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PSYB32: Abnormal Psych Exam Notes

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Konstantine Zakzanis

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PSYB32 Abnormal Psych Exam Notes Chapter 11 SchizophreniaIntroDiagnosis ofhas existed for over a century More research than any other psych problemLifetime prevalence of all psychotic disorders3Prevalence for schizophrenia is 1Real variation across geographic areas Asian popns have lowest prevalenceSignificantly more likely in malesSometimes begins in childhood but usually appears in late teensearly adulthoodAbout 13 of those with a schizophreniaspectrum disorder schizophrenia related disorders related PDs etc are early onsetBegins a bit earlier for men than for women10 of those withcommit suicide50 withhave a comorbid disorder including many having depression anxietyMany also have substance abuse mainly in male schizophrenicsComorbidity with OCD is related to a previous history of suicide ideationattemptsPTSD is also highly prevalent and underdiagnosed among military veteran schizophrenics Clinical Symptoms of SchizophreniaThere are no essential symptoms out of the huge list so schizophrenics are heterogeneous Positive SymptomsExcessesdistortions such as disorganized speech hallucinations delusionsThese define acute episodesDisorganized speech formally known as thought disorder o Incoherence person may make repeated refs to a central theme fragments are too disconnected to understando Loose associationsderailment difficulty sticking to one topic drifting off on a train of associations This is similar to loose associations of manic people o Disturbances in speech were once regarded as principal symptom of Delusions o Beliefs held contrary to reality o persecutory delusions are common o over half of those with have delusions o delusions are also found in mania delusional depression and other disorders o however delusions in schizophrenics are often more bizarre and impossibleHallucinations and other disorders of perception o World feels different or unreal depersonalization o Difficulty paying attention to goings on around you o Common auditory hallucinations that happen more often inthan other diagnosesHearing voices arguingHearing own thoughts spoken by another voiceHearing a voice commenting on own behv Negative SymptomsBehavioural deficits that tend to endure beyond acute deficitsStrong predictor of poor quality of lifeAssociated with earlier onset brain damage enlarged ventricles and progressive loss of cog skills IQ declineImportant to distinguish negative symptoms that are really offrom those due to other factors like side effect of meds or from depressionAvolition lack of energy or interest or inability to persist in what are usually routine activitiesAlogia a negative thought disorder that can take several forms o Poverty of speech little info vague repetitive poverty of content Notof wordsAnhedonia inability to experience pleasureFlat Affect virtually no stimulus can elicit an emotional response o Found in majority of people witho Vacant stare muscles of face flaccid eyes lifeless o Only the outward expression inwardly they may not be impoverished at allReport same amount of emotion just less facially expressiveAsociality severly impaired social relationshipso Few friends poor social skills little interest in being with people shy o More childhood social troubles are an early indicator o Deficits in recognizing emotional cues displayed by others Other Symptoms that are neither Positive or NegativeCatatonia motor abnormalities like gesturing repeatedly flailing limbs or catatonic immobility maintaining an unusual posture for extended amounts of time These people may also have waxy flexibility where they can be moved into different positionsInappropriate affect emotional responses that are out of context shifting rapidly in emotions for no discernible reason Both of these symptoms are very rare but also fairly unique toHistory and Concept of SchizophreniaFirst discovered by Emil Kraplin and Eugen BleulerKraeplin called it dementia praecox at first he had came up with 2 major groups of psychoses manicdepressive and dementia praecox Praecoxa common core an early onsetand he meant dementia as in mental enfeeblement and not the same dementia that old havewithin this he included 3 concepts dementia paranoids paranoid schizophrenia catatonia hebephrenia disorganized schizophreniaBleuler disagree that o it did not ahve to be an early onset o does not inevitably progress to dementiathusdementia praecox was no longer appropriate Became Bleulers term schizophreniaBleuler believed that the common aspect of schizophrenics was the breaking of associative threads in words and thoughts Blocking total loss of train of thought total destruction of associative threadsPrevalence has fallen sharply since 1960sPart of the reason is that Bleuler first caused the diagnosis to expand such that many people were said to be schizophrenics and then the diagnosis later narrowedSchizophrenic psychosis was a diagnosis in DSM 1 of schizophrenicaffective symptomsBefore schizophrenia was diagnosed whenever delusionshallucinations were presentSeveral personality disorders were also the same as schizophrenia back thenThose with acute onset and rapid recovery were also diagnosed incorrectlyBeginning in DSM 4 the diagnosis became significantly narrower in 5 ways o Explicit detailed criteria o People with symptoms of mood disorder were specifically excluded Schizoaffective type is now listed as schizoaffective disorder in a separate section of psychotic disorders This is a mixture of schizophreniamood disorders o Requires min 6 months of disturbance for diagnosis with min 1 month of active phaseActive phaseat least two of delusions hallucinations disorganized speech disorganized or catatonic behv negative symptoms if the delusions are bizarre or hallucinations consist of voices commenting or arguing only that 1 symptom is neededRemaining time of 6 months can be either prodromal before active phase or residual afterThis criteria is to eliminate people who have a brief psychotic episode which is now diagnosed as either schizophreniform disorder 16 months or brief psychosis 1 day tomonth due to extreme stressSome of what DSM 2 called mildare now PDsDifferentiating between paranoid schizophrenia and delusional disorderdelusions such as erotomaniabelieving that one is loved by some other person typically a stranger of high status Unlike paranoid schizophrenia no disorganized speech hallucinations and less bizarre delusions It is quite rare and typically begins later in life Related toby genetics o The criteria generally holds well crossculturally but people in developing countries have more acute onset and a more favourable course than in industrialized societies unknown why this is
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