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UW-Madison PSYCH 202 - Psych 202 Lecture April 28

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Psych 202 Lecture April 28, 2015- Electroconvulsive therapy- only used in severe cases of depression where someone is not responding to other treatmento We don’t know why it workso 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 disordero 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 againo Only 20% of patients who continue medication experience relapseo 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 approacheso Caring therapistso Catharsis and “confession”- having a chance to confess and process things in ways that are therapeuticSchizophrenia- 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 disturbanceso Catatonic behavior-Disorganized schizophrenia/Thought Disorder videoclipo Playing with his hairo Talking about random things; jumping around to different topicso 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 symptomso (+)= excesseso Delusions, hallucinations, loosening of associations, disorganized behavioro 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 + Schizophreniao If mood disturbance is present in schizophrenia, it usually presents as “flat” or “inappropriate”affecto 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 listeno 2. Catatonic Clinical picture is dominated by catatonic motor behavior such as…- “Scared stiff” theory Relatively rare Complete lack of movement/ echoing of behavioro 3. Disorganized All of the following are prominent:- Disorganized speech and behavior- Flat or inappropriate affecto 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, eventhough she is actually a womano 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 familyo 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 causationo Anatomical studies show diverse structural abnormalitieso Dopamine and glial cells may be involved in causation- Etiology: the role of genetic predispositiono Since not a 100% concordance in monozygotic twins, shows that there is an environmental aspect to schizophreniao Figure 13.12 shows the risk of schizophrenia compared to genetic relatedness- Environmental Factors Influence Schizophreniao Stress is


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UW-Madison PSYCH 202 - Psych 202 Lecture April 28

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