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Chapter 11

Chapter 11 for FALL 2010 semester

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Konstantine Zakzanis

PSYB32 CHAPTER 11: SCHIZOPHRENIA NOV.8 .2010 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 adolescenceor 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 and Comorbidity - comorbid conditions appear to play a role in the development, severity, and course of schizophrenia - comorbid 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 comorbidity between schizophrenia and depression - comorbid 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 - comorbidity with OCD is also related to a previous history of suicidal ideation and suicide attempts - PTSD is highly prevalent and underdiagnosed 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 www.notesolution.com positive symptoms in schizophrenia, behavioral excess, such as hallucinations and bizarre behavior - positive symptoms comprise excessor 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 seepage 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 www.notesolution.com - patients with schizophrenia often report that the world seems somehow different or even unreal to them 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 some patients hear voices commenting on their behavior Negative Symptoms negative symptoms behavioral deficits in schizophrenia, such as flat affect and apathy - the negative symptoms of schizophrenia consist of behavioral deficits, such as avolition, alogia, anhedonia, flat affect, and asociality - these symptoms tend to endure beyond an acute episode and have profound effects on the lives of patients with schizophrenia - the presence of many negative symptoms is a strong predictor of a poor quality of life (eg: occupational impairment, few friends), 2 years following hospitalization - in addition to prognosis, there is also some evidence that negative symptoms are associated with earlier onset brain damage (eg: enlarged ventricles) and progressive loss of cognitive skills (eg: IQ decline) - when assessing negative symptoms, its important to distinguish among those that are truly symptoms of schizophrenia and those that are due to some other factor; observing patients over extended periods of probably the only way to address this issue Avolition avolition a negative symptom in schizophrenia in which the individual lacks interest and drive - apathy or avolition refers to a lack of energy and a seeming absence of interest in or an inability to persist in what are usually routine activities - for example, they may have difficulty persisting at work, school, or household chores and may spend much of their time sitting around doing nothing Alogia alogia a negative symptom in schizophrenia marked by poverty of speech and of speech content - alogia can take several forms www.notesolution.com - in poverty of speech, the sheer amount of speech is greatly reduced - in poverty of content of speech, the amount of discourse is adequate, but it conveys little information and tends to be vague and repetitive Anhedonia anhedonia a negative symptom in schizophrenia in which the individual in unable to feel pleasure - this is an inability to experience pleasure - it is manifested as a lack of interest in recreational activities, failure to develop close relationships with other people, and lack of interest in sex - patients are aware of this symptoms and report that normally pleasurable activities are not enjoyable for them Flat Affect flat affect a deviation in emotional response wherein virtually no emotion is expressed whatever the stimuli, emotional expressiveness is blunted, or a lack of expression and muscle tone is noted in the face - in patients with this, virtually no stimulus can elicit an emotional response - the patient may stare vacantly, the muscles of the face flaccid, the eyes lifeless; when spoken to, the patient answers in a flat and toneless voice - the concept of flat affect refers only to the outward expression of emotion and not to the patients inner experience, which may not be impoverished at all Asociality asociality a negative symptom of schizophrenia marked by an inability to form close relationships and to feel intimacy - patients with this have few friends, poor social skills, and little interest in being with other people - a study showed that people with schizophrenia have lower sociality and greater shyness; they also report more childhood social troubles - some of these interpersonal deficits could reflect related deficits in the ability to recognize emotional cues displayed by others; eg: facial recognition Other Symptoms - 2 important symptoms in this category are catatonia and inappropriate affect Catatonia - catatonia is defined by several motor abnormalities catatonic immobility a fixity of posture, sometimes grotesque, maintained for long periods, with accompanying muscular rigidity, trancelike state of consciousness, and waxy flexibility www.notesolution.com
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