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Chapter 11

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University of Toronto Scarborough
Konstantine Zakzanis

Chapter 11Schizophrenia Schizophrenia psychotic disorder characterized by major disturbances in thought emotion and behaviourDisordered thinking in which ideas are not logically relatedFaulty perception and attentionFlat or inappropriate affectBizarre disturbances in motor activitySchizophrenics withdraw from reality and have fantasy life of delusions and hallucinations Prevalence in general population varies between 02 to 2 lifetime prevalence is about 1Asian populations have the lowest prevalence ratesMaleFemale ratio14 significantly higher in malesUsually appears in late adolescence or early adulthoodearlier for men than womenTypically have a number of acute episodes of their symptomsBetween episodes may have less severe but still debilitating symptoms 10 of people with schizophrenia commit suicideApproximately 50 of those with schizophrenia also have a comorbid disorderPersonality disorders substance use disorders mood disorders anxiety disordersCommon perception that personality disorders worse outcomes of schizophrenia moreSubstance use disorder in schizophrenics was largely due to childhood conduct disorders40 of schizophrenics had depression at onsetComorbid anxiety disorders impose additional burden on them and result in further decline to perceived quality of lifeOCD related to previous history of suicidal ideation and attemptsPTSD highly prevalent and underdiagnosed among veterans with schizophreniaClinical symptoms of SchizophreniaDisturbances in thought perception attention motor behaviour affect or emotion and life functioningNo essential symptom must be present for a diagnosis of schizophreniaThis means schizophrenics can differ from each other more than do people with other disordersHeterogeneity may be appropriate to subdivide people into types that manifest particular constellations of problems Positive SymptomsComprise excesses or distortionsdisorganized speech hallucinations and delusionsAcute episode of schizophreniaPresence of too much of a behaviour that is not apparent in most people opposite to the absence of behaviour seen in negative symptoms Chapter 11SchizophreniaDisorganized SpeechThought disorder problems in organizing ideas and in speaking so that a listener can understandIncoherence sometimes seen in the conversations of schizophrenicsMay have repeated references to central ideas but have disconnected imagesfragmentsDifficult to understandLoose associations derailmentMore successful in communication but have difficulty sticking to one topicSeem to drift off on a train of associations evoked by an idea from the pastSpeech of many schizophrenics not necessarily disorganized and sometimes have resemblance to loose associations in manic patientsDelusionsBeliefs held contrary to reality Ex persecutory beliefsFound in 65 of schizophrenic samplesDifferent formsPerson may be unwilling recipient of bodily sensationsthoughts imposed by external sourceBelieve that their thoughts are broadcast or transmitted so that others know what they are thinkingMay think their thoughts are being stolen from them unexpectedlyBelieve that their feelings are controlled by an external forceBelieve that their behaviour is controlled by external forceBelieve that impulses to behave in certain ways are imposed on them by external forceFound in other disorders mania and delusional depression but tend to be more bizarre and implausibleHallucinations and other disorders of perceptionReports of the world appearing to be different or even unrealChanges in how body feels or feelings of depersonalization like a machineHallucinationssensory experiences in the absence of any stimulation from the environmentMore often auditory than visual 74 report auditory hallucinationsDifferent forms of hallucinationReport hearing their own thoughts spoken by another voiceHear voices arguingHear voices commenting on their behaviourNegative SymptomsConsist of behavioural deficits avolition alogia anhedonia flat affect and asociality
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