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Chapter 11

PSYB32_Chapter 11

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University of Toronto Scarborough
Konstantine Zakzanis

Chapter 11-Schizophrenia Spawned more research than any psychological problem Schizophrenia is a psychotic disorder characterized by disturbances in thought, emotion, and behaviour o Disordered thinking in which thoughts are not related o Faulty perception and attention o Flat or inappropriate affect o Bizarre disturbances in motor activity Schizophrenic people withdraw from people and reality Has a prevalence of 1% Asian populations have the lowest prevalence rates Incidence is higher in males than females Sometimes begins in childhood but usually begins in late adolescence or early adulthood Somewhat earlier for men than for women Between episodes have less severe but still debilitating symptoms Many people with schizophrenia are chronically impaired Schizophrenia and Comorbidity Substance abuse is comorbid with as many as 70% of them Childhood conduct disorders are risk factors for substance abuse disorders in schizophrenia Comorbid anxiety disorders are also common, and comrobidity with obsessive compulsive disorders is related to a previous history of suicide ideation and suicide attempts PTSD is highly prevalent in patients with schizophrenia Clinical Symptoms of Schizophrenia Along with how many problems and in what degree must be present, the duration of the disorder is also important No essential symptom must be present for a diagnosis of schizophrenia (unlike other DSM disorders) Schizophrenia has great heterogeneity (much like mood disorders) There are two categories of symptoms (actually three): Positive symptoms (includes disorganized symptoms), Negative symptoms Positive Symptoms Positive symptoms are distortions and are the presence of too much of a behaviour that is not apparent in most people o Negative symptoms is the absence of a behaviour that is apparent in most people Disorganized Speech Thought disorder or disorganized speech is problems in organizing ideas and in speaking so that a listener can understandincoherence Speech may also be disordered by loose associations or derailement which is a flight from topic to topic or idea to idea Disorganized speech is not present in some people with schizophrenia and it does not allow differentiation with other disorders such as mood disorders (loose associations are present in mania) Delusions Delusions are beliefs contrary to the truth Some of the most important delusions are: o May be the recipient of thoughts or sensations from an external source o Patients may believe their thoughts are broadcast o Patients think their thoughts are being stolen o Patients believe their feelings are controlled o Patients believe their behaviour is being controlled o Patients believe impulses to behave a certain way are imposed on them by an external force Delusions are also found in people with mania and delusional depression, however delusions in schizophrenia are much more bizarre Hallucinations and Other Disorders of Perception Patients with schizophrenia report that the world feels unreal, and they experience depersonalization Hallucinations are sensory experiences in the absence of any stimulation from the environment Most common hallucination is auditory Some hallucinations are important diagnostically because they occur more often in schizophrenia patients than other psychotic patients o Hearing their thoughts spoken by another voice o Hear voices arguing o Hear voices commenting on their behaviour Negative Symptoms Negative symptoms are a lack of behaviours, are behaviour deficits The presence of many negative symptoms is a strong predictor of poor quality of life Negative symptoms are associated with earlier onset brain damage, and loss of cognitive skills It is important to distinguish the symptoms that are truly hallmark of schizophrenia, and those that are due to some other factor (eg. Drugs) o Observing patients over an extended period can solve this issue Negative symptoms such as flat affect and anhedonia are difficult to distinguish from depression Avoilition Avolition is a lack of energy and interest or inability to persist in routine activities o Not brushing teeth, taking care of clothes, showering Alogia Alogia is a thought disorder that has several forms, such as poverty of speechamount is reduced, and poverty of speech content where speech is vague and repetitive Anhedonia Anhedonia is an inability to experience pleasure and a lack of interest in recreational activities, failure to maintain close relationships and lack of interest in sex Flat Affect In flat affect no stimulus can create an emotional response Eyes are lifeless Flat affect refers only the outward expression of emotion not the inner experience Asociality Asociality is characterized by having few friends, poor social skills and little interest being with other people o This symptom first appears in childhood before more psychotic symptoms
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