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Chapter 10

PSYC 208 Chapter Notes - Chapter 10: Differential Diagnosis, Encephalitis, White Matter

19 pages67 viewsFall 2012

Department
Psychology
Course Code
PSYC 208
Professor
Paul Wehr
Chapter
10

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Schizophrenia 10/31/2012 10:38:00 AM
Introduction to Schizophrenia
Schizophrenias are a heterogeneous collection of psychotic disorders (mind split from reality)
1 in 100 will develop schizophrenia
Not multiple personality disorder (DID)
Cognitive deficits
o Thought
o Perception: ability to perceive sensory input
o Behavior
o Emotion
Severe mental disorder
o Dramatic reduction in fitness beginning during prime reproductive years
o Strikes at the peak of reproductive years
Negative Symptoms
Behavior deficits
o Avolition: apathetic towards work, social, personal activities (e.g. grooming); often
inactive
o Alogia: poverty of speech or content
o Anhedonia: inability to experience pleasure
o Flat affect: no visible expression of internal emotional states
Affect: emotion
Doesn’t mean they’re not experiencing emotion
Refers to expression only, not experience
Kring & Neale: patients showed little facial expression while watching an
emotional film, but reported similar feelings as non-patients
o Inappropriate affect: wrong emotion
o Asociality (social withdrawal): few friends and poor social skills
o Impoverished motor activity
Positive Symptoms
Behavioral excesses or peculiarities
o Delusions: persistent and unrealistic false beliefs
o Hallucinations: perceptions that occur in the absence of a physical stimulus, or that
are distorted
o Disorganized or hyperactive motor behavior
o Disorganized or chaotic thought
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Most patients exhibit both; differ in degree only
o Positive > Negative: Better adjustment before onset and better response to non
treatment
Subtypes Defined by Positive Symptoms
Paranoid Type (common)
o Delusions of persecution and grandeur
Theft of thoughts or broadcasting of thoughts
Thought control
Behavioral control
o Auditory hallucinations
Own thoughts spoken by another voice
Voices arguing
o Become suspicious of social network, institutions, unknown persons/entities
Disorganized Type
o Severe deterioration of speech and behavior
Incoherent and fragmented speech (repeated reference to a theme)
Derailment (loose associations): difficulty staying on topic
o Flat or inappropriate affect and social withdrawal
Subtype Defined by Negative Symptoms
Catatonic Type (uncommon)
o Mutism: absence or minimal speech
o Stupor: slowed or lack of voluntary movement
o Negativism: no response to instructions or does the opposite
o Catalepsy: rigidity of limbs and bizarre posturing; “waxy flexibility” when limbs
moved
o Stereotyped behavior: persistent, repetitive purposeless movements
o Mannerisms: conspicuous, exaggerated and distorted movement
o Echolalia (imitates speech) and echopraxia (imitates movement)
o Characterized by motor disturbances
Other Subtypes
Undifferentiated Type (most common): Idiosyncratic mixture of symptoms
Residual Type: psychotic symptoms have subsided but persist in attenuated form
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Schizophreniform Disorder: schizophrenic episode lasting longer than 1 month but less than 6
months
Good prognosis
o Rapid onset vs. insidious onset
o Confusion at height of episode
o High social and occupational functioning prior to onset
o Absence of flat affect (negative symptoms)
Other Schizophrenias
Schizoaffective Disorder
o Shizophrenic episode combined with Major Depression, Mania, or both; delusions or
hallucinations occur in the absence of mood symptoms (2 weeks)
o Continuum with mood disorder and psychotic disorders at anchors
Delusional Disorder
o Non-bizarre delusions (e.g. being followed)
o Hallucinations consistent with the delusion, but no other psychotic symptoms; high
level of functioning
o Specific types
Erotomanic Type: someone important in love with the individual
Grandiose Type: inflated worth
Jealous Type: unfaithful spouse
Persecutory Type: malevolent intentions of others
Somatic Type: physical defect or disease
Mixed Type
Unspecified Type
o Also overlaps with OCD
Epidemiology
Lifetime prevalence: <1% worldwide
Onset is typically in late adolescence or young adulthood
o Some cases in childhood
o Rare after age 40
Male to female ratio 1.2:1.0
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