PSYB32 Final Exam Notes.doc

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22 Apr 2012

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PSYB32 Final Exam Notes
Chapter 11 Schizophrenia
- psychotic disorder chracterised by major disturbances u thought, emotion and
behaviour, ideas are not logically related
- most sever psychopathology (0.2-25 prevalence)
- asaun populations have the lowest population have the lovest prevalence rates
- usually appears in late adolescence or early adulthood comorbid with personality
disorder ( avoidant, paranoid, depedndent and antisocial
- childhood conduct disorder is a potent disorder
- involve disturbances in several major areas: thought, perception and attention;motor
behaviour affect or emotion and life functioning
Positive symptoms: comprmises excesses or distortions sucha s disordganized speech,
hallucination and delusions, presence of too much behaviour
- Disorganized: thought disorder refers to problems in organizing ideas and in
speaking so that a listner can understand , incoherence, speech that is disordered are
called loose association or derailment, does not discriminate well between
schizophrenia and other psychoses
- Delusions: beliefs held contrary to reality, persecutory delusions are founf in 65%
of a cross sectional study
- Hallucination: sensory expeiences int eh absence of any stimulation from the
- Negative Symtoms:
oConsist of behavioural defecits such as avolition,alogia,anhedonia,flat affect
and asociality all of which are described below , endure beyond an acute
episode and have profound effecrs on people lives
oAvolition: or apathy refers to a lack of energy and a seeming absence of
interest in or an inability to persisit, inattentive to grooming and personal
oAlogia: can take several forms , kin poverty of speech and the sheer amount
of speech
oAnheodonia: inability to experience pleasire, lack of interesr in recreational
activities, failure to develop close relationsjip with others
oFlat effect: virtually no stimulus acan elicit an emotional response, stare
vacantly , flat and toneless voice, found in a majority of people with
oAsociality: severly impaired social relationships, few friends, pooor social
skills , and little interesr iun being with other people
- Other symptoms:
oCatatonia: defined by severall motor abnormlaites, gesture repeatedly using
peculiar and sometimes complex sequences of finger,. Hand and arm
movements that often seem to be purposeful, odd as they may be
oCatatonic immobility: unusual postures and maintain them for a very long
periods of time
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oWaxy flexibility: another person can move the person limbs into strange
positions that they maintain for extended periods
oInappropriate affect: emotional responses of thes individuals are out of
Early descriptions:
- formulated by European psychiatrists Emil kraepelin and Eugen Bluerler
- Kraepelin presented hisnotion of dementia praecoz and identified two major
groups:endogenous or internall caused psychoses, manic depressive illness and
dementia praecox, early onser and deteriorating course marked by a progressive
intellectual deterioiration
- Bleuler: belived that the disorder did not necessarily have an early onset and he
believes that it did notinevitably progress toward dementia, led to broader
DSM diagnosis:
- people with a mood disorder are specifically exclusded
- least six months of disturbance and must include at least one month of active
phasewhich is defined by the precense of at leat two of the following, delusions,
hallucination, disorganized speech, grossly disorganizes or catatonic behaviour,
min 6 months can be eother a prodormal (before active phase) or a residual phase
( after the active phase)
- a person with delusional disorder is troubled by persistent persecutory delusions or
by delusional jealousy which is the unfounded conviction that a spouse or lover is
- three types of schizophrenia: disorganized( hebephrenic), catatonic and paranoid:
Disorganized: speech is disorganized and difficult for a listener to follow, breaking into
inexplicable fits of laughter and crying , deteriorate to the point of incontinence
Catatonis:nost obvious symptoms, alternate immobility and wild exciement, resist
instructions and suggestions and often echo , seldom seen today
Paraniod schizophrenia: substantial number of recently admitted clients to psychiatric
hospitals, key is the presence of prominentn delusions , grandiose delusions:
exagerateed sense of their own importance, some have delusional jealousy,vivid
auditory hallucinations, develop ideas of rerfernce;they incoporateuninportant events
within a delusional framework and read personal significance into the trivial activities
of others
Diagnosisi of undifferentiated schizophrenia applies to people who meet diagnostic
criteria for schizophrenia , diagnosis of residual schizophrenia is used when the clients
no longer meets the full criteria but still shows signs of the disorder
Biochemical Factors;
- dopamine facotes:
oexcess of dopamine
oreceptors that are blocked by first generation or conventional anypsychotics
are called D@ receptors
odopamine theory: literature on amphetamine psychosis , amphetatmines can
prosuce a state that closely resembles paraiod schizophrenia, exacerbate the
symptoms of schizophrenia
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oassociated with the positive symptoms of schizophrenia
- GABA nerons hhvae alaso ben implicated
- Low levels of glutamate have been found in cerbbrospinal fluid of people with
Brain function:
- enlarged ventricles
oloss of subcorticol brain cells
- Prefrontal cortex:
oIs known to play a role in behaviour such as speech, decision makinnf and
willed action all of which are disrupted in schizophrenia
- highest rates of schizophrenia are found in central city areas inhibited by people in
the lowet social-economic class, believe that sressors ascoiated with being in a low
social class may cause or contribute to the development of schizophrenia- the
sociogenic hypothesis
- social-selection theory which reverses the direction of casuality between social
class and schizophrenia
- schizophregenic mother: describe the supposedly cold and dominant, conflict
inducing aprent who said to produce schizophrenia in her offspring
- people who come from homes of Low EE have a 10% relapse rate and those who
come from high EE homes have a relapse rate of 58%
Schock and psychosurgery:
- insulin-inducing comas has serious risks inclusing irreversible coma and death
- 1935: EGAS Moniz a portugeuese psychiatrist introduced preforontal lobotomy
which destroys the tracts connecting the frontal lobes to lower centres of the brain
after surgery clients may become: ull,listless and suffers serious losses int ehri
cognitive capacities
Drug therapies:
Antipsychotic drugs
First generation: phenothiazine, chlorpromazine ( thorazine) , they reduce some of the
positive symptoms of schizphreniabut theya re not a cure
- Drugs used in adjunction:lithium , antidepressants,anticonvulsants and tranquilizers
- Side effects : dizziness, blurred vision, restlessness ans sexual dysfunction
- Extrprymidial side effects, dysfuntions of the nerve tracts that descends from the
brain to spinal motor neurons, resemble PArkinsons
- Dystonia: a state of muscular rigidty and dyskensia and abnormal motion of
voluntary muscles, chewing movements
- Tardative dyskenesia: sucking, lip smacking ad chin wagging motions 10-205 of
- Nueroleptic malignant syndrome: 1% prevalence, fatal severe muscualar rigidity
develops accompanied by fever
Second generation:
- Clzapine ( clozaril)
- Greater therapeutic gains than traditional antipsychotics
- Risperidone: improves verbal working memory
Psychological treatments;
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