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Chapter 11

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Konstantine Zakzanis

Chapter 11- Schizophrenia PSYB32 Janany Sivalingam Schizophrenia: psychotic disorder that is characterized by major disturbances in thought, emotions, and behaviour: disordered thinking in which ideas are not logically related faulty perception and attention, a flat or inappropriate affect and bizarre disturbances in motor activity o Withdraw from other people and reality go into a fantasy life of delusions and hallucinations One of the most severe psychopathologies Prevalence ~0.2-2.0% o Lifetime prevalence ~ 1.0% o Meta-analysis indicated that there may be a variation in schizophrenia across geographical regions around the world Sometimes begins in childhood; but usually appears in late adolescence or early adulthood earlier for men than woman Read rest of page 351statistics Schizophrenia and Comorbidity Comorbidity plays a role in the development, severity and course of schizophrenia Comorbid personality disorder (eg. avoidant, paranoia, dependent, and antisocial) are common o Substance use disorders comorbid as well ~37% of a sample of individuals with schizophrenia has substance abuse problems as well. !40% were depressed at the onset PTSD highly prevalent among military veterans that have schizophrenia The developing phase of schizophrenia = prodromal o Comorbid with psychiatric syndromes (MDD-major depressive disorder) and cannabis dependence Clinical Symptoms of Schizophrenia Disturbances in: o Thought o Perception o Attention o Motor behaviour o Affect or emotion o Life function range of problems of people diagnosed as schizophrenia is extensive; only some of thse problems may be present at any given tie the presence of a specific symptom is not mandatory to diagnose people with schizophrenia o leads to variation in people with schizophrenia Positive symptoms positive symptoms: excesses or distortions such as disorganized speech, hallucinations and delusions o acute episode of schizophrenia Disorganized Speech formally known as thought disorder Disorganized speech: problems in organizing ideas and in speaking so that a listener can understand Incoherence: verbal expression is marked by disconnectedness, fragmented thoughts and jumbled phrases Loose associations (derailment): aspect of thought disorder wherein the client has difficulty sticking to one topic and drifts off on a train of associations evoked by an idea from the past o May be more successful in communicating withlistener but may have trouble sticking to one topic At one time, disturbances in speech was regarded as principal clinical symptom of schizophrenia; o HOWEVER, the speech of many people not disorganized and presence of disorganized speech does not discriminate well between schizophrenia and other psychoses (eg. mood disorders) Delusion delusion: beliefs held contrary to reality o common positive symptoms of schizophrenia may take several forms: o person may be unwilling recipient of bodily sensations or thoughts imposed by an external agency o belief that thoughts are broadcasted or transmitted so that others know what theyre thinking o belief that thoughts are being stolen by external force o belief that their feelings are controlled by an external force o belief that impulses are controlled by external force delusions found among more than half of schizophreniacs; but such symptom also found in other diagnoses (eg. mania and delusional depression) Hallucinations and other disorders of perception world seems different or unreal to them may mention changes in hor their body feels or depersonalization occurs (body feels like a machine) hallucinations: sensory experiences in the absence of any stimulation from the environment o more auditory than visual (~74% of a sample experience auditory hallucinations) types of hallucinations: o hearing own thoughts spoken by another voice o hear voices arguing o Hear voices commenting on their behaviour 2Negative Symptoms Negative symptoms: schizophrenia consist of behavioural deficits such as avolition, alogia, anhedonia, flat affect, and asociatlity Beyond acute episode Has profound effects on peoples lives Indicator of poor quality of life (eg. few friends, occupational impairment) Important to observe clients over extended periods to ensure that the negative symptoms are indeed truly symptoms of schizophrenia and not doe to some other factors Avolition Avolition (apathy): lack of energy and a seeming absence of interest in or an ability to persist in what are usually routine activities Inattentive to grooming and personal hygiene uncombed hair, dirty nails, disheveled clothes Difficulty persisting at work, school or household chores May spend much of time sitting around doing nothing Alogia Can take several forms In poverty of speech, the amount of speech is greatly reduced In poverty of content, speech is adequate but conveys very little information and tends to be vague and repetitive Anhedonia Anhedonia: inability to experience pleasure Lack
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