PSYC 407 1st Edition Lecture 22 Outline of Last Lecture I. ExamOutline of Current Lecture I. What is Schizophrenia?II. Nature of Schizophrenia and Psychosis: An Overviewa. Historyb. Current ThinkingIII. Positive and Negative Symptoms of HallucinationsIV. Hallucinations related to MetacognitionV. Introduction to MutationsCurrent LectureSchizophrenia and Other Psychotic DisordersSchizophrenia- A brain disease• A complex syndrome• Many different presentations• All involve nearly every aspect of daily functioning• Affects about 1 out of 100• Important research question: Is it one disorder or many disorders?Nature of Schizophrenia and Psychosis: An Overview• Schizophrenia vs. psychosis– Psychosis – broad term (e.g., hallucinations, delusions) – Schizophrenia – a type of psychosis These notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.– Psychosis and schizophrenia are heterogeneous– Disturbed thought, emotion, behaviorNature of Schizophrenia and Psychosis: History• Historical background– Emil Kraepelin (1856-1926)– used the term dementia praecox to mean early mental defect– Categorized previously believed to be separate disorders and created subtypes ofschizophrenia:Kraepelin’s subtypes• Catatonia- alternating immobility and agitation• Hebephrenia- silly and immature immotionality• Paranoia- delusions of grandeur or persecution• He believed that an early onset of symptoms developed into “mental weakness” showing symptoms including• Hallucinations• Delusions• Negativism• Stereotyped behaviorEugen Bleuler (1857-1939)- A Swiss psychiatrist- Introduced the term “schizophrenia”• “Splitting of the mind” • Associative splitting- aspects of the personality are split off from each other.Nature of Schizophrenia and Psychosis: History and Current Thinking• Impact of early ideas on current thinking– Many of Kraeplin and Bleuler’s ideas are still with us– Understanding onset and course considered importantNO LONGER HOPELESS• Combined drug and psychosocial interventions have impact on improved functioningOverview1. Interpersonal impairment– Social functioning– Fulfilling roles– Personal care2. Positive sx– Hallucinations– Delusions– Disorganization Negative Sx.– -withdrawal– -apathy– -anhedonia– -poverty of speech– Cognitive Impairments– -memory impairments– -higher order processing– Mood Problems– -depression– -anxiety– -angerEpidemiology• Tend to be stable across cultures, but recent studies support differential rates across countries due to diagnostic criteria• About equal in males and females– Below age 36 more females– After age 36 more males– Can still occur after age 75• More schizophrenia in urban areas (whether the person was born there or moved there)• Age of onset is early adulthood when developmental milestones achieved:• Less likely to marry or stay married• Only 14 to 20% work (hold competitive employment)Schiffman et al., (2004) Study• Researchers taped high risk children w/schizophrenia having lunch in 1972.• 20 years later found those who developed schizophrenia showed less positive and more negative affect than those who did not develop schizophrenia.• An early marker?SYMPTOMS• Three major groups:– 1. Positive Sx– 2. Negative Sx– 3. Cognitive impairments• Most disorders have 1 or 2 symptoms that define the disorder.• But schizophrenia has several types of presentations.Positive Sx:- Positive symptom, something more that other people (the normal people) don’t have- Thoughts, sensory experiences, and behaviors absent in those without the disorder:o Hallucinationso Delusionso DisorganizationPositive SX: HallucinationsHallucinations: false sensory perception that occurs in the absence of a related sensory stimulus.Auditory and visual most common.75% of schizophrenia diagnosed-individuals experience auditory hallucinationsPerson must be consciousRule out delirium (occurs mainly in medical and substance abuse problems) biological causeNot an illusion (misinterpretation of stimulus)Auditory hallucinations can be:- clear voice of another person- muffled sounds- buzzing- constant or intermittentHallucinations related to Metacognition- Thinking about thinking- You might say “I wish he were dead” but you can think about this thought and know it’snot appropriate- People who have auditory hallucinations appear to have intrusive thoughts, but they believe they are coming from someone else. SPECT studies– Findings from SPECT studies• Single photon emission computerized tomography• Brain-imaging techniques to study the cerebral blood flow of men w/schizophrenia who had auditory hallucinations. Studied when they hadthe hallucinations and when they did not.• The brain part that was most active was Broca’s area, involved in speech production.• They had predicted it would involve Wernicke’s area where we comprehend speech of others.• The finding supports a metacognitive theory that people who are hallucinating (auditory) are not hearing the voices of others but are listening to their own thoughts or voice and cannot discern the difference.Positive SX: Delusions• A false belief that can not be explained by culture or education.• A disorder of thought content.• Person cannot be persuaded belief is incorrect despite evidence to the contraryTypes of delusionsMost Common• Grandeur: I’m special• Guilt : I have committed an unpardonable sin• Ill Health : I have a terrible disease• Jealousy : Spouse is unfaithful• Passivity : I am controlled by radio waves• Persecution: ‘They’ are intent on hurting me• Poverty: I am facing destitution (contrary to evidence)• Reference: I am being talked about on tv or in the newspaper• Thought control: Ideas are being put in my head by othersBizarre Delusions• Thought Broadcasting• Thought Control• Thought InsertionSchizophrenia: The “Disorganized” Symptom Cluster• The disorganized symptoms– Severe and excess • speech• behavior• EmotionPositive Sx: Disorganized Behaviors• Inappropriate affect- laughing or crying– Ex. Laughing at a funeral when someone has died• Catatonic posturing: maintaining a peculiar posture• Removing one’s clothes in public• Repeatedly making the sign of the cross• Speech