PSY100H1 Chapter Notes - Chapter 11: Disorganized Schizophrenia, Brief Psychotic Disorder, Persecutory Delusion

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9 Feb 2013
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Chapter 11
Psychosis: unable to tell the difference between what is real and what is unreal;
many forms and causes; number of psychotic disorders in the DSM
Schizophreniform disorder: same symptoms as schizophrenia, lasting more than
one month but less than six months
Schizoaffective disorder: symptoms of schizophrenia coinciding with symptoms
of depression or mania, but at least two week period when only symptoms of
schizophrenia present
Delusional disorder: evidence only of non-bizarre delusions (ex: one if being
followed or deceived) of at least one month’s duration; functioning at relatively
high level
Brief psychotic disorder: presence of delusions, hallucinations, disorganized
speech or behaviour for at least one day but less than one month
Shared psychotic disorder: individual in a close relationship with someone who
is delusional with similar delusions (aka folie a deux)
Substance induced psychotic disorder: hallucinations or delusions caused by
the direct physiological affects of a substance (like cocaine)
Schizophrenia: at least one month of acute symptoms of delusions,
hallucinations, disorganized thought and speech, disorganized behaviour and
negative symptoms and at least six months of some symptoms of disorder
Costs of schizophrenia: over 90% of sufferers seek treatment in a mental health
facility; direct health care and non-health care costs $2.02 billion a year but with
other factors estimated to be $6.85 billion; likely to develop in late teenage or
early adult years; need continual services as it tends to be a lifelong disorder
Prevalence: 0.5-2% of the Canadian population diagnosed with a schizophrenia-
spectrum disorder; very stigmatized; research suggest most sufferers live
independent or in their family’s home; higher incidence in immigrants than native
born populations; more common in men than women and women tend to have
better premorbid histories; female onset in late 20s or early 30s and they show
fewer cognitive deficits
oGender differences: not well understood; oestrogen may affect dopamine
regulation in ways that are protective for women; normal sexual
differences in brain might explain cognitive deficits; slower pace of
prenatal brain development in male (higher risk for brain insults); greater
abnormalities in brain structure/functioning in male sufferers than female
Symptoms
Positive symptoms: type I symptoms; characterized by presence of unusual
perceptions, thoughts or behaviours; represent very salient experiences; can occur
in other disorders so can make differentiation between schizophrenia and mood
disorder with psychotic features; psychotic symptoms should occur substantially
in absence of depression or mania for diagnosis of schizophrenia
Delusions: ideas that an individual believes are true but are unlikely or simply
impossible; different from self-deceptions in that delusions are often completely
implausible (which self-deceptions are not), people tend to be preoccupied with
their delusions, looking for evidence and taking action based on them and people
holding delusions are resistant to arguments/compelling facts contradicting these
delusions; can be simple and transient but are often complex, elaborate and long-
standing; several types can co-occur and work together
oPersecutory delusion: oneself or one’s loved ones are being persecuted,
watched or conspired against by others
oDelusion of reference: random events are directed at oneself; connected
to persecutory and sometimes part of a grandiose belief system
oGrandiose delusion: one has great power, knowledge or talent or that one
is a famous and powerful person
oDelusions of being controlled: one’s thoughts, feelings or behaviours are
being imposed or controlled by an external force
Thought broadcasting: one’s thoughts are being broadcast from
one’s mind for others to hear
Thought insertion: another person/object is inserting thoughts
into one’s head
Thought withdrawal: thoughts are being removed from one’s
head by another person/object
oDelusion of guilt/sin: one has committed a terrible act or is responsible
for a terrible event
oSomatic delusion: one’s appearance or body part is diseased/altered
Hallucination: unreal perceptual experiences; can occur in otherwise healthy
people precipitated by exhaustion, stress, alcohol or drugs; can involve any
sensory modality
oAuditory hallucination: hearing voices, music, etc; most common type;
more common in women than men; ex: accusatory voices, voices
encouraging self-harm; schizophrenics can try to talk back to the voices
oVisual hallucination: often accompanied by auditory ones; ex: see Satan
oTactile hallucinations: perception that something is happening to the
outside of one’s body; ex: bugs crawling on flesh
oSomatic hallucination: perception that something is happening inside
one’s body; ex: worms are eating one’s intestines
Disorganized thought and speech: often referred to as formal thought
disorder; tendency to slip from one topic to seemingly unrelated topic with little
coherent transition (loosening of associations or derailment); word salads; making
up words that have meaning only to oneself (neologisms); repeat words or
statements (perseverate); schizophrenic men tend to show more severe deficits in
language than women, possibly because language is controlled more bilaterally in
women while it is quite localized in men
oSmooth pursuit eye movement: keeping one’s head still and tracking a
moving object; suggests cognitive and attentive deficits; one study
suggests deficits may be relatively independent of schizophrenia
symptoms
Working memory: deficits in capacity to hold information in memory and
manipulate it; hard to suppress unwanted or irrelevant information or to pay
attention to relevant information; impair ability to learn and retrieve new
information; research suggests that memory deficits are so comprehensive no
single model can account for the heterogeneity of dysfunction
Disorganized/catatonic behaviour: unpredictable or untriggered agitation,
suddenly shouting, swearing or pacing; socially unacceptable behaviour; trouble
organizing daily routines; concentration used to accomplish a single task
oCatatonia: group of disorganized behaviours that reflect an extreme lack
of responsiveness to the outside world
oCatatonic excitement: one type in schizophrenia; person becomes wildly
agitated for no apparent reason and is difficult to subdue; may articulate
delusions or hallucinations and be incoherent; can be infused with angry
and agitated outbursts
Negative symptoms: type II symptoms; losses or deficits in certain domains;
absence of usual emotional and behavioural responses; difficult to diagnose
reliably as involve absence (not presence) of behaviours, lie on a continuum
between normal and abnormal and can be caused by a host of other factors (social
isolation, depression, medicine side effects); less responsive to medications
Affective flattening: also called blunted affect; severe reduction in or complete
absence of emotional responses to the environment; monotone, unresponsive body
language, immobile face, lack of eye contact; distinguish between this lack of
overt expression of emotion and actual experience of emotion/arousal (which
schizophrenics do report but often can’t express)
Alogia: poverty of speech; severe reduction in or complete absence of speech;
may not initiate speech or give brief, empty replies; lack of motivation to speak or
lack of thinking?
Avolition: inability to persist at common goal-directed activities; difficulty
completing tasks and is disorganized, careless and unmotivated; may withdraw
and become socially isolated
Other symptoms: depression, anxiety, substance abuse, inappropriate affect,
anhedonia and impaired social skills; many are not part of formal diagnostic
criteria but occur frequently
Inappropriate affect: laughing at sad things or crying at happy ones;
inappropriate emotional reactions as opposed to flattened reactions; may occur
because they are thinking about something other than what is occurring in the
environment or because brain processes that match stimuli with the proper
emotions and emotional responses aren’t working properly
Anhedonia: loss of interest in everything in life (similar to what characterizes
depression); lose ability to experience, not just express, emotion
Impaired social skills: difficulty in holding conversations, maintaining
relationships and holding a job; due more to negative symptoms than positive
ones; negative symptoms can lead to lower educational attainments, less success