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Chapter 9

PS280 Chapter Notes - Chapter 9: Communication Disorder, Flattening, Proverb

by

Department
Psychology
Course Code
PS280
Professor
Kathy Foxall
Chapter
9

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PS280 - Chapter 9
Schizophrenia
Introduction and Historical Perspective
Characterized by heterogeneity - the tendency for people with the disorder to
differ from each other in symptoms, family and personal background, response to
treatment, and ability to live outside of a hospital; makes it difficult to forecast
their future
Perhaps more than 50% improve over time and in response to treatment
Outlook is better than ever before
Not all patients benefit from medication - up to 1/3 continue to suffer from
hallucinations/delusions
Prevalence, Onset, Demographic and Socio-Economic Features
About a 1% risk
Development of psychotic or positive symptoms marks formal onset of first
episode of schizophrenia
Typically begins between ages 15-45
Symptoms typically emerge slowly over time
Equal risk for men and women, but emerges earlier for men
Poor outcome more likely among males, those who develop it at a younger age,
and those who experience longer delay between first appearance of symptoms and
treatment
Approx. 1 in 7 experience recovery
Occurs more frequently in lower socio-economic groups
More likely to develop additional psychiatric problems i.e. depression, substance
abuse
Historical Perspective: The Missing Illness
Often assumed that it has always existed because "madness/insanity" have been
documented for so long
However, although madness in some form existed in the past, it is uncertain
whether this included schizophrenia
View that schizophrenia-like disorder was very rare or absent until late 18th
century is encouraged
Speculated that increasing industrialization, movement of people into cities from
towns, and environmental changes may have been involved in sudden and
escalating emergence of schizophrenia in modern life
Typical Characteristics
Positive (Psychotic) and Negative Symptoms
Positive Symptoms - Exaggerated, distorted adaptations of normal behaviour;
include more obvious signs of psychosis (delusions, hallucinations, thought and
speech disorder, and grossly disorganized or catatonic behaviour)
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Negative Symptoms - The absence or loss of typical behaviours and experiences;
may take form of sparse speech and language, social withdrawal, avolition
(apathy and loss of motivation), anhedonia (inability to feel pleasure and lack of
emotional responsiveness) and diminished attention and concentration
Hallucinations
Misinterpretations of sensory perceptions that occur while a person is awake and
conscious and in the absence of corresponding external stimuli
Auditory hallucinations are the most common - voices are perceived as distinct
from patient's own thoughts, may include instructions to do things
Kraepelin first described schizophrenia in detail, mentioned hallucinations
May develop from a "misattribution of sensory experience" - inability to
discriminate between internal and external sources of information and experience
Patients with hallucinations confuse their own responses and the responses of
other people
Delusions
Implausible beliefs that persist despite reliable contradictory evidence
Reflect a disorder of thought content and may include a complex delusional belief
system or a single belief relating to one aspect of daily life
Persecutory Delusions - Individuals believe that they are being pursued or
targeted
Referential Delusions - The belief that common, meaningless occurrences have
significant and personal relevance
Somatic Delusions - Beliefs related to the patient's body
Religious Delusions - Involve the belief that biblical or other religious passages
or stories offer the way to destroy or save the world
Delusions of Grandeur - A belief in divine or special powers that can change the
course of history or provide a communication channel to God
Disorganized Speech and Thought Disorder
Unusual sounding, nonsensical speech
Loosening of associations and logical connections between ideas, shifting quickly
from one topic to another
Answers to questions are tangential (hardly related)
Common way to elicit thought and language disorder is to ask patient to explain a
proverb or saying
Negative and Emotional Symptoms
Avolition (inability to initiate and preservers in activities) and restricted affect
Affective Flattening - A lack of emotional expressiveness, failing to convey any
feeling in face, tone of voice, or body language
Deterioration of academic or occupational proficiency
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