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PSYB32H3 (1,174)
Chapter 11

PSYB32-Chapter 11 Notes .doc

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Konstantine Zakzanis

Chapter 11 Schizophrenia Schizophrenia is a psychotic disorder characterized by major disturbances in thoughts emotions and behaviour disordered thinking in which ideas are not logically related faulty perception and attention flat or inappropriate affect and bizarre disturbances in motor activity Hospitalization rates are typically much higher among young men relative to young women About 10 of people with schizophrenia commit suicide Despite recent advances in treatment many people with schizophrenia remain chronically disabled The disability can be attributed to symptoms inherent to schizophrenia as well as the comorbid disorders from which approximately 50 of those with schizophrenia suffer Schizophrenia and ComorbidityComorbid personality disorders eg avoidant paranoid dependent and antisocial are common and have implications for the course and clinical management of schizophrenia that treatment should include evaluation of cooccurring substance use disorders especially alcohol and cannabis abuse or dependence and that attention to associated mood especially Major Depression Disorder and anxiety syndromes particularly social phobia may be important for optimal outcomes Comorbid substance abuse is a major problem for people with schizophrenia Comorbidity with OCD is also related to a previous history of suicidal ideation and suicide attempts Clinical Symptoms of Schizophrenia The symptoms of people with schizophrenia involve disturbances in several major areas thought perception and attention motor behaviour affect or emotion and life functioning No essential symptom must be present for a diagnosis of schizophrenia Thus people with schizophrenia can differ from each other more than do people with other disordersPositive SymptomsPositive symptoms comprise excess or distortions such as disorganized speech hallucinations and delusions They are what define for the most part an acute episode of schizophrenia Positive symptoms are the presence of too much of a behaviour that is not apparent in most people While the negative symptoms are the absence of a behaviour that should be evident in most people Disorganized SpeechAlso known as formal thought disorder disorganized speech refers to problems in organizing ideas and in speaking so that a listener can understand Speech may also be disordered by what are called loose associations or derailment In these cases the person may be more successful in communicating with a listener but has difficulty sticking to one topicDisturbances in speech were at one time regarded as the principal clinical symptoms of schizophrenia and they remain one of the criteria for the diagnosis Delusions Delusions beliefs held contrary to reality are common positive symptoms of schizophrenia The following descriptions of these delusions are draw from Mellor 1970The person may be the unwilling recipient of bodily sensations of thoughts imposed by an external agency People may believe that their thoughts are broadcast or transmitted so that others know what they are thinking People may think their thoughts are being stolen from them suddenly and unexpectedly by an external force Some people believe that their feelings are controlled by an external force Some people believe that their behaviour is controlled by an external force Some people believe that impulses to behave in certain ways are imposed on them by some external force Hallucinations and Other Disorders of PerceptionThe most dramatic distortion of perception are hallucinations sensory experiences in the absence of any stimulation from the environment Some people with schizophrenia report hearing their own thoughts spoken by another voiceSome people claim that they hear voices arguing Some people hear voices commenting on their behaviour
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