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PSY240H1 (234)


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Konstantine Zakzanis

Chapter 11: Schizophrenia • Schizophrenia: psychotic disorder characterized by major disturbances in through, emotion, and behaviour disordered thinking in which ideas are not logically related, faulty perceptions and attention, flat or inappropriate affect, and bizarre disturbances in motor activity • They withdraw from people and reality, often into a fantasy life of delusions and hallucinations • Its one of the most severe psychopathologies • Prevalence of 1% Clinical Symptoms of Schizophrenia • Disturbances in several major areas –thought, perceptions and attention, motor behaviour; affect or emotions and life functioning • There is a lot of heterogeneity Positive Symptoms • Positive symptoms: comprise excesses or distortions, such as disorganized speech, hallucinations and delusions, an acute episode of schizophrenia • It involve the presence of a behaviour that is not apparent in most people Disorganized speech • Aka formal thought disorder • Disorganized speech: problems in organizing ideas and in speaking so that a listener can understand • There is incoherence in conversations (not connected and hard to understand) • Speech may also be disordered as loose associations/derailment (difficulty sticking to one topic) o They may drift off in what they are saying • But disorganized speech is not a discriminator between schizophrenia and other psychoses (like some mood disorders) Delusions • Thinking that others are plotting against you • Delusions: beliefs held contrary to reality, are common positive symptoms • Persecutory delusions are found in 65% of them • They may think their thoughts are beings stolen from them or are being broadcasted Hallucinations and Other disorders of Perception • They may feel depersonalized • Hallucinations: sensory experiences in the absence of any stimulation from the environment (more auditory than visual) o They hear their own thoughts spoken by another voice o They hear voices arguing o Here voices commenting on their behaviour Negative Symptoms • Negative symptoms: behavioural deficits, such as avolition, alogia, anhedonia, flat affect and ascoiality • They tend to endure beyond an acute episode and have profound effects on the lives of patients • Flat affect can be a side effect of antipsychotic medication Avolition • Apathy/avolition: lack of energy and seeming absence of interest or inability to persist in what are usually routine activities • Inattentive to grooming and personal hygiene • Difficulty persistent at work, school or household chores Alogia C h a p t e r 1 1 : S c h i z o p h r e n i a Page 1 • A negative thought disorder • Poverty of speech, sheer amount of speech is greatly reduced • Poverty in content of speech • Vague and repetitive speech Anhedonia • An inability to experience pleasure • They are aware of it Flat Affect • No stimulus can elicit an emotional response • Stare vacantly, muscles of face flaccid, and eyes lifeless • Flat and toneless voice Asociality • impaired social relationships • few friends, poor social skills and little interest being with people • Schizophrenia onset is beginning in childhood • It is also said that they might not be able to recognize the emotions on top of not being able to express it Other Symptoms • Catatonia: several motor abnormalities o Gesture repeatedly, using peculiar and complex finger sequences of finger, hand and arm movements o Sometimes excitement, wild flailing of the limbs o Catatonic Immobility: patients adopt unusual postures and maintain hem for a very long period of time (stand on one leg) o Waxy flexibility: another person can move the patient’s limb into strange positions that the patient will then maintain for extended periods • Inappropriate affect: emotional response are out of context (laugh at someone’s death) o they shift rapidly from one state to another for no discernible reason History of the Concept of Schizophrenia Early Descriptions • formulated by Kraepelin and Bleuler • dementia praecox: early term for schizophrenia • he divided it into 2 major groups of endogenous or internally caused psychosis o manic-depressive illness o dementia praecox  included dementia paranoids, catatonia, and hebephrenia The DSM-IV-TR Diagnosis • Schizoaffective disorder: comprises a mixture of symptoms of schizophrenia and mood disorders • Requires at least 6 months; at least 1 month of the active phase (the presence of at least 2 of the following: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behaviour and negative symptoms) o Only 1 is required if delusions are bizarre or hallucinations consists of commenting or arguing voices • Prodromal: before the active phase • Residual: after the active phase • Problems during prodormal and residual o Social withdrawal, impaired role functioning, blunted or inappropriate affect, lack of initiative, vague and circumstantial speech, impaired hygiene, grooming C h a p t e r 1 1 : S c h i z o p h r e n i a Page 1 o Odd beliefs or magical thinking and unusual perceptual experiences • Schizophreniform disorder: acute schizophrenia DSMII o Same as those of schizophrenia symptoms but lasts only from 1-6 months • Brief psychotic disorder: lasts from 1day to 1 months and usually brought on by extreme stress • Delusional disorder: troubled persistent persecutory delusions or by delusional jealousy, the unfounded conviction that a spouse or lover is unfaithful o Somatic delusions: believing some internal organ is malfunctioning o Delusions of erotomania: believed that one is loved by some other person (usually a complete stranger in higher status) o A person with delusions disorder does not have disorganized speech or hallucinations, and delusions are less bizarre o It is quite rare and begins later in life than schizophrenia Categories of Schizophrenia is DSM-IV-TR • 3 types of schizophrenic disorders in the DSM IV TR • Disorganized (hebephrenic) o Speech is disorganized and difficult for a listener to follow o Incoherently, stringing together similar sounding words or even inventing new words o Accompanied by silliness or laughter o They may have flat affect or constant shift of emotions o Inexplicable fits of laughter and crying o Behaviour is generally disorganized and not goal directed o Sometimes they just completely neglect their appearance, never bath, brush etc • Catatonic Schizophrenia o Alternate between catatonic immobility and wild excitement (but one is more dominant) o Resist instructions and suggest and often echo (repeat back) the speech of others o Onset of catatonic reactions may be more sudden o Person is likely to have previous shown some apathy and withdrawal from reality o It is hardly seen today, the motor processes are not seen because of drug therapy • Paranoid Schizophrenia o Pro
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