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CH 11 schizophrenia.docx

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Konstantine Zakzanis

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CH11 SCHIZOPHRENIASchizophreniaa psychotic disorder characterized by major disturbances in thought emotion and behaviour disordered thinking in which ideas arent logically related faulty perception and attention flat or inappropriate affect and bizarre disturbances in motor activity They withdraw from other ppl and reality often into a fanstasy life of delusions and hallucinations Prevalence in general population is between 02 and 2 lifetime prevalence abt 1Metaanalysis prevalence and incidence rates conducted by Cdn researchers concluded there may be real variation in schizophrenia across geographical regions arnd the world Asian populations had the lowest prevalence rates Higher in males than females malefemale ratio 14Appears in late adolescence or late adulthood earlier for men than women Ppl with schiz have aof acute episodes of their symptoms btwn episodes hav less severe but stil debilitating symptoms Treated in community and sometimes in hospitals Its comorbid and inheritableEarly treatment adaptations in case of early nonremission are mandatoryCdn rsrchers comorbid personality disorders avoidant paranoid dependent antisocial are common and have implications for the course and clinical management of schizophrenia the treatment should include evaluation of cooccurring substance use disorders esp alcohol and cannabis abuse or dependence and that attention to associated esp major depressive disorder and anxiety syndromes social phobia may be important for optimal outcomesSchizophrenia depression and anxiety were familiar because they had common etiology factorsCLINICAL SYMPTOMS OF SCHIZOPHRENIASymptoms disturbances in major areas such as thought perceptions and attention motor behaviour affect or emotion and life functioning Only some of these problems may be present at a given time The DSM determine how many prblms must be present and in what degree to justify diagnosis and also the duration Walter Heinnrichs key to understand schiz is to recognize its heterogeneity at the empirical and conceptual levelsPositive SymptomsComprise excesses or distortions such as disorganized speech hallucinations and delusionsAn acute episode of schiz they are presence of too much of a behaviour tht is not apparent in most ppl while negative symptoms are absence of behaviour tht should be evident in most pplDisorganized speech thought disorder disorganized speech problems in organizing ideas and in speaking so tht a listener can understandIncoherence found in conversation of individuals with schiz The person may make repeated references to central ideas or a theme the images and fragments of thought arent connected it is difficult to understand exactly what the person is trying to tell the interviewerLoose associations or derailment speech is disordered The person may be successful in communicating with the listener but has difficulty sticking to one topic People with mood disorders also display this symptomDelusions beliefs held contrary to reality Kurt Schneider delusions may take other forms feelings and behaviour are controlled by external forceHallucinations ppl with schiz often report the wrld seems different or unreal to them changes in how their body feels or the persons body may become so depersonalized tht it feels like a machine and not know whats happening around them Its the most dramatic distortions of perceptions A sensory experience in the absence of any stimulation from the environment More auditory than visual their own thoughts spoken by another voice arguing commenting on their behaviour etcNegative SymptomsConsist of behavioural deficits such as avolition alogia anhedonia flat affect and associality Not acute episodes and has profound effects on ppls lives Its associated with earlier onset brain damage enlarged ventricles and progressive loss of cognitive skillsSymptoms tht are due to other factors can only be addressed if clients are observed for longer periodsAvolition lack of energy and seeming absence of interest in or inability to persist wht are usually routine activities such as hygiene or work school or household chores and may spend much of their time sitting around doing nothingAlogia a negative thought disorder tht can tke several forms In poverty of speech the sheer amnt of speech is greatly reduced In poverty of content of speech the amnt of discourse is adequate but it conveys little information and tends to be vague and repetitive umm yeahAnhedonia inability to experience pleasure A lack of interest in recreational activities failure to develop close relationships with other people and lack of interest in sex Clients are aware of this symptom and report tht normally pleasure activities arent enjoyable to them Flat affect virtually no stimulus elicits an emotional response The client may stare vacantly the muscles of the face flaccid the eyes lifeless Talks in a flat toneless voice It only refers to outward expression of emotion and not to the persons inner experience which may not be impoverished at all Kringe and Neale ppl with schiz and normal participants watched excerpts frm films while their facial reactions and skin conductance were recorded after each clip the participants self reported on the moods the films elicited While clients were much less facially expressive than were
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