PS280 Lecture Notes - Antipsychotic

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Published on 16 Oct 2011
School
WLU
Department
Psychology
Course
PS280
Professor
Page:
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Schizophrenia
Affects about 1% of the population
Sex ratio equal in males and females
Probably not just one disorder but a set of disorders
Fever analogy - many causes for a fever, similarly many different causes for
schizophrenia; also different course in different people
Highly disabling condition
Drugs to reduce symptoms; most work on reducing dopamine levels
oSide effects, does not cure
~11% commit suicide
Usually first diagnosed in late adolescence or early adulthood (most likely to have
first episode between ages 17-25)
Rare to begin before late teens or later than 20's
Earlier in males than females; estrogens may have a protective effect
Usually but not always becomes less severe from age 40 onwards
oPerhaps because of fewer dopamine receptors
If it newly occurs in people over 45, usually paranoid form, and usually in people
with sensory deficit and social isolation
Question if late onset should be called schizophrenia or classified as a different
disorder, e.g. paraphrenia
Estrogens may affect either dopamine levels or dopamine sensitivity, which have
been associated with schizophrenia
Case of Mark*
Friend died and company he worked for went bankrupt
Lacked energy and motivation to look for work
Moved home with parents
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Disagreements became intense
More reclusive, sloppy, and bizarre
Parents took him to hospital
Mark to psychologist:
“I am an unreal person. I am made of stone, or else I am made of glass. I am wired
precisely wrong, precisely. But you will not find my key. I have tried to lose the key to
me. You can look at me closely if you wish, but you see more from afar.”
The psychologist noted that
Mark smiles when he is uncomfortable, and smiles more when in pain. He cries
during television comedies. He seems angry when justice is done, frightened when
someone compliments him, and roars with laughter on reading that a young child was
burned in a tragic fire. He grimaces often. He eats very little but always carries food
away.
After two weeks, the psychologist said to him:
“You hide a lot. As you say, you are wired precisely wrong. But why won’t you let me
see the diagram?”
Mark answered:
“Never, ever will you find the lever, the eternal lever that will sever me forever with
my real, seal, deal, heel. It is not on my shoe, not even on the sold. It walks away.”
Diagnosis
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2
DSM criteria currently used are quite restrictive
Prior to DSM III, so many people were diagnosed it was called a waste-bucket
diagnosis
People with psychotic symptoms, cognitive disorders, severe borderline p.d.,
schizotypal p.d., people with a brief psychotic episode (in response to a stressor)
were wrongly diagnosed
The Symptoms of Schizophrenia
They appear to reflect an excess or distortion of normal functions
Associated with inferior premorbid (before the onset of illness) social functioning
and carry a poorer prognosis
Two categories of symptoms; note that negative and positive are not used in the
evaluative sense)
1) Positive (symptoms present during active stage)
Psychotic symptoms such as delusions and hallucinations
Disorganization - speech and behaviour, motor disturbances, thought disorder
Psychotic symptoms disappear or are greatly reduced with treatment
2) Negative symptoms (the person lacks what is normally present)
The more negative symptoms, the poorer the prognosis
Flat affect – person is lacking in emotion, robotic, almost no inflection
in speech
Alogia (lack of meaningful speech)
Anhedonia (unable to feel pleasure)
Apathy
Avolition (cannot act towards a goal)
Positive symptoms
Delusions are firmly held beliefs with no or little basis in reality; persistent
Delusions reflect a loss of distinction between one’s private thoughts and external
reality
They may believe that the entire world is audience to their most private thoughts
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Document Summary

1: affects about 1% of the population. Case of mark: friend died and company he worked for went bankrupt, lacked energy and motivation to look for work, moved home with parents. 2: disagreements became intense, more reclusive, sloppy, and bizarre, parents took him to hospital. I am made of stone, or else i am made of glass. I have tried to lose the key to me. You can look at me closely if you wish, but you see more from afar. Mark smiles when he is uncomfortable, and smiles more when in pain. He seems angry when justice is done, frightened when someone compliments him, and roars with laughter on reading that a young child was burned in a tragic fire. He eats very little but always carries food away. After two weeks, the psychologist said to him: As you say, you are wired precisely wrong. But why won"t you let me see the diagram? .