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Chapter 13

Abnormal Psychology CHAPTER 13 NOTES - I got a 4.0 in the course

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PSY 240
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Chapter 13- Schizophrenia and Other Psychotic Disorders Schizophrenia: “Positive” Symptoms: • Positive means more than normal • delusions, hallucinations, or disorganized speech, perhaps also grossly disorganized (or catatonic) behavior, or negative symptoms • some signs of these must exist for greater than 6 months • severity of each of 8 primary symptoms is rated on a 0 to 4 scale • Active manifestations o Delusions o Hallucinations • Exaggerations, excesses, or distortions of normal behavior • 50-70% experience these symptoms • Delusions o Disorder of thought content o Abelief most members of society would say is a misrepresentations of reality o Someone is constantly following me, aliens are messing with my brain, etc. o Grandeur o Persecution o Thought insertion-things putting thoughts into my head o Capgras and Cotard’s syndromes-someone he or she knows has been replaced by a double (Capgras). You believe that you are in fact dead (Cotard) o Etiological views:  Motivational-they are so freaked out and distressed by what’s going on with their disorder that they are motivated to come up with some way of dealing with it: delusions  Deficit-biologically something is wrong with the brain • Hallucinations o Sensory experience in absence of environmental stimuli o Can involve all senses o Most common: auditory  Meta cognition theory-hallucinations are thoughts that come from somewhere else? • Broca’s area active during auditory hallucinations • Negative Symptoms: o Absence or insufficiency of normal behavior o 25% experience o Symptom cluster: o Avolition-lack of drive or motivation o Alogia- inability to speak o Asociality- lack of motivation to engage in interaction o Anhedonia- inability to feel pleasure o Affective flattening-inability to show emotion • Disorganized Symptoms: o Erratic behaviors that affect many domains o Disorganized Speech:  Cognitive slippage also known as:  Tangentiality/loose associations/derailment/thought disorder o Inappropriate affect o Unusual behaviors  Catatonia-(any of 3) • stupor, • catalepsy (don’t respond to external stimulus), • agitation, • mutism, • waxy flexibility (small resistance to having their body parts moved around, they will stay wherever you move them), • negativism, • posturing(assumes a strange posture on their own), • mannerism (do things that are basically normal but charicatures), • sterotpy (movements with no goals), • grimacing, • echolalia (mimicking someone elses speech) • or echopraxia (mimicking anothers’movements)  Can be a specifier in many disorders o Disorganized symptoms may come from cognitive deficits  Attention deficits  Working Memory deficits  Executive Function deficits o These deficits are often stable over time • Course of Psychotic Disorders: o If the disorder lasts one year or more describe course  First episode currently acute  First episode in partial remission  First episode in full remission  Multiple episodes currently acute  Multiple episodes currently in partial remission  Multiple episodes currently in full remission  Continuous • Severity of Schizophrenia and other Psychotic disorders is rated along 8 dimensions on a 0 to 4 scale (not present, equivocal, present but mild, present & moderate, present & severe) o Hallucinations o Delusions o Disorganized Speech o Abnormal psychomotor behavior o Negative Symptoms (restricted emotional expression or avolition) o Impaired cognition o Depression o Mania Schizophreniform Disorder: • Schizophrenic symptoms • For 1-6 months • Associated with good premorbid functioning (before the person is psychotic, they seem totally normal [with regular schizophrenia you can retrospectively notice signs of schizophrenia]) • Most resume normal lives • Prevalence 0.2% (life) Brief Psychotic Disorder: • Positive or disorganized symptoms • Have had these for 1 month or less o May only have only 1 symptoms • Usually precipitated o Extreme stress o Trauma • Typically return to premorbid baseline Schizoaffective Disorder: • Symptoms of schizophrenia plus a mood disorder (depression, bipolar, etc) • Very tricky to diagnose • Disorders must be independent o Schizophrenic symptoms for 2 weeks in absence of mood disorder symptoms o Specify if bipolar or depressive type or if catatonia • Prognosis = similar to schizophrenia o Persistent o No improvement without treatment Delusional Disorder: • Delusions contrary to reality, but not bizarre • Just delusions, no other symptoms • Lack other positive and negative symptoms • Types o Persecutory-everyone is trying to kill me o Jealous-everyone is jealous of me o Erotomanic- Britney Spears wants to fuck me o Somatic-bodily complaints that arent real o Grandiose- thinking you are super special o Mixed-several of these at the same time • Rare • Later age of onset o Avg = 40 to 49 • Female>Male o 55% to 45% • Prognosis o Better than schizophrenia o Worse than other psychotic disorders Schizophrenia; General Information: • Prevalence = 0.2% to 1.5% (lifetime) • Female : Male = ~1:1 o Females  later age of onset  better outcomes • Course = Chronic • Life expectancy = less than average o Suicide • Onset is usually 20-30 years old • Typically believe that once someone becomes fully blown schizophrenia the course is almost always chronic, however there are 5 different types of courses: o Course 1- have one episode o Course 2- have an episode, return to normal, and repeat o Course 3- some people have an episode and get better but not back to baseline o Course 4- some people have an episode and get better but get less better after each episode o Course 5- some people have an episode and never recover • Comorbidity with Schizophrenia: o 90% of people with schizophrenia also qualify for another DSM 5 diagnosis  80% have a major depressive or bipolar disorder  60% have a substance abuse disorder  ~50% have panic attacks or anxiety disorders o High suicide rate  paranoid subtype highest  also higher if more positive & fewer
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