PSYCH 509 Lecture 23: Lecture 23

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Benjamin Dykman

Schizophrenia (Cont'd) • Subtypes (Cont'd) o Catatonic ▪ Unusual motor activity (stuporous or excited) ▪ Increasingly uncommon • Due to medications o Undifferentiated ▪ Mixed features ▪ Many people with schizophrenia o DSM-V symptoms clusters ▪ For 2 subtypes to differ, they should differ along many dimensions • Symptoms picture • Course • Etiology • Response to treatment • Prognosis o Positive-negative distinction may meet this goal better than symptom-cluster scheme ▪ Positive subtype (type 1) Negative subtype (type 2) Sxs Presence of sxs Absence of sxs Behavioral excesses Behavioral deficits Delusions Anhedonia Hallucinations Alogia Loose associations Avolition Inappropriate affect Apathy, social withdrawal Etiology Disturbance in brain Structural brain changes (esp. chemistry (esp. high brain atrophy) dopamine) Onset Acute (reactive schiz.) Gradual (process schiz.) Sudden, episodic Slow, gradual process process Premorbid (before Good Poor diagnosis) Signs even in childhood functioning Course Fluctuating Chronic (Prognosis gets worse after every episode; episode -> residual symptoms after episode) Response to Better response Poorer response traditional neuroleptics (affects serotonin and dopamine) Prognosis Better Poorer (slow brain deterioration is more difficult to correct) • Dif. Diag. o Different from MPD, Bipolar, Schizotypal P.D. o Bipolar can have delusions in manic episode and depressed episode ▪ Delusions wax and wane with mood state ▪ In schiz. delusions occur no matter what mood state o Schizotypal Personality Disorder ▪ People who are peculiar, paranoia, idea of reference, magical thinking, soft signs of schiz. ▪ Functioning is not that disorganized • Unlike people with schiz. ▪ Vulnerability factor to schiz. o Different from delusional disorder ▪ Have beliefs that have no basis in reality ▪ Tend to have nonbizarre delusions (beliefs that could possibly occur in real life) ▪ Otherwise functioning well • Unlike people with schiz. • Ertomanic type: delusion that another person (usually of higher status) is secretly in love with them • Will stalk, call, send gifts, etc. to person • Jealous type: delusion that romantic partner is unfaithful • Based on small bits of "evidence" • Checking on whereabouts, following spouse, following suspected "lover" • Grandiose type: delusion that they have a special talent, special purpose, or special relationship with God • May have followers, a cult, or be cult leaders • Epid. o Prevalence: 1/100 (holds across countries) o Social class ▪ Much more common in lowest SES (esp. large cities) • About 4x • Sociogenic hypothesis: poor health conditions, pregnant women not getting adequate prenatal care, higher rates of physical abuse, greater
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