years), male symptoms ten to be more
oHypothesis estrogen might be
protective factor
10% of schizophrenics eventually commit
Family members often more affected by
negative symptoms the person they knew
seems no longer there
Costly, 8% of Canadian hospital beds
devoted to schizophrenia typically long
hospital stays
Positive (Type I) Symptoms
(Excess or distortion of normal functions)
Usually present in early stages of
Usually more prominent
2 dimensions:
oPsychotic delusions/fixed beliefs,
oDisorganized thought/speech, bhvr
Schizophrenia Subtypes
Prognoses vary
Subtypes diagnosed by current
symptoms at time of assessment
Paranoid prominent persecutory or
grandiose delusions and/or auditory
hallucinations, normal preserved cognitive
function, can communicate properly
oHighest risk of violence when anger
involved but only small proportion of
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