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Chapter 11

CHAPS 11, 12, 13, 16 from 4TH EDITION

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11 SCHIZOPHRENIASchizophrenia a group of psychotic disorders characterized by major disturbances in thought emotion and behaviour disordered thinking in which ideas are not logically related faulty perception and attention bizarre disturbances in motor activity flat or inappropriate emotions and reduced tolerance for stress in interpersonal relations The person withdraws from people and reality often into a fantasy life of delusions and hallucinationsMisurellia schizophrenic woman described in the blue boxSchiz usually appears in late adolescence or early adulthood somewhat earlier for men than for women Schizophrenia and Comorbidity o Comorbid personality disorders are common and have implications for the course and clinical management of schizophreniao Treatment should include evaluation of cooccurring substance use disorders and attention to associated mood and anxiety syndromes may be important for optimal outcomes CLINICAL SYMPTOMS OF SCHIZOPHRENIASymptoms involve disturbances in several major areas attention thought perception motor behaviour emotion life functioningWalter Heinrichs suggested key to understanding schiz is to recognize its heterogeneity at the empirical and conceptual levelsnoted that presentation course and outcome of schiz are variable and diverse POSITIVE SYMPTOMS o Positive symptoms behavioural excesses such as hallucinations and bizarre behaviour o Disorganized speechthought disorderproblems in organizing ideas and in speaking so that a listener can understand o Incoherence aspect of thought disorder wherein verbal expression is marked by disconnectedness fragmented thoughts and jumbled phrases o Loose association derailment aspect of thought disorder wherein the client has difficulty sticking to one topic and drifts off on a train of associations evoked by an idea from the past o Delusions beliefs contrary to reality firmly held in spite of evidence to the contrary common in paranoid disorders of control belief that one is being manipulated by some external force such as radar television or a creature from outer space of grandeur belief that one is an especially important or powerful person of persecution belief that one is being plotted against or oppressed by others o Most important delusions were described by german psychiatrist Kurt SchneiderPerson unwilling recipient of bodily sensationsthoughts imposed by external agencyPerson believes their thoughts are transmittedbroadcast so everyone knowsPerson thinks their thoughts are stolen from them by external forceBelieves feelings are controlled by external forceBelieves behaviours are controlled by external forceBelieves impulses to behave in certain ways are imposed on them by external force o Hallucinations perceptions in any sensory modality without relevant and adequate external stimuli o some hallucinations are thought to be important diagnostically because they occur more often in ppl with schiz than in other psychotic pplSome people with schiz report hearing their own thoughts spoken by another voiceSome people claim they hear voices arguingSome people hear voices commenting on their behaviour NEGATIVE SYMPTOMS o Negative symptoms behavioural deficits in schiz such as flat affect and apathy o Presence of many negative symptoms is a strong predictor of poor quality of life o Negative symptoms also associated with earlier onset brain damage o Avolition a NS in schiz in which the individual lacks interest and drive o Alogia marked by poverty of speech and of speech content o Anhedonia the individual is unable to feel pleasure o Flat Effect a deviation in emotional response wherein virtually no emotion is expressed whatever the stimulus emotional expressiveness is blunted or a lack of expression and muscle tone is noted in the face o Asociality marked by an inability to form close relationships and to feel intimate OTHER SYMPTOMS o Catatonia several motor abnormalitiesCatatonic immobility a fixity of posture sometimes grotesque maintained for long periods with accompanying muscular rigidity trancelike state of consciousness and waxy flexibilityWaxy Flexibility an aspect of catatonic immobility in which the persons limbs can be moved into a variety of positions and maintained that way for unusually long periods of time o Inappropriate Affect emotional responses that are out of context such as laughter upon hearing tragic news HISTORY OF THE CONCEPT OF SCHIZOPHRENIAEARLY DESCRIPTIONS o Concept of schiz formulated by Emil Kraepelin andEugen Bleuler o Dementia praecox early term for schizophrenia o Kraelepin differentiated two major groups of internally caused psychosisManic depressive illness and dementia praecox o Bleuler believed the disorder did not necessarily have an early onset and he believed that it did not inevitably progress toward dementia o In 1908 Bleuler proposed his own term schizophrenia from the Greek word schizein meaning split and phren meaning mind o Kraepelin preferred to limit the diagnostic category to clients who had a poor prognosis o Bleulers work led to broader concept of schiz he diagnosed clients with a good prognosis as schiznophrenicTHE HISTORICAL PREVALENCE OF SCHIZOPHRENIAo Data suggest rates of schiz haven fallen sharply since the 1960s worldwide o Number of ppl diagnosed with schiz has varied depending on how schiz has been conceptualized and defined tho In the 20 century frequency of diagnoses of schiz increased in US but not in England mainly because several prominent figures in US psychiatry expanded Bleulers already broad concept of schiz even more
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