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Chapter 13

PSYCH257 Chapter Notes - Chapter 13: Emil Kraepelin, Impulsivity, Lobotomy

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Allison Kelly

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PSYCH 257: March 12, 2013
Chapter 13: Schizophrenia and Other Psychotic Disorders
Schizophrenia: devastating psychotic disorder that may involve characteristic disturbances in thinking
(delusions), perception (hallucinations), speech, emotions, and behaviour
Perspectives on the Concept of Schizophrenia
Emil Kraepelin has 2 important accomplishments in the description and categorization of schizophrenia:
1) Combined several symptoms of insanity under the term of dementia praecox (“premature
loss of mind”, early label for schizophrenia emphasizing the disorder’s frequent appearance
during adolescence)
- Catatonia: disorder of movement involving immobility or excited agitation
- Hebephrenia: silly and immature emotionality
- Paranoia: irrational delusions of grandeur or persecution
2) Distinguished dementia praecox from bipolar disorder
- Dementia praecox involves early age of onset and a poor outcome
Eugen Bleuler
- Introduced the term schizophrenia (combined the Greek words of “split” and “mind”
- Believed that there was an associative splitting of the basic functions of personality (eg.
cognition, emotion, perception)
- Disorder defined by the difficulty of keeping a consistent train of thought
- Unlike many other mental disorders, schizophrenia cannot be defined by a particular behaviour,
way of thinking, or emotion
- People with schizophrenia do not necessarily share all the same behaviours or symptoms
Clinical Description
- Schizophrenia involves psychotic behaviour
o Psychotic: disorder involving delusions, hallucinations, loss of contact with reality or
disorganized speech or behaviour
- Must have 2 or more characteristic symptoms for at least one month: delusions, hallucinations,
disorganized speech, grossly disorganized behaviour, and negative symptoms
- 2 people may receive the same diagnosis but have different symptoms
POSITIVE SYMPTOMS: more overt symptoms of schizophrenia
Delusions: psychotic symptoms involving disorder of thought content and presence of strong beliefs
that are misrepresentations of reality
Types of delusions:
o Delusion of grandeur
o Delusion of persecution
o Cotard’s syndrome: person believes a part of his/ her body has changed in some
impossible way
o Capgras syndrome: person believes that someone he/she knows has been replaced by a

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- Individuals with current delusions expressed a much stronger sense of purpose and meaning in
like and less depression in comparison to people who previously had delusions
HALLUCINATIONS: psychotic symptom of a perceptual disturbance in which things are seen or heard or
otherwise sensed although they are not real or actually present
- Auditory hallucinations (hearing things that aren’t there) are the most common
- One theory is that auditory hallucinations are actually one’s own voice (not the voice of others),
but one is unable to recognize the difference
- Another theory is that auditory hallucinations arise from the abnormal activation of the primary
auditory cortex
o Auditory hallucinations were found to be associated with increased metabolic activity in
the left primary auditory cortex and in the right middle temporal gyrus
NEGATIVE SYMPTOMS: less outgoing symptoms, such as flat affect and poverty of speech, indicates the
absence or insufficiency of normal behaviour
Avolition: apathy, or the inability to initiate or persist in important activities
o Little interest in performing the most basic of functions (eg. maintaining personal
o Avolition is more highly associated with poor outcome
Algoia: deficiency in the amount or content of speech
o May respond to questions with brief replies that have little content
o May appear uninterested in the conversation
o May have trouble finding the right words to formulate thoughts
o Delayed comments or slow responses to questions
Anhedonia: inability to experience pleasure
o Indifference to activities that would be considered pleasurable (eg. eating, social
interactions, and sexual relations)
o Relates to a delay in seeking treatment for schizophrenia
Flat Affect: apparently meaningless demeanour (including toneless speech and vacant gaze)
when a reaction is expected
o Vacant stare, flat and toneless speech, seem unaffected by the things going on around
o Responding to the situation on the inside but not reacting openly
o Difficulty expressing emotion, not a lack a emotion
Asociality: severe deficits in social relationships
o Few friendships, little interest in socializing, and poor social skills
o Also associated with shyness and inhibition in childhood
o Best predictor of asociality is chronic cognitive impairment (difficulties in processing
DISORGANIZED SYMPTOMS: variety of erratic behaviours that affect speech, motor behaviour, and
emotional reactions
Disorganized speech: style of talking that involves incoherence and a lack of typical logical
o Tangentiality: going off on a tangent instead of answering the question

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o Cognitive slippage, associative splitting, loose association, derailment
Inappropriate Affect: emotional displays that are improper for the situation
o Laughing or crying at improper times
o Bizarre behaviours (eg. hoarding objects or acting in unusual ways in public)
Disorganized Behaviour
o Catatonia: disorder of movement involving immobility or excited agitation
o Waxy flexibility: the tendency to keep their bodies and limbs in the position they are put
in by someone else
System for subtyping schizophrenia into 2 types, emphasizing the positive, negative, and disorganized
symptoms by Strauss, Carpenter, and Bartko
- Type I: positive symptoms of hallucinations and delusions, good response to medication,
optimistic prognosis, absence of intellectual impairment
- Type II: negative symptoms of flat affect, poverty of speech (algoia), poor response to
medication, pessimistic prognosis, and intellectual impairments
Alternative system of subtypes based on Kraepelin’s concept of schizophrenia:
Paranoid Type: type of schizophrenia with symptoms primarily involving delusions,
o Speech, motor, and emotional behaviour are relatively intact (do not have disorganized
speech or flat effect)
o Typically have a better prognosis than other forms of schizophrenia
o Delusions and hallucinations usually share a theme (eg. grandeur or persecution)
o Patients with the paranoid type of schizophrenia are suggested to have particular
deficits in social information processing
Disorganized Type (hebephrenic): type of schizophrenia featuring disrupted speech and
behaviour, disjointed delusions, and hallucinations, and silly or flat affect
o May seem self-absorbed and spend considerable amounts of time looking at themselves
in the mirror
o Delusions or hallucinations, if present, are not organized around a central theme
o Experience difficulty early, problems are chronic, and lack improvement in symptoms
Catatonic Type: type of schizophrenia in which motor disturbances (rigidity, agitation, odd-
mannerisms) pre-dominate
o Display odd mannerisms with their bodies and faces
o Echolalia: repeat or mimic the words of others
o Echopraxia: repeat or mimic the movements of others
Catatonic immobility:
disturbance of motor behaviour in
which the person remains
motionless, sometimes in an
awkward position for extended
periods of time
Wild agitation (eg.
excitedly move their
fingers or arms in
stereotyped ways)
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