PSYC 330 1st EditionFinal Exam Study Guide Lectures: 17-21Lecture 18 (April 9)PsychosisDefinition:- Reality contact impaired.- Impairment in perceptions/ responses to stimuli.- Delusions/Hallucinations- Psychosis doesn’t just occur in individuals with Schizophrenia; it can also occur in individuals with Bipolar Disorder and MDD.*HistoryEmil Kraeplin (1896)- Coined the phrase “Dementia Praecox” (Latin for “Premature Mental Deterioration”).- Observed delusions, hallucinations, and attention/motoric problems we see similarly today in patients with schizophrenia.The Problem with the Definition:- The condition is not necessarily premature (Emil thought that schizophrenia manifested in adolescence; we know today that it commonly develops in the mid/late 20’s).- It’s not necessarily progressive deterioration (Opposite to Emil’s theory, schizophrenia can actually develop very acutely/suddenly).Eugen Bleuler (1911)- Coined “Schizophrenia” (“Split Mind”)- The mind is split among psychic functions (emotion, perception, cognition).- Schizophrenia and Dissociative Identity Disorder differ in that:- DID will move from the host personality to a different personality in order to cope with stress or stimuli.*Schizophrenia SymptomsThere are positive and negative symptoms.- Positive Symptoms: Indicate the presence of something that shouldn’t exist/be experienced.- Negative Symptoms: Indicate the presence of something that doesn’t exist but should be experienced.Positive Symptoms:Delusions (Paranoid, Grandeur, Control: (TB, TI, TW), Erotomanic)- Paranoid- Someone is out to harm, kill, poison, etc. the patient/those close to the patient.- Grandeur- The belief that the patient holds that they have special powers/abilities.- Control- The belief that some outside force is controlling the patient’s thoughts/actions.- Thought Broadcasting: Thoughts ae being publically broadcasted (like a radio).- Thought Insertion: Other people are inserting specidic thoughts (often aggressive/violent) into the patient’s mind.- Thought Withdraw: Others are stealing thoughts from the patient’s mind.- Erotomanic- Romantic conceptions the patient holds of someone they don’t know.- It is possible for it to be someone they know, but it is widely a romantic obsession of a famous person (movie star, etc) or someone with high status.Hallucinations (Auditory (most common), visual (second most common), command, running commentary)- Can have hallucinations in all 5 senses.- 50% say that the hallucinations benefit them (soothing, companionship).- 100% say that there are negative effects to hallucinations (interference in life and social relationships).- 2/3 would eliminate them if they could.- When the patient “hears” a voice in their head, Broca’s area (responsible for speech production) activates, as if they are hearing a real voice.- This indicates when they are hearing voices, they are actually hearing their own subvocalthoughts.- These voices often tell the patient to hurt/kill themselves.Disorganized Speech (Alogia: Loose Associations, Neologisms, Clanging, Hebephrenia)- Loose Associations: Tangential speech.- Neologisms: “Real Words” that the patient makes up and will use grammatically properlyin sentences. (Trundep=Dog). - This isn’t a conscious decision to replace a word with another, it just happens.- Clanging: Rhyming type experience- Hebephrenia: “Word Salad”- Random sequence of words impossible to decipher that don’t mean anything.Catatonic Behavior (Immobility, Waxy Flexibility)- The rarest of all positive symptoms.- Catatonic Immobility: The patient stays in one place and position for long periods of time.- Waxy Flexibility: The patient can be moved around/positioned, but they stay like that until moved again.- This is the most difficult sub symptom to treat.- The patient generally doesn’t remember the episode or anything that happens while they are in the stupor.Negative Symptoms:Flat Affect- The patient has no emotion, very stoic, non-responsive to circumstances that cause emotion.- Anhedonia- Lack of pleasure in activities.- Avolation- Lack of motivation.- Social withdrawalThere are three conditions that are similar in that they all can have these symptoms, but they are different by these standards:- All three disorders have to have 2 of the symptoms listed above.- Either that, or they must have Hallucinations OR Delusions and have the symptom be highly impairing to be diagnosed.- Brief Psychotic Disorder: Have had symptoms for 1 month or less.- Schizopheniform: Have had symptoms for 1-6 months.- Schizophrenia: Have had symptoms for 6+ months.- An individual with schizophrenia that also suffers from MDD is diagnosed as someone with Schizoaffective Disorder.- 2/3rds of people with Schizopheniform develop Schizophrenia.Shared Psychotic Disorder (Folie a Deux): Refers to delusions. When someone begins to experience/adopt similar false belief patterns as the original patient (Very rare).Prevalence:- 1% of population.- Slightly higher likelihood among men.- Similar symptoms prevalence across cultures.- Industrialized societies: Fear police.- Un-Industrialized societies (Like a tribe in Africa): Fear sorcerer/shaman. Age of Onset and Prognosis:- Typically, the earlier the onset, the worse the prognosis.- The deterioration of gray matter in the brain (disturbs neurons/dopamine levels among other things) happens sooner if the onset is earlier.- Men: Typically develop it among mid 20’s.- Women: Typically develop it among late 20’s.- Women tend to have milder cases of schizophrenia (fewer hospitalizations, less social impairment)- This is possibly because estrogen may delay the onset.- Also perhaps social factors (greater social support/resources help.*Gender Differences:- Type I Schizophrenia has more positive symptoms.- Type II Schizophrenia has more negative symptoms.Males (Commonly Type II):- Have more negative symptoms.- Have poorer premorbid adjustment.- Have poorer medical responses.- Have worse prognosis.- Have more brain abnormalities.Women (Commonly Type I):- Have more positive symptoms.- Have more affective symptoms.Lecture 19 (April 14)Course of SchizophreniaProdromal Phase• Onset sudden (e.g., drugs, trauma) or gradual (prodromal)• Social withdrawal, hygiene, work, emotionsActive Phase• Prominent symptomsResidual Phase• Ordinarily minimal recovery (gradual)• 10% (severe symptoms), 75% (residual to active phases)• 15% (return to and maintain