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Chapter 9

PS280 Chapter Notes - Chapter 9: Auditory Hallucination, Speech Disorder, Thought Disorder

Course Code
Kathy Foxall

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Chapter Nine – Schizophrenia
Introduction and Historical Perspective
-Is there a disorder as strange and challenging, as poorly portrayed and misunderstood as
-Complex condition characterized by heterogeneity. There is a 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 hospital. Heterogeneity makes it
difficult to predict how a person will be affected by schizophrenia; what their prospects
are for the future; and whether their condition will improve, stabilize, or worsen.
-Outlook is better than ever before in terms of treatment options and both drug and
psychological therapies.
-Up to 1/3 of patients continue to suffer from positive symptoms like delusions or
hallucinations, some endure unpleasant side effects, and many are difficult to assist with
counseling or rehabilitation
-Stigma and negative image
Prevalence, Onset, Demographic and Socio-economic features
-Prevalence, or total number of cases with the disorder at a given point in time, changes
depending on how the diagnosis is made.
-If the estimated prevalence rate of 1% is accepted, schizophrenia Is twice as common as
Alzheimers and five times as common as MS… 300,000 people in Canada with
-Onset: development of psychotic or positive symptoms
-Late adolescence and early adulthood = 15 to 45 years of age
-Men and women are at equal risk (men in early twenties, women in late twenties)
-If disorder occurs after 45 years of age, more common in women and comprises
emotional and mood related symptoms
-Poor outcome = more likely in males, individuals who develop the disorder at a younger
age, and those who experience a longer delay between the first appearance of symptoms
and treatment
-Chronic and relapsing
-1/7 experience recovery
-Course is favourable in 20%
-Once disorder is developed, more likely to develop additional psychiatric problems
(depression and suicide attempts, drug and alcohol abuse)… social drif
-Rivals stroke and heart attack in terms of hospital care, 1/12 beds occupied with this
-$6.85 billion annually
-Approximately 3% of total burden of human disease is attributed to schizophrenia
-Once disorder is developed, less likely to continue education or work
-Not known if the disorder has been part of the human condition for thousands of years or
whether it is a latecomer, a “new disorder” that was rare before the year 1800.
-An Eighteenth Century Sculptor with Schizophrenia – Franz Messerschmidt – “demon
of proportion” (pg. 209)

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Historical Perspective: The Missing Illness
-Although madness in some form existed in the past, it is uncertain whether these
historical disturbances included schizophrenia
-Descriptions of madness and lunacy before 1800 suggest that these conditions occurred
at any time of life rather than primarily in young people
-Auditory hallucinations or “hearing voices” and other sounds occur ip up to 70 percent
of patients whit schizophrenia at some point during their disorder (auditory hallucinations
are extremely rare in cases of madness before 1700)
-Cases of madness usually only lasted a few days, often drug or alcohol induced
-First recognizable descriptions of modern schizophrenia did not appear in English or
French until early 19th century
-Canada’s maritimes provinces show that the number of insanity cases per 1000 people in
the population increased by more than 2000 percent between 1847 and 1960
--it has been speculated that increasing industrialization, the movement of people
to cities from towns and countryside, and environmental changes may have been
involved in the sudden and escalating emergence of schizophrenia in modern life
-Turner argued that people in earlier times viewed mental illnesses differently and may
have recorder or commented on symptoms of schizophrenia from more generic categories
like lunacy and insanity – thus the disorder existed but was not recognized as a distinct
entity until Haslam’s case studies and the later and definitive descriptions of Kraeplin and
Blender. However, disorders like mania, mental retardation and depression are
recognizable in historical records… HARD TO SAY IF SCHIZOPHRENIA EXISTED
Typical Characteristics
-Positive symptoms refer to exaggerated, distorted adaptations of normal behavior. They
include the more obvious signs of psychosis, namely, delusions, hallucinations, thought
and speech disorder, and disorganized or catatonic behavior.
-Negative symptoms refer to the absence or loss of typical behaviours and experiences.
May take the form of sparse speech and language, social withdrawal, and avolition
(apathy and loss of motivation). Anhedonia (inability to feel pleasure, as well as 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 (or
misinterpret normal sensory experiences)
-Auditory is most common. Voices are perceived as distinct from the patient’s
own thoughts and may include instructions to perform actions that involve self-
harm or danger. They may urge the patient to stop fulfilling
-Hallucinations may develop from a misattribution of sensory experience. This
involves an inability to discriminate between internal and external sources of
information and experience. Laori and Woodward reveal that patients with
schizophrenia who have hallucinations confuse their own responses and the
responses of other people. Hearing voices may result from patine’ts inability to
recognize their own thoughts and a tendency to attribute them to external sources
-Delusions – implausible beliefs that persist despite reliable contradictory evidence.

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-Persecutory delusions – paranoid, individuals believe that they are being
pursued or targeted for sabotage, ridicule, or deception MOST COMMON
DELUSION. One theory proposes that these develop because people make
interpretations of experience too quickly and jump to conclusions based on
minimal evidence. Another theory proposes the existence of a bias in reasoning so
that negative events are always perceived as coming from the environment or
from other people. Still another theory holds that persecutory delusions reflect an
inability to imagine the feelings, perspectives, and experiences of other people
-Referential delusions – common, meaningless occurrences have significant and
personal relevance.
-Somatic delusions – related to the patieent’s body (ex. Convinced that their
inner organs had been turned to dust or that they had a special ‘nerve’ of laughter
in their stomachs that was the origin of all humour in the world
-Religious delusion – biblical or other religion passages or stories offer the way
to destroy or to save the world
-Delusions of grandeur - may entail 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 – shifts quickly from one idea to another, answers are
tangential or hardly related to the original point
-Thought disorder reveals itself in the structure of spoken or written language and
therefore provides a more objective index schizophrenic disturbance than
symptoms like hallucinations and delusions. However, it is the last common of the
positive symptoms.
-May reflect more basic cognitive problems in symptomatic patients… a
reduction in the amount of information a person can hold in immediate memory at
one time, distractibility, unawareness of language deviations, and inconsistencies
and abnormal “spread” of activated word meanings all seem to associate with this
-Negative and Emotional Symptoms – represent deficits and losses in normal
-Affective flattening – lack of emotional expressiveness, failing to convey any
feeling in their face, tone of voice, or body language.
-Anhedonia is consistent with the patient’s apathy and denotes a lack of pleasure
or reward experiences
-Negative symptoms of schizophrenia may also be seen in the deterioration of
academic or occupational proficiency that is usually observed, perhaps due to a
weakening in cognitive efficiency
-Bleuler was especially impressed with the apparent lack of emotional response in
many patients with schizophrenia when crisis situations or emergencies were
-Negative symptoms are moderately associated with impairment on objective tests
of cognitive abilities, including attention, learning and memory, and mental
efficiency, and also relate to everyday functioning and community adjustment
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