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Lecture 8

Lecture 8 Psychotic Disorders.docx

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University of Toronto St. George
Stephanie Cassin

Psychotic Disorders Symptoms o Alterations in perceptions, thoughts or consciousness  DSM-IV categories o Schizophrenia o Schiozphreniform disorder History of Schizophrenia  Kraeplin - "dementia praecox"  Bleuler - "schizophrenia" o Fragmented mind/split head o His son did the first outcome study  "group of schizophrenias" Schizophrenia Diagnosis  Two or more of the following, each present for a significant portion of time during a 1-month period: o Delusions o Hallucinations o Disorganized speech o Grossly disorganized or catatonic behaviour o Negative symptoms  Note: only 1 symptom is required in certain circumstances (bizarre delusions, multiple voices conversing, running commentary)  Must cause significant dysfunction  Must last more than 6 months (acute symptoms + residual symptoms)  More prevalent in people of lower socioeconomic status  Prevalent in about 1% of the population  Occurs about equally between both genders  About 10 years younger in males (15-25 years) o Course tends to be more chronic  Between about 25 and 34 years in females  Theory exists that estrogen may provide some sort of protective factor against schizophrenia  High suicide rate  Very costly disorder  About 8% of all hospital beds in Canada are dedicated to schizophrenia patients o These patients tend to have a long stay Positive Symptoms (Type I symptoms)  Excess or distortion of normal functions and are usually present in the early stages of schizophrenia  Tend to occur in the early stages of the disorder  Two dimensions: o Psychotic - delusions, hallucinations o Disorganized - thought/speech, behaviour Delusions  Distortion in thought content  Bizarre vs. non-bizarre o Persecutory  Belief of being followed, tormented, tricked or ridiculed o Referential  Gestures, news reports, etc. are directed to them specifically o Grandiose  Belief that you have special powers, relationships with people who are really high up o Somatic o Being controlled  Thought broadcasting, removal and implementation of thoughts  Tend to be very firmly held beliefs and usually involve some sort of misperception Hallucinations  Distortions in perception  May occur in any sensory modality o Auditory  (most common, voices that are distinct from one's own thoughts or voice) o Visual o Tactile o Somatic o Gustatory (smell or taste things that don't exist, fairly rare)  Have to take into consideration whether or not these hallucinations are not part of a religious context and do cause distress or interference in some way Disorganized Speech  Distortions if thought process o Derailment  Where a person is speaking but just seems for "fall off the tracks" and the conversation doesn't make sense o Tangentiality  Sounds coherent, but the way they answer questions is completely unrelated o Word salad  Non-sensical speech o Neologisms  Making up new terms , may sound like it fits in the sentence or in context of conversation, but is not a real word o Clang associations  Rhyming answers o Perseveration  Repetition of words or sentences o Thought to be single most important feature of schizophrenia o Most people with the disorder will exhibit this feature Disorganized Behaviour  Grossly disorganized behaviour o Dishevelled appearance, inappropriate dress (eg. For the season) o Inappropriate sexual behaviours o Unpredictable, non-goal specific behaviour  Catatonic behaviour o Rigid, bizarre posture o Lack of response to external stimuli o Waxy-flexibility  Can "remodel" the person's posture Negative Symptoms  Loss of normal functions  usually appear during the later stages of schizophrenia o Later onset may be due to brain damage from chronic schizophrenia o Family members tend to be more distressed by the negative symptoms than the positive symptoms  Loss of the person they used to know o Flattened affect  Decrease in emotions  Monotone, very little eye contact, may not engage or interact with the environment  About 66% of affected individuals will experience this feature o Alogia  Decreased communication  May have something to do with thought-blocking  May stay quite because they don't want to relay everything that's going through their mind o Avolition  Absence of goal directed behaviour  May roam around aimlessly  Not motivated to take part in any sort of behaviour  Particularly difficult to treat o Anhedonia  Loss of interest Prodormal and Residual Symptoms  Prodormal symptoms: o Are present before people go into the acute phase of schizophrenia  Residual symptoms: o Are present after people come out of the acute phase  During these phases, people may exhibit beliefs that are not delusional but are unusual  May express positive symptoms, however not full blown symptoms (eg. Tangential but coherent speech)  Negative symptoms are particularly prominent in the prodormal and residual phases  During the prodormal phase, family members may describe the affected individual as "slipping away" Schizophrenia Subtypes  Paranoid o Persecutory or grandiose delusions and/or hallucinations o Outright, they seem normal, but as you get to know the person better, actions and behaviours start to seem more abnormal o More likely to engage in violet behaviours o Outcome/prognosis fairly good (best out of all subtypes)  Disorganized o Has the worst prognosis o Tends to have an earlier onset o Disorganized speech/behaviour and flat affect
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