Psych 202 Lecture April 28 2015 Electroconvulsive therapy only used in severe cases of depression where someone is not responding to other treatment o We don t know why it works o Potential side effects include memory and cognitive effects i e impairment o Single most effective treatment for severe depression SAD responds to phototherapy Exercise helps depression Treatment for bipolar disorder o Medication Li2CO3 has unique anti manic properties with 80 positive response in actively manic patients also reduces depressions o Adjunctive psychotherapy for Medication management Family and social relationships Education learn about their illness Problem solving and reality testing have people in life who alert you when symptoms are starting to develop again o Only 20 of patients who continue medication experience relapse o Treatments that focus on behavior and cognition are superior for anxiety disorders learned component o Psychotherapy helps and common underlying factors contribute to all psychological approaches o Caring therapists o Catharsis and confession having a chance to confess and process things in ways that are therapeutic Schizophrenia Schizophrenia A disorder characterized by the profound disruption of basic psychological processes a distorted perception of reality altered or blunted emotion and disturbances in thought motivation and behavior occurs in about 1 of the population Not as heritable as bipolar disorder Seems as though a switch was flipped to people who know the person who developed it people with schizophrenia may not know they have a disorder doesn t develop until adolescence or young adulthood Delusion a patently false belief system often bizarre and grandiose that is maintained in spite of its irrationality Hallucination a false perceptual experience that has a compelling sense of being real despite the absence of external stimulation Disorganized speech a severe disruption of verbal communication in which ideas shift rapidly and incoherently from one to another unrelated topic Grossly disorganized behavior behavior that is inappropriate for the situation of ineffective in attaining goals often with specific motor disturbances o Catatonic behavior Disorganized schizophrenia Thought Disorder videoclip o Playing with his hair o Talking about random things jumping around to different topics o No insight to what s happening for him doesn t know something is wrong with him About 25 of people recover from schizophrenia not inevitably bad prognosis Schizophrenia has positive and negative symptoms o excesses o Delusions hallucinations loosening of associations disorganized behavior o Delusions and associated beliefs Persecution paranoia that someone is trying to harm them Reference someone releases a song and the song gives a message to me TV is talking specifically to me Grandeur I m Jesus Christ and I ve been sent here to save the world from sin Identity I m the goddess of wind and rain Guilt think they ve committed a terrible sin Control other people are controlling my thoughts or behaviors o Negative symptoms are deficits in functioning and indicate a worse prognosis Isolation Withdrawal Apathy Blunted emotional expression Less influenced by medications that positive symptoms Disordered Thought in 2 Forms o A Formal Thought Disorder Derailed or incoherent speech Word salad o B Disorder of Thought Content delusions May not be incoherent Mood Disturbance Schizophrenia o If mood disturbance is present in schizophrenia it usually presents as flat or inappropriate affect o If significant depression or mania in the clinical picture the diagnosis probably shifts away from one of schizophrenia and toward one of Schizoaffective disorder Bipolar disorder with psychosis Major depressive disorder with psychosis Remember Mood Congruent concept Brief Overview of Subtypes o 1 Paranoid Preoccupation with one of more delusions usually persecutory or grandiose or frequent auditory hallucinations None of the following is prominent Disorganized speech or behavior Flat or inappropriate affect Sometimes hard to tell if just delusional takes time to listen o 2 Catatonic Clinical picture is dominated by catatonic motor behavior such as Scared stiff theory Relatively rare Complete lack of movement echoing of behavior o 3 Disorganized All of the following are prominent Disorganized speech and behavior Flat or inappropriate affect o 4 Undifferentiated Criteria not met for other types of schizophrenia May be delusional but not paranoid May be organized delusion May hallucinate but not paranoid type hallucinations Ex man convinced that Patti Coffey is a male friend dressed up as a female even though she is actually a woman o 5 Residual No present prominent delusions hallucinations formal thought disorder or catatonic behaviors Continuing evidence of disorder in milder form Not fully recovered from schizophrenia 3 Cases related to schizophrenia o Ms Wilcox videoclip they were harassing me my family and my friends Paranoid Delusional Stabbed herself suicide so that people would quit harming her family o Ms Leonard videoclip Ignoring the man Hears voices that are threatening her want to take over her body Looking off in another direction distracted that s where voice is coming from Sitting very still but not catatonic fearful here comes the dog o David videoclip Paranoid that he won t get the correct prescription I am possibly under surveillance by FBI and private investigators the FBI told me Poor health because of paranoia of eye doctor and or dentist implanting something into his glasses or teeth this is common for paranoid schizophrenics What causes Schizophrenia o Genetic studies show heritability and polygenic causation o Anatomical studies show diverse structural abnormalities o Dopamine and glial cells may be involved in causation Etiology the role of genetic predisposition o Since not a 100 concordance in monozygotic twins shows that there is an environmental aspect to schizophrenia o Figure 13 12 shows the risk of schizophrenia compared to genetic relatedness Environmental Factors Influence Schizophrenia o Stress is implicated in etiology o Environmental spread of a schizovirus has been hypothesized o Higher concordance in late splitting MZ twins 60 compared to early splitting MZ twins 10 30 supports the viral theory o Urban environmental stress o More likely to be born in late winter or early spring months Etiology Dopamine dysfunction Etiology Structurally disorganized