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Lecture 8

Lecture 8; Schizophrenia.docx

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Psychology 2310A/B
Rod Martin

Schizophrenia and Other Psychotic Disorders Introduction to Schizophrenia Psychotic disorder - out of touch w reality Most severely debilitating of mental disorders Most patients unable to care for themselves (can’t hold down jobs and even basic care like hygiene, cooking) - 40-60% live with family members - others are hospitalized or homeless - 10-20% of homeless people living on the streets have schizophrenia Begins early in life (age 16-25) Long-term disability Suicide rates 8% - 10% 2x as common as Alzheimer’s, 5x MS - more common than you think Cystic fibrosis (Shinerama) – 300x 300,000 Canadians - 1 / 12 hospital beds Huge health care and social costs Estimated $6.85 billion annually in Canada A major world-wide health problem. Men and women at equal risk, but seems to strike men years earlier and maybe more severely Occurs more in low SE groups A Brief History Apparently rare before 1800 - Increased urbanization, industrialization? - evidence that it only developed in the last couple hundred years - this is based on when you look back on writings over the centuries, there are descriptions of people with mental illnesses; can clearly see those with depression, mania but no descriptions with the characteristics of schizophrenia - could of existed but just wasn’t written about, or could of risen due to industrialization Emil Kraepelin called schizophrenia “Dementia praecox”  was the first name for schizophrenia (“early onset senility”) Saw it as a deterioration of brain functioning Saw it as an organic condition, and that is was irreversible Believed prognosis is extremely poor Eugene Bleuler Coined the term “schizophrenia” (literally means “split mind”) His term lead to the conception that it is like multiple personality disorder but it is not Focused more on the cognitive aspects; saw it as a cognitive disorder, agreed there was a biological basis but also psychological and environment factors Disordered thinking processes Biology-environment interaction Believed recovery is possible On-going debate Symptoms of Schizophrenia st Disordered Thought Process (disorganized speech)- 1 group of symptoms - the way this becomes observable is through their speech Incoherence: when they are talking they don’t make sense “Word salad”: in severe cases, speak but it is just a lot of diff words jumbled together that together don’t make sense Neologisms: made up words don’t exist that are thrown into their text (ex. calling a cup of coffee a cuppie; will continue to use these kinds of made up words) Loose associations: jumping from one topic to another Poverty of speech – alogia: the opposite ^, they just don’t speak at all sometimes just totally mute Affective flattening- lack of emotional expressiveness Perseveration: will get stuck on one topic Thought blocking: will be talking a lot and then will just lose their train of thought and go blank Disordered Thought Content - content of the thinking; delusions - hallucinations are not visual, only auditory Ideas of reference: people with schizophrenia think of mundane events as a bigger deal than they are ex. think a news person on tv are talking specifically to them Delusions: well organized beliefs that have no basis in reality, will hold onto these beliefs very strongly Grandeur: beliefs you are some really important person for ex. specifically called by god for some great mission, in olden days it was thinking you were napoleon Control: other forces that are trying to control the person and controlling the persons thoughts Persecution: (or paranoid) delusions of persecutions ex. police are out to get them Somatic: bodily beliefs, ex. believing all their organs have melted away Thought insertion: belief that other aliens or some sort of forces or powers are inserting thoughts into their mind Thought broadcasting: belief that other people can hear what they are thinking Thought withdrawal: belief that the thoughts are being stolen from their head Disordered Perception Hallucinations (most commonly auditory, hearing voices). Can be voices of someone they know, or can be voices/multiple voices of strangers Can be friendly and encouraging or negative Hearing their own thoughts, but perceiving them as it coming from somebody else Attentional Deficits Breakdown of selective filter- we are constantly bombarded with a lot of stimuli but were able to block things out and focus on what’s relevant; people with schizo (this is seen as the central problem) inability to block out things that are irrelevant and stay focused Engage in overinclusiveness in the things around them that have no relevance Cognitive distractibility by irrelevant ideas and information Associative intrusions: some words have a variety of meanings and schizophrenic can get distracted and continue thoughts off of the other irrelevant meanings of the word Disordered Motor Activity Disorganized behaviour: the person is very agitated, excited, hyperactive behaving in bizarre ways like dressing in strange clothes, shouting at people in public who aren’t there, spreading feces Catatonic immobility – “waxy flexibility”, echolalia: just repeat back what others say, echopraxia: imitate the actions of another person Disordered Affect (Mood) Flat or blunted affect – anhedonia: lack of pleasure, no positive/negative emotions about things Inappropriate, silly affect: silly emotional responses, ex. laughing about things that aren’t funny Impairment of Functioning Impairment in social skills, occupational and social functioning Schizoid withdrawal: will draw in to themselves and avoid other people Positive vs. Negative Symptoms Positive symptoms Behavioral excesses or distortions (not positive in a sense of being desirable but that they is too much of it) e.g., hallucinations, delusions, disorganized speech, disorganized behavior, catatonic behaviour positive symptoms, it is these positive symptoms that response most to anti-psychotic drugs Respond to antipsychotic medications- these are the symptoms that will usually go away Negative symptoms Behavioral deficits e.g., poverty of speech (alogia**), flat affect, social withdrawal, anhedonia**, lack of motivation (avolition **) Less response to antipsychotic meds. DSM-IV Diagnosis of Schizophrenia Prodromal, active, and residual phases Prodromal – clear deterioration of functioning - Prodromal phase: just starting to have symptoms, beginning to behave in unusual ways but don’t have the full symptoms can last for months or even a few years - family members can often recognize these beginning signs before it turns into full blown Active phase involves 2 or more symptoms: Full blown psychotic symptoms Delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms Only 1 symptom if: (1) bizarre delusions (bizarre delusions couldn’t possibly be true ex. aliens out to get them, non-bizarre delusions ones that are possible ex. police out to get them) or (2) auditory hallucination of voice keeping running commentary, or (3) two or more voices conversing - delusions that are mood congruent are consistent with the persons emotional state and reflect a mood disorder rather than schizophrenia; bizarre delusions are often inconfurent with a persons mood Residual – attenuated symptoms following active phase - it is episodic; have a psychotic episode and then may go back to somewhat normal for a period of time: the residual phase (not normal but don’t have the full psychotic symptoms) - this can go in and out over years Active phase has to last at least 1 month All phases last at least 6 months If less than 6 months: Schizophreniform Disorder (1-6 months): looks like schizophrenia but not sure yet, diagnosis will be changed to schizophrenia after 6 months - are cases where they recover under this time period Brief Psychotic Disorder ( < 1 month) Social and occupational dysfunction. Subtypes of Schizophrenia - DSM-5 is dropping this Paranoid Type Delusions, auditory hallucinations No disorganized speech, behavior, or affect Most common, least severe type Disorganized Type Disorganized speech, behavior; inappropriate affect Most severe Catatonic Type Motoric immobility, waxy flexibility, mutism, posturing, grimacing, echolalia (a pathological, senseless kind of verbal repetition), echopraxia (repetitive imitation of another persons movements) Behavioral excitement, agitation Undifferentiated Type Doesn’t meet criteria for first three About half can’t fit into the other three (another reason why these subtypes are not all that useful) Residual Type Negative symptoms and attenuated positive symptoms In that residual phase indefinitely No prominent delusions, hallucinations, disorganized speech or behavior. Markers and Endophenotypes for Schizophrenia - objective diagnosis is possible if measurable disease markers can be identified - to further subdivide this marker concept; vulnerability and genetic markers, also endophenotypes- genetic and vulnerability markers may define this, biological or behavioural predispositions that make the disorder more likely - Cognitive performance Test has been studied as a cognitive marker of the disorderon avg patients with this disorder score lower on the test - another potential marker of schizophrenia involves smooth pursuit eye movements, exhibit irregular eye movements observed through eye tracking Prognosis Overall, less severe impairment with aging - begin to function better with age, could be because they learn to cope over time 22% of patients only have one episode
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