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Chapter 11

Chapter 11 - Schizophrenia an Related Psychotic Disorders (8).pdf

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PSYC 3140
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John Nash,A Beautiful Mind • has paranoid schizophrenia,was hospitalized but kept relapsing • his son developed it too Psychosis - not being able to distinguish between real and unreal SYMPTOMS, DIAGNOSIS AND COURSE • In DSM-5 delusions,hallucinations or disorganized speech,one of these will be added as required for diagnosis,but in DSM-IV-TR it is not required Three categories of symptoms: 1. Positive Symptoms: A. Delusions ‣ ideas that the person thinks are true but are highly unlikely and often impossible ‣ self-deceptions such as I will win the lottery are different as they're possible not impossible,people think of them occasionally not all the time and people with self-deceptions acknowledge that they may be wrong but delusions are highly resistant to arguments ‣ CommonTypes of Delusions: ‣ Delusions across cultures:if somethings in the culture are not considered to be delusions such as dead family watching over the living,but overall similar across cultures B. Hallucinations ‣ unreal perceptual experiences which are bizarre and complex and not influenced by sleep deprivation,drugs or alcohol ‣ Auditory Hallucination:hearing voices,music etc.,is the most common and also mostly in women • voices that talk in 3rd person,inside the mind,giving instructions, commentary of behaviour,has negative quality,criticizes and tells person to hurt themselves,people talk to them in presence of others ‣ Visual Hallucination:2nd most common,often accompanied by auditory hallucinations,hallucinations can be consistent with delusions ‣ Tactile Hallucinations:perception that something is happening to the outside of the body (e.g.bugs crawling up back) ‣ Somatic Hallucination:something is happening inside the body (e.g. worms eating intestines) ‣ Across cultures:similar but specific content of hallucination can be different C. Disorganized Speech andThought ‣ formal thought disorder,often slip from one topic to an unrelated topic with no transition,called loosening of associations or derailment ‣ word salad - totally incoherent and disorganized,a bunch of words thrown together ‣ neologisms - making up words that only mean something to him or her ‣ Clangs - associate words based on sound not content ‣ men show severe deficits in language and thought than women as women's brain control language bilaterally (both sides) D. Disorganized or Catatonic Behaviour ‣ may display unpredictable and untriggered agitation suddenly shouting, swearing or pacing,can occur in response to hallucinations or delusions ‣ for example,a man who believes he is being persecuted may hallucinate a frightening figure chasing him so he runs and screams ‣ trouble with daily routines,dressing,bathing and eating regularly as they have impaired memory and attention ‣ Catatonia - disorganized behaviour that reflects unresponsiveness to the world ‣ catatonic excitement - person becomes wildly agitated for no apparent reason 2. Negative Symptoms A. Affective Flattening or BluntedAffect ‣ severe reduction or absence of affective (emotional) responses to the environment ‣ face remains immobile and body language unresponsive ‣ speak monotone and avoid eye contact ‣ for example,a man set his house on fire then sat down to watchTV when it came to his attention that the house was burning he calmly walked outside ‣ reflects anhedonia (a loss of interest in everything in life) ‣ can't assume that people with affective flattening aren't experiencing emotion as they may be experiencing it but just can't express it B. Alogia ‣ or poverty of speech,a reduction in speaking ‣ doesn't initiate speech and gives short,quick,empty replies ‣ lack of motivation to speak C. Avolition ‣ inability to persist at common,goal directed activities at work,school and home ‣ trouble completing tasks,disorganized and careless,unmotivated 3. Cognitive Deficits ‣ deficits in attention and memory ‣ greater difficulty in maintaining attention and difficulty focusing ‣ deficits in working memory so not able to hold information in memory and manipulate it ‣ hard for them to distinguish between thoughts that are relevant to situation and ignore stimuli from the environment that isn't relevant ‣ these deficits contribute to hallucinations,delusions and disorganized thought and behaviour ‣ acts as an early marker and leads to development of other symptoms Diagnosis • Emil Kraepelin (1883) labelled the disorder as dementia praecox because he believed the disorder results from premature deterioration of the brain • Bleuler introduced the label schizophrenia (schizein=split and phren=mind in greek) - splitting of usually integrated psychic functions such as mental associations and thoughts • he argued that what underlies it is the breaking of association thread in memory,thought language and problem solving • DSM-IV-TR states that a person has to show symptoms of disorder for 6 months and 1 month has to be acute symptoms such as delusions etc. • Prodromal Symptoms:symptoms that are present before the person goes into the acute phase of the schizophrenia • Residual Symptoms:are the symptom that are present after they emerge from it • left untreated it is episodic and chronic • negative symptoms are less responsive to medication than the positive ones Subtypes of Schizophrenia These subtypes may be dropped in DSM-5 except for paranoid schizophrenia as their validity and usefulness is not strong 1. Paranoid Schizophrenia ⿞John Nash ⿞delusions and hallucinations that involve themes of persecution and grandiosity ⿞don't show lots of disorganized speech or behaviour ⿞lucid and elaborate at creating stories of plots against them ⿞resistant to arguments against their delusions and become aggressive if there is ⿞act arrogantly as if they are superior to others ⿞can be suicidal or violent towards others due to persecutory and grandiose ⿞prognosis is better than other types of schizophrenia ⿞ can live independently and hold on to a job as they have better social functioning ⿞episodes are triggered by stress and occurs later in life ⿞is a milder and less insidious form of schizophrenia 2. Disorganized Schizophrenia ⿞don't have well formed delusions or hallucinations ⿞thoughts and behaviours are severely disorganized ⿞ speak in word salads and be incoherent to others ⿞prone to odd and stereotyped behaviours such as grimacing and mannerisms ⿞can lead to not bathing,dressing or eat ⿞no emotional reactions or inappropriate reactions (e.g.laughing at a funeral) ⿞usually disabled and unresponsive to treatment 3. Catatonic Schizophrenia ⿞almost complete unresponsiveness to their environment ⿞diagnostic requires 2 of the following: ‣ catatonic stupor - remaining motionless for long periods of time ‣ catatonic excitement - excessive and purposeful motor activity ‣ maintenance of rigid postures or being completely mute for long periods of time ‣ odd mannerisms such as grimacing or hand flapping ‣ echolalia - senseless repetition of words just spoken by others or echopraxia - repetitive imitation of the movements of others 4. Undifferentiated Schizophrenia and Residual Schizophrenia ⿞undifferentiated schizophrenia have symptoms that meet criteria for schizophrenia (delusions,hallucinations etc) but do not meet criteria for paranoid,disorganized or catatonic schizophrenia and is chronic with early onset and difficult to treat ⿞residuals have at least one one acute episode of positive symptoms but not long term,signs of disorder through negative symptoms and mild versions of positive symptoms Prognosis • life expectancy is 10 years shorter • 50-80% are hospitalized for one episode • higher rate of infectious and circulatory disease • 10-15% commit suicide • stabilize within 5-10 years of first episode • 20-30% stabilize or recover within 10-20 years of onset Gender andAge Factors • women tend to have better predisorder histories such as graduating high school,having children,getting married and having good social skills • women onset is late 20s or early 30s • women are hospitalized less and for short times have better social adjustment, mild negative symptoms between acute positive symptoms and fewer c
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