PSY240H1 Chapter Notes - Chapter 11: Eugen Bleuler, List Of Sovereign States By Suicide Rate, Prefrontal Cortex

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Chapter 11: Schizophrenia
Schizophrenia: a psychotic disorder characterized by major disturbances in
thought, emotion, and behavior.
Prevalence: 0.2% - 2%; lifetime prevalence is generally accepted to be 1%
It is underestimated because some people do not admit to have schizophrenia,
and the population does not include homeless, hospitalized or supervised residential
people.
Can be cultural variant
More males than females (1.4 times more)
Onset: late adolescence or early adulthood; earlier in men than women
Acute episodes of the symptoms
Early treatment adaptations in case of early non-remission are mandatory
Schizophrenia and Comorbidity
Comorbid personality disorders are common and have implications for the
course and clinical management of schizophrenia
Substance abuse is a major problem for people with schizophrenia; 37% of
the people with schizophrenia comorbid with substance abuses.
Prodromal phase of schizophrenia: wide variety of comorbid psychiatric
syndromes, esp MDD and cannabis dependence.
11.1 Clinical Symptoms of Schizophrenia
Several important factors: thought, perception, attention, motor behavior,
emotion, life functioning, and duration of the symptoms
Key to understand schizophrenia: recognizing its heterogeneity at the empirical
and conceptual levels
Positive Symptoms
Positive Symptoms: comprise excesses or distortions, such as disorganized
speech, hallucinations and delusions. It is the presence of too much of a
behavior (abnormally)
Disorganized Speech
Also known as thought disorder, disorganized speech
Incoherence: the images and fragments of thought are not
connected.
Loose associations or derailment: The person has difficulty to stick
to one topic.
However, the patients with mood disorder in manic episode can
have the problems with disorganized speeches, too. (misdiagnose with
bipolar disorders)
Delusions
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Beliefs held contrary to reality (such as persecuting others)
65% of the delusions are persecuted delusion
The delusions are likely presented as follow:
o The person may be the unwilling recipient of bodily
sensations or thoughts imposed by an external agency
o People may believe that their thoughts are broadcast
or transmitted, so that others know what they are
thinking
o People may think their thoughts are being stolen from
them, suddenly and unexpectedly, by an external force
o Some people believe that their feelings are controlled
by an external force
o Some people believe that their behavior is controlled
by an external force
o Some people believe that impulses to behave in certain
ways are imposed on them by some external force
Hallucinations and Other Disorders of Perception
Hallucinations are the most dramatic distortions of perception. Its
the absence of sensory experiences and any stimulation from the
environment.
More auditory than visual (74% of auditory hallucination)
The hallucinations are likely presented as follow:
Some people with report hearing their own thoughts spoken
by another voice
Some people claim that they hear voices arguing
Some people hear voices commenting on their behavior
Negative Symptoms
Negative symptoms consist of behavioral deficits.
Endure even beyond the acute episodes, and lead to a poor quality of the
lives
Early onset of brain damage (enlarged ventricles) and progressive loss of
cognitive skills
However, the symptoms can be attributed to other factors such as flat
affect can be a side-effect of antipsychotic medication
Hard to distinguish them from depressions; observing the clients over the
periods is probably the only way to address this issue
Avolition:
- A lack of energy and a seeming absence of interest in or an inability
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to persist in what are usually routine activities.
Alogia:
- The sheer amount of speech is greatly reduced or
- The amount of discourse is adequate, but it conveys little
information and tends to be vague and repetitive
Anhedonia
- An inability to experience pleasure; lack of interest in recreational,
interrelationships and sex
Flat Affect
- Virtually no stimulus can elicit an emotional response
Asociality
- Poor social skills, and little interest in being with other people
Other Symptoms (Disorganization)
Positive and negative symptoms do not necessarily reflect exclusive
subtypes because they are dimensions that often coexist within the same
person.
Bizarre behavior: talk to themselves in public
Catatonia
Defined by several motor abnormalities, such as gesture repeatedly,
using peculiar and complex sequences of finger, etc.
Catatonic immobility: clients adopt unusual postures and maintain
them for very long periods of time.
Waxy flexibility: another person can move the persons’ limbs into
strange positions that they maintain for extended periods.
Inappropriate Affect
The emotional responses are out of context
Easy to shift from one emotional state to another for no reason
Suicide rate is high
11.2 History of the Concept of Schizophrenia
Early Descriptions
Dementia praecox: Mental enfeeblement, coined by Emil Kraepelin
Eugen Bleuler coined schizophrenia in 1908
The Historical Prevalence of Schizophrenia
Rates of schizophrenia have fallen sharply since the 1960s in inpatient
prevalence (Kinston, Ontario)
In 1930s New York, prevalence rate is 20%, but it became to 80% in 1940
1952
Constant at 20% prevalence rate in Europe (London)
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