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Chapter Thirteen - Schizophrenia and Other Psychotic Disorders.docx

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David Moscovitch

[ THIRTEEN ] – SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS  Schizophrenia = startling disorder characterized by broad spectrum of cognitive & emotional dysf’ns, such as delusions & hallucinations, disorganized speech & beh’, and inappropriate emotions - can disrupt perception, thought, speech and mvmt—almost every aspect of daily f’n’g - recovery rare - financial drain; majority of ppl w/ scz in CAN unemployed and living in poverty PERSPECTIVES ON THE CONCEPT OF SCHIZOPHRENIA Early Figures in Diagnosing Schizophrenia  Kraeplin combined several symptoms of insanity: - catatonia = alt’g immobility and excited agitation - hebephrenia = silly and immature emotionality - paranoia = delusions of grandeur/persecution  all included in dementia praecox  Kraeplin distinguished dementia praecox from manic-depressive illness (bipolar D)  Bleuler intro’d term schizophrenia - reflected his belief tht underlying all unusual beh’s shown by ppl w/ scz was associative splitting of basic f’ns of personality Identifying Symptoms  Difficult to diagnose - is actually # of beh’s/symptoms tht aren’t necessarily shared by all CLINICAL DESCRIPTION  Psychotic = characterizes many unusual beh’s, although in its strictest sense it usually involves delusions (irrational beliefs) and hallucinations (sensory exp’s in absence of ext. events) - scz is one D tht involves psychotic beh’  Media portrayals cont’ to frequently depict ppl w/ scz as vio’ - mistakenly assume scz mean ―split personality‖  +ve symptoms include more active manifestations o abnormal beh’, or excess/distortion o f normal beh’ i.e. delusions and hallucinations  -ve symptoms involve deficits in normal beh’, in such areas as speech and motivation  Disorganized symptoms include rambling speech, erratic beh’, and inappropriate affect  Diagnosis req’s 2/more +ve/-ve/disorganized symptoms be present for at least 1 mth Positive Symptoms Delusions  … = misinterpretation of reality; disorder of thought content  ―basic characteristic of madness‖  Cotard’s syndrome = person believes part of his/her body (i.e. brain) has changed in some impossible way  Capgrass syndrome = person believes someone he/she knows has been replaced by a double  Future studies should test whether deficit in integration of new material could have causal role in persistence of delusions Hallucinations  … = exp’ of sensory events w/o any input from surrounding env’  Ppl tend to exp’ hallucinations more frequently when unoccupied/restricted from sensory input  Theories: - not hearing voices of others, but are listening to own thoughts and can’t recognize difference - auditory verbal hallucinations arise from abnormal activation of 1 auditory cortex Negative Symptoms  Include emotional & social w/drawal, apathy, poverty of thought/speech  Abt 25% scz display these symptoms Avolition  … = inability to initiate and persist in activities  Aka apathy  Show little interest in performing even basic daily f’ns (i.e. personal hygiene) Alogia  … = relative absence of speech  May respond w/ very brief replies tht have little content and may appear uninterested in convo - sometimes delayed comments or slow reponses  Deficiency in comm’n believed to reflect –ve thought D rather than inadequate comm’n skills - suggested tht they may have trouble finding right words to formulate thoughts Anhedonia  … = presumed lack of pleasure exp’d  Indifference to activities considered pleasurable i.e. eating, social interactions, sexual rel’ns Affective Flattening  Flat affect = ~ to ppl wearing masks b/c dN show emotions when you would normally expect them to  Although they dN react openly to emotional situations, may be responding inside  May rep’ difficulty expressing emotion, not lack of feeling Asociality  Severe deficits in soc’ rel’nshps i.e. few friendships, little interest in socializing, poor social skills  Suggested: difficulties in processing info may contribute significantly to social skills deficits and other social difficulties Disorganized Symptoms Disorganized Speech  Often lack insight—awareness tht they have problem  Exp’ ―associative splitting‖ and ―cognitive slippage‖ - sometimes jump from topic to topic - talk illogically  Tangentiality = going off on a tangent instead of answering specific q’n  Loose association = derailment; abruptly changing topic of convo to unrelated areas Inappropriate Affect and Disorganized Behaviour  Inappropriate affect = laughing/crying at improper times; hoarding objects; acting in unusual ways in public  Catatonia = involves motor dysf’ns tht range from wild agitation to immobility  Catatonic immobility = fearful of sth terrible happening if they move Schizophrenic Subtypes  3 divisions: - paranoid = delusions of grandeur/persecution - disorganized = hebephrenic; silly and immature emotionality - catatonic = alt immobility and excited agitation Paranoid Type  Cognitive skills and affect relatively intact  Generally dN have disorganized speech or flat affect  Typically better prognosis than other forms Disorganized Type  Marked disruption in speech and beh’  Show flat/inappropriate affect  Unusually self-absorbed and may spend considerable amnts of time looking at themselves in the mirror  If delusions/hallucinations present, tend not to be organized around central theme  Problems often chronic Catatonic Type  Motor dysf’ns  Sometimes display odd mannerisms w/ bodies and faces, including grimacing  Often repeat/mimic words of others—echolalia—or mvmts of others—echopraxia Undifferentiated Type  Ppl who have major symptoms but who dN meet criteria for other types Residual Type  Had at least on episode of scz but no longer manifest major symptoms  May display residual/―leftover‖ symptoms i.e. –ve beliefs, social w/drawal, bizarre thoughts, inactivity, flat affect Other Psychotic Disorders Schizophreniform Disorder  Exp’ symptoms of scz for a few mths only and then usually resume normal lives  Lifetime prevalence: 0.2%  Onset of psychotic symptoms w/in 4wks of first noticeable change in usual beh’, confusion at height of psychotic episode, good premorbid social and occupational f’n’g, absence of blunted/flat affect Schizoaffective Disorder  In addition to presence of mood disorder there have been delusions/hallucinations for at least 2 wks in absence of prominent mood symptoms  Prognosis ~ scz Delusional Disorder  Persistent belief contrary to reality, in absence of other scz characteristics  Characterized by persistent delusion not result of organic factor (i.e. brain seizures or severe psychosis)  Flat affect, anhedonia, other –ve symptoms  Become socially isolated b/c suspicious of others  Delusions often long-standing, sometimes persisting several yrs  Subtypes: - erotomanic = belief tht higher-status & unsuspecting person is in love w/ them - grandiose = believing in one’s inflated worth/pwr/knowledge/identity/special rel’nshp to diety/famous person - jealous = believes sexual partner is unfaithful - persecutory = believes he/she/someone close is being malevolent treated in some way - somatic = feels afflicted by phys defect or general medical condition  Relatively rare (affect 24-30 out of 100 000 in general pop’n)  Onset relatively late - avg age of admission to psychiatric facility: 40-49  Seems to afflict more F than M (55:45)  Other Ds can cause delusions, and should be ruled out before diagnosing delusional D i.e. substance use, brain tumours, Huntington’s, Alzheimer’s Brief Psychotic Disorder  Presence of 1/more +ve symptoms lasting 1mth or less  Often precipitated by extremely stressful situations Shared Psychotic Disorder (Folie à Deux)  Ind
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