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Lecture 7

PS280-Z Lecture 7 – Tuesday July 30th, 2013.docx

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Kathy Foxall

th PS280-Z Lecture 7 – Tuesday July 30 , 2013 Schizophrenia Gerald Video - The textbook definition of someone with schizophrenia - Paranoid (he is scared of people) - Many thoughts – would jump from topic to topic without connection between the two Schizophrenia is a Heterogeneous Condition - Schizophrenia is a complex disorder o Probably many forms, many causes, and my ways that it can happen to a person - Affects a wide range of individuals with a wide range of symptoms Prevalence and Sex Differences - Lifetime prevalence estimates range from 0.5% to 1% - Onset is usually somewhere between the ages of 17 and 35 - Less now than before (more around the time of the industrial revolution) Life Outcome - Once diagnosed, individuals are less likely to complete their education or maintain a job - High comorbidity rate with depression (~11%) and substance abuse - Life expectancy is shorter - High rate of suicide in this population Historical Perspective: The Missing Illness th - Historical evidence suggests schizophrenia was extremely rare until the late 18 century when there was an apparent surge in cases - Industrialization, obstetric, immunological, and infectious changes may be related to the escalating emergence of this disorder - Increases in rates of admission to asylums from 1859-1914 Symptoms of Schizophrenia - For a DSM diagnosis, the individual must display two or more of the follow: o Delusions (may be the only symptom if delusions are bizarre) and hallucinations o Disorganized speech o Grossly disorganized or catatonic behaviour o Negative symptoms o Marked dysfunction in social, occupational or other important areas of functioning Positive Symptoms - Positive is not meant to be the evaluative sense; these are not ‘good’ symptoms - Presence of behaviours/symptoms that are not normally seen in others Hallucinatoins (Positive Symptom) - Distortions or misinterpretations of sensory perceptions - False perceptions occurring in the absence of relevant sensory stimuli - Any sense of modality: auditory (most common), visual, olfactory (not usually smelling roses, smelling something unpleasant), tactile, taste Delusions - Distortions in thought content - Implausible or false (fixed) beliefs strongly held even in face of solid contradictory evidence - Types of delusions o Delusions of grandeur o Delusions of control o Delusions of thought broadcasting o Delusions of reference o Thought withdrawal o Thought insertion o Somatic delusions  I am made of glass, I am made of stone, etc Disorganized Speech and Thought - Thought form disorder: disorganized and incoherent expressions of ideas - Derailment o Person goes from topic to topic based on loose associations - Neologisms o The person comes up with reasonable sounds yet non-existent words - Word salad (doesn’t normally happen in paranoid schizophrenia) o Severely disorganized and jumbled speech, incomprehensible - Excessive concreteness - Clang associations o Excessive rhyming Disorganized Behaviour - Variety of inappropriate, unusual, or extreme behaviours o E.g., childlike silliness, unpredictable agitation, lack of hygiene Catatonia - Decrease in reactivity to one’s environment - Stuporous catatonia - Catatonic rigidity o The person will have a rigid posture and will resist being moved - Catatonic negativism o Resisting to someone moving them - Catatonic posturing - Waxy flexibility o Letting someone move you - Echopraxia o The patient imitates another person’s movements - Echolalia o The person imitates another person’s speech - Catatonic Excitement o Purposeless and excessive motor activity (running around the room for no reason) Negative Symptoms - Absence of behaviour that is normally present, loss of normal functions, experience, behaviours - Associated with impairment in memory, learning, attention, and mental efficiency - Impoverished emotional expression - Anhedonia o Inability to experience pleasure - Asociality - Attention deficits - Alogia o Poverty of speech – empty replies Symptom-Based Subtypes of Schizophrenia - 5 classic subtypes of schizophrenia were recognized in the DSM-IV-TR - The DSM-5 dropped the subtypes due to low reliability - Still useful to look at the different forms commonly found Paranoid - Was thought to be the least severe with best prognosis - Most common - Delusions and hallucinations relating to a central theme - Absence of disorganized speech/behaviour - Preservation of cognitive function and mood Disorganized - Was thought to be the most severe and disabling - Disorganized speech - Disorganized behaviour - Flat or inappropriate mood - Absence of goal oriented behaviour - Most severe and disabling Catatonic - Acute psychomotor disturbance Undifferentiated - Symptoms of schizophrenia are present but do not fit clearly into any other category Residual - In remission but still display some symptoms Schizophreniform Disorder - Same criteria as with schizophrenia BUT o Shorter time period of symptoms: 1 month less than 6 months o Impaired social or occupational functioning is not required Schizoaffective Disorder - Symptoms of schizophrenia combined with mood symptoms such as depression or mania - Better prognosis than schizophrenia Delusion Disorder - A separate diagnosis
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