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Chapter 11

Chapter 11: Schizophrenia

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Mark Schmuckler

B32: Abnormal Psychology Chapter 11 Schizophrenia schizophrenia a group of psychotic disorders characterized by major disturbances in thought, emotion, and behavior; 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 patient withdraws from people and reality, often into a fantasy life of delusions and hallucinations - estimates in the prevalence in the population vary between 0.2-2%, in part dependent upon the measurement instrument; however, its lifetime prevalence is about 1% - the incidence is significantly higher in males than in females (male:female ratio = 1:4) - although schizophrenia sometimes begins in childhood, it usually appears in late adolescence or early adulthood, somewhat earlier for men than for women - people with schizophrenia typically have a number of acute episodes of their symptoms; between episodes, they often have less severe but still very debilitating symptoms - most people with schizophrenia are treated in the community, however, hospitalization is sometimes necessary - in Canada, hospitalization rates are typically much higher among young men relative to young women - about 10% of people with schizophrenia commit suicide - 50% of people with schizophrenia have comorbid disorders SCHIZOPHRENIA & COMORBIDITY - co-morbid conditions appear to play a role in the development, severity, and course of schizophrenia - co morbid substance abuse is a major problem for patients with schizophrenia, occurring in as many as 70% of them - research suggests that childhood conduct disorder problems are potent risk factors for substance use disorders in schizophrenia - theres co morbidity between schizophrenia and depression - those diagnosed with schizo who were also depressed, were more likely to use relapse related mental health services to be a safety concern (violent, arrested, victimized, suicidal), to have substance-related problems, and report poorer life satisfaction, quality of life, mental functioning, family relationships, and medication adherence. - co morbid anxiety disorders are also common and can impose an additional burden on people with schizophrenia and result in further decline in their perceived quality of life - co morbidity with OCD is also related to a previous history of suicidal ideation and suicide attempts - PTSD is highly prevalent and under diagnosed among military veterans with schizophrenia Clinical Symptoms of Schizophrenia - the symptoms of patients with schizophrenia involve disturbances in several major areas: thought, perception, and attention; motor behavior; affect or emotion; and life functioning - no essential symptom must be present for a diagnosis of schizophrenia Positive Symptoms 1 www.notesolution.compositive symptoms in schizophrenia, behavioral excess, such as hallucinations and bizarre behavior - positive symptoms comprise excess or distortions, such as disorganized speech, hallucinations, and delusions - positive symptoms define an acute episode of schizophrenia - positive symptoms are the presence of too much of a behavior that is not apparent in most people, while the negative symptoms are the absence of a behavior that should be evident in most people DISORGANIZED SPEECH disorganized speech (thought disorder) speech found in schizophrenics that is marked by problems in organization of ideas and in speaking so that others can understand - this refers to problems in organizing ideas and speaking so that a listener can understand incoherence in schizophrenia, an aspect of thought disorder wherein verbal expression is marked by disconnectedness, fragmented thoughts, and jumbled phrases - people with schizophrenia, although they may make repeated references to central ideas or a theme, the images and fragments of thought are not connected; its difficult to understand exactly what the patient is trying to tell the interviewer loose associations (derailment) in schizophrenia, an aspect of thought disorder wherein the patient has difficulty sticking to one topic and drifts off on a train of associations evoked by an idea from the past - with loose associations (derailment), the patient may be more successful in communicating with a listener but has difficulty sticking to one topic - evidence indicates that the speech of many patients with schizophrenia is not disorganized and that the presence of disorganized speech doesnt discriminate well between schizophrenia and other psychoses, such as some mood disorders DELUSIONS delusions beliefs contrary to reality, firmly held in spite of evidence to the contrary, common in paranoid disorders - delusions, which are common beliefs contrary to reality, are common positive symptoms of schizophrenia (please see page 327-328 for examples of delusions) - although delusions are found among more than half of people with schizophrenia, as with speech disorganization, theyre also found among patients with other diagnoses notably, mania and delusional depression - the delusions of patients with schizophrenia are often more bizarre than those of patients in other diagnostic categories; their delusions are highly implausible HALLUCINATIONS AND OTHER DISORDERS OF PERCEPTION - patients with schizophrenia often report that the world seems somehow different or even unreal to them; body may even feel like a machine hallucinations perceptions in any sensory modality without relevant and adequate external stimuli - the most dramatic distortions of perception are hallucinations, sensory experiences in the absence of any stimulation from the environment; theyre more often auditory than visual - some hallucinations are thought to be particularly important diagnostically because they occur more often in patients with schizophrenia than in other psychotic patients; these types of hallucinations include: some patients of schizophrenia report hearing their own thoughts spoken by another voice some patients claim that they hear voices arguing 2 www.notesolution.com
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