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Psychopathology 2.docx

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Joe Kim

Psychopathology 2 Module 1: Schizophrenia - There is no main symptom of schizophrenia – often combination - Several broad categories of symptoms o Positive: behaviours that increase in someone with schizophrenia  Disorders of thought  Schizophrenic thinking is characterized by loose associations: the individual’s train of thought may consist of ideas that are often only loosely related to each other  Schizophrenic speech may be vague and abstract  Patients start making associations with a certain word and trail off from original intent  Content may of schizophrenic thought is often unusual o May contain fragmentary or bizarre delusions – a belief that is irrational, or unsupported by external evidence e.g. individual is being persecuted by other, or that events or objects have special significance for the individual. Delusion may be that person on TV is speaking to them. Delusions are often about thought or thinking:  Thought broadcast – belief that others can hear one’s thoughts  Thought withdrawal – belief that the individual’s thought are being removed from his head before he can think them  Thought insertion – belief that thoughts are being placed in the individuals head by others  Also can be new behaviours that emerge such as hallucinations – perceptions of things that are not really there. Auditory hallucinations occur more often than visual hallucinations. The individual may report that she hears voices in her head or speaking to her from parts of her body – the voices are often negative, giving orders, or commenting on individual’s behaviour o Negative: behaviours that decrease in someone with schizophrenia (usually engagement with the outside world)  The individual becomes less and less interested in people and events in the outside world and more concerned with internal ideas or fantasies. This may lead to a growing estrangement from family and coworkers and an increasing neglect of one’s personal appearance. The individual’s emotional responses may also change  Affect – emotional responsiveness  Flat/Blunted Affect – person shows very little emotional response  Inappropriate Affect – person shows inappropriate emotion responses for the situation. E.g. laughing when speaking about loss of family remember o Catatonic: movement behaviours that an individual exhibits which are not in response to any event in the environment  Behaviours are unrelated to stimuli from outside world  Catatonia may involve a dramatic reduction in movement sometimes to the point of no movement at all = catatonic rigidity/stupor. This individual may maintain a single posture for very long periods and resist being moved.  Or may involve ‘waxy flexibility’- patient’s arms and legs can moved into a variety of positions like wax figure and then very slowly move back to original  Or may be repeated and stereotyped motor movements that seem to have no purpose at all and are unrelated to surroundings.  Catatonic excitement- very active or frantic repeated movements o Any given patient may experience only some of these symptoms and the severity varies from one case to another - Subtypes of symptoms: recognized by DSM and based on pattern of symptoms that dominate o Paranoid  The dominant symptom is delusions or auditory hallucinations within a single theme  Individual’s thinking may be relatively coherent with no disturbed affect or psychomotor disturbances  Individual often shows anger or anxiety related to disturbing content of delusions o Catatonic  Dominant symptom=psychomotor disturbances (may include, catatonic stupor excitement or alteration b/t the two.) There may be stereotyped postures or mannerisms together with waxy flexibility o Disorganized  Considered to be most severe and disruptive  Thoughts and speech are markedly incoherent – w/ very loose associations  Disorganized behaviour  Individual shows flat or inappropriate affect and delusions are incoherent and fragmentary.  Marked psychomotor disturbances and profound social withdrawal o Undifferentiated schizophrenia  Cases that do not neatly fit into any of the other three categories - Causes of Schizophrenia o Diathesis-stress Hypothesis: genetic predisposition for schizophrenia and environmental stress triggers the symptoms o Epidemiological evidence for genetic predisposition consistent  Probability that an individual will develop symptoms increases the more closely he or she is related to someone who has the disorder – identical twins more likely to both develop schizophrenia than fraternal twins  Adoption studies report that schizophrenia is more common in biological relatives of adoptees than in non-related members from adopted families  Not clear what inherited disposition is: abnormalities in brain structure or changes in levels of neurotransmitters o Not sure what environmental event triggers schizophrenic symptoms  Leading candidate= stress and problems w/ relationship w/ others esp immediate family.  Evidence of higher levels of dysfunction in families of schizophrenics – but difficult to tell wither it was there before the disorder appeared or occurred as the family tried to deal with the individual’s symptoms - Treatment of Schizophrenia o Until 1960s when effective drug treatments became available, schizophrenics were put in long-term psychiatric care o Pharmacological treatment is now the most common therapy  But drugs not equally successful with all patients or with all types of symptoms  Most drugs that are effective against symptoms of schizophrenia have severe side effects of their own – so some patients would rather experience schizophrenia symptoms that side effects therefore affect on compliance rates o Most studies find psychotherapy does not help very much in treating the major symptoms of schizophrenia  However, may help the patient develop new coping strategies once drugs have relieved their symptoms  In CBT, patient is taught how to think about psychosis in ways that allow him to better cope. Patients learn to identify and avoid triggers or learn positive ways to react to these triggers. CBT is also often used to encourage patients to comply with medicinal instructions through rewarding adherence. 
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