Psychology 2310A/B Lecture Notes - Auditory Hallucination, Eugen Bleuler, Psychosis

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Schizophrenia and Other Psychotic Disorders
Introduction to Schizophrenia
Psychotic disorder
Most severely debilitating of mental disorders
Most patients unable to care for themselves
10% - 20% of homeless people
Begins early in life (age 16-25)
Long-term disability
Suicide rates 8% - 10%
2x as common as Alzheimers, 5x MS
Cystic fibrosis (Shinerama) – 300x
300,000 Canadians - 1 / 12 hospital beds
Huge health care and social costs
oEstimated $6.85 billion annually in Canada
A major worldwide health problem
A Brief History
Apparently rare before 1800
oIncreased urbanization, industrialization?
Emil Kraepelin
o“Dementia praecox” (“early onset senility”)
oSaw it as an organic condition
oBelieved prognosis is extremely poor
Eugene Bleuler
oCoined the term “schizophrenia” (“split mind”)
oDisordered thinking processes
oBiology-environment interaction
oBelieved recovery is possible
On-going debate
Symptoms of Schizophrenia
Disordered Thought Process (disorganized speech)
oIncoherence
o“Word salad”
oNeologisms
oLoose associations
oPoverty of speech - alogia
oPerseveration
oThought blocking
Disordered Thought Content
oIdeas of reference
oDelusions
oGrandeur, control, persecution, somatic
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oThought insertion
oThought broadcasting
oThought withdrawal
Ddisordered Perception
oHallucinations (most commonly auditory).
Attentional Deficits
oBreakdown of selective filter
oOver inclusiveness
oCognitive distractibility
oAssociative intrusions
Disordered Motor Activity
oDisorganized behaviour
oCatatonic immobility – “waxy flexibility”.
Disordered Affect (Mood)
oFlat or blunted affect - anhedonia
oInappropriate, silly affect
Impairment of Functioning
oSocial skills, occupational and social functioning
oSchizoid withdrawal
Positive vs. Negative Symptoms
Positive symptoms
oBehavioral excesses or distortions
oe.g., hallucinations, delusions, disorganized speech, disorganized behavior
oRespond to antipsychotic medications
Negative symptoms
oBehavioral deficits
oE.g., poverty of speech (alogia), flat affect, social withdrawal, anhedonia,
lack of motivation (avolition)
oLess response to antipsychotic meds
DSM-IV Diagnosis of Schizophrenia
Prodromal, active, and residual phases
Prodromal – clear deterioration of functioning
Active phase involves 2 or more symptoms:
oDelusions, hallucinations, disorganized speech, grossly disorganized or
catatonic behavior, negative symptoms
oOnly 1 symptom if: (1) bizarre delusions, or (2) auditory hallucination of
voice keeping running commentary, or (3) two or more voices conversing
Residual – attenuated symptoms following active phase
Active phase lasts at least 1 month
All phases last at least 6 months
If less than 6 months:
oSchizophreniform Disorder (1-6 months)
oBrief Psychotic Disorder (< 1 month)
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