HD 3700 1st Edition Lecture 17 Outline of Last Lecture I To Be or Not To Be II Schizophrenia schizotypes and endophenotypes III First Generation typical Antipsychotics IV Second Generation Antipsychotics Outline of Current Lecture I R D Laing s revolutionary approach II Subtypes of SCZ III Hamlet s speech to the players IV Prelim Study Guide Current Lecture I R D Laing s The Divided Self Laing s revolutionary approach approached the schizophrenic experience with insight and compassion Psychiatrist innovator He felt that the medical model was obscuring us from the mental experience of schizophrenics Review of medical model o Hereditary contributions Born with genetic vulnerability to schizophrenia and an outside trigger stress causes a schizophrenic break o Medication does not cure the illness but helps to regulate the symptoms o Dopamine is in the mesolimbic pathway unclear what underlying mechanisms cause it We assume that SCZ is a developmental neurological disorder There is a structural problem that comes into effect after puberty i e the brain changes o Women diagnosed with SCZ at a later age it is much milder for them After menopause it gets much worse Menstruating prevents the intensity of SCZ The Divided Self R D Laing o Phenomenology Defined as the field of philosophy that focuses on understanding the constituencies of consciousness How does the mind create How does the mind develop hypotheses Etc The goal is to reconstruct and try to experience the way that his patients are experiencing him o Therapist goal is to be quiet to figure out what it means to the patient to be in their body Patient brings his existence his state of mind into the therapeutic session It is the task of existential phenomenology to articulate what the other s world is and his way of being in it o Our consciousness is trapped in our bodies We can feel very close distant from others However we are still separate physical beings We have an incurrent aloneness that no activity can change We can t know ourselves without our relationships with others Lonely to miss being known by someone who is important to you Relationships are affecting your consciousness all the time The relationships that your form are also shaped by boundaries These boundaries determine the experience of our selfhood o Psychotherapy is an activity in which that aspect of the patient s being his relatedness to others is used for therapeutic ends The therapist acts on the principle that since relatedness is potentially present in everyone then he may not be wasting his time in sitting for hours with a silent catatonic who gives every evidence that he does not recognize his existence Kraepelin s Patient o 18 years old strongly built with a pale complexion o Sits with his eyes shut and pays no attention to his surroundings o He does not look up even when he is spoken to o The patient is as Kraepelin noted inaccessible o Although he undoubtedly understood all of the questions he was asked he has not given us a single piece of useful information His talk was only a series of disconnected sentences having no relation whatsoever to the general situation o What would Freud say to do Like a Freudian slip take the slip his inaccessible useless information seriously So approaching patients as individuals with consciousness o Laing s categories of schizophrenic experience o Engulfment the world is coming into you and obliterating you Although the episode is not incredibly severe it still drastically moves you you are forced to make connections that you wouldn t have before o Implosion it s not about the outside world controlling you its about your own mind Empathize with the implosion Understand what s happening inside the patient to see how its shaping their external experience o Petrification and depersonalization Ontological insecurity o The nature of our critical inquiry o Someone who has a psychotic disorder cannot depend on anything Their consciousness can t make connections o Consciousness to Lain A sense of security in regard to being in the world II Subtypes of SCZ Four clinical subgroups of SCZ o Sensitivity psychosis o Drug related psychosis o Trauma related psychosis o Anxiety psychosis o Each subgroup has its own trigger stressor and personality type Sensitivity psychosis o The person slides into the disorder gradual onset in teens early 20s o Relatively minor stress e g leaving home for college starting work precipitates episodes o Caregivers usually very involved Encouraging and supportive May be trying too hard High expectations o Feels under pressure but at a standstill o Idea delusions of reference and thought broadcasting especially frequent particularly when overstimulated o Prominent negative symptoms Drug related psychosis o Drug induced psychosis at initial presentation hallucinogens amphetamines LSD cocaine heavy use of cannibis o Recurrence or perpetuation of symptoms when drugs not present on testing o Initially may be given diagnosis of personality disorder or drug misuse only o Hallucinations paranoia replay of original psychosis o Onset usually in teens or 20s o May have rebellious personality o Frequently from a disrupted family o Caregiver often very uncertain how to help and may therefore give confused messages to client o Frequently poor cooperation with services Trauma related psychosis o If you are already vulnerable to and have the genetic likelihood for SCZ when you experience this traumatic episode it is a much different psychotic break o Auditory hallucinations Abusive violent and or sexual content Second person you re a swear word Command kill yourself kill your children o Experienced as shocking and alien o Repetitive and distressing o Fluctuating insight o Blames self o Associated with PTSD especially sexual abuse Depression suicidal and depressive thoughts o Overlap with borderline personality disorder Anxiety psychosis o Onset Acute it builds up over a few days or weeks Generally later in life late 20s onward o Stress related e g work pressure o Anxiety relieved by crystallization into a meaningful explanation for distressing feelings Delusional perception or delusional conclusion e g the neighbors are responsible or I m persecuted because I ve been sent to save them o Isolation common Geographic e g living alone or working away from home Interpersonal e g relationships broken down o Usually delusions present may be grandiose or persecutory developing into a delusional system o Further episodes in