Psych 238 Important Concepts Chapters 8-9 and 11Chapter 8: SchizophreniaPositive symptoms (hallucinations, delusions)- Delusions: ideas that individual believes are true but that are highly unlikely and often simply impossibleo Persecutory delusions: false belief that oneself or one’s loved ones are being persecuted, watched, or conspired against by otherso Delusion of reference: belief that everyday events, objects, or other people have an unusual personal significance o Grandiose delusion: false belief that one has great power, knowledge, or talent orthat one is a famous and powerful persono Delusion of being controlled: belief that one’s thoughts, feelings, or behaviors arebeing imposed or controlled by an external forceo Thought broadcasting: belief that one’s thoughts are being broadcasted from one’s mind for others to hearo Thought withdrawal: belief that thoughts are being removed from one’s mind by another person or by an objecto Delusion of guilt or sin: false belief that one has committed a terrible act or is responsible for a terrible evento Somatic delusion: false belief that one’s appearance or part of one’s body is diseased or altered- Hallucinations: unreal perceptual experienceso auditory hallucinations: hearing voices, music, most commono visual hallucinations: seeing things that aren’t really thereo tactile hallucinations: perception that something is happening to the outside of the person’s body o somatic hallucinations: perception that something is happening inside the person’s body- disorganized thought and speecho formal thought disorder: disorganized thinking of people with schizophreniao loose associations or derailment: tendency to slip from one topic to a seemingly unrelated topic with little coherent transitiono “word salad”: person’s speech is so disorganized as to be totally incoherent to the listenero neologisms: make up words that mean something to only him or hero clangs: associations between words based on the sounds of the words rather than on the contento men with schizophrenia tend to show more severe deficits in language than women- disorganized or catatonic behavioro display unpredictable and apparently untriggered agitationo trouble organizing their daily routineso socially unacceptable behavioro catatonia: disorganized behavior that reflects unresponsiveness to the environment Negative symptoms (more common in men)- involve the loss of certain qualities of the person- restricted affecto severe reduction in or absence of emotional expression in people with schizophreniao anhedonia: loss of ability to experience pleasure - avolition/asocialityo avolition: inability to initiate or persist at common, goal oriented activities, including those at work, at school, and at homeo asociality: the lack of desire to interact with other people Cognitive Deficits- deficits in attention, memory, and processing speed- difficulty focusing and maintaining their attention at will - deficits in working memory- difficult to distinguish thoughts in their mind that are relevant to the situation and to ignore stimuli in their environment that are not relevant to what they are doing- Context maintenance: in working memory, the ability to hold information in memory and manipulate it, make it difficult for people with schizophrenia to pay attention to relevant information and to suppress unwanted or irrelevant information Phases of schizophrenia (prodromal, active, and residual)- prodromal symptoms: before the acute phase- residual symptoms: after the acute phase- prodromal and residual: predominantly negative symptoms with milder forms of positive symptoms- active phase: symptoms must be consistently and acutely present for at least 1 month, and must have at least 2 of the following, and at least one must be 1, 2, or 31. delusions2. hallucination3. disorganized speech4. grossly disorganized or catatonic behavior5. negative symptomsDifferential diagnosis- Before a diagnosis of schizophrenia can be given, disorders with similar symptoms must be ruled out as a possibility1. Mood Disorders with Psychotic Symptoms2. Schizoaffective Disorder3. Schizophreniform Disorder4. Brief Psychotic Disorder5. Delusional DisorderDistinctions between schizophrenia and mood disorders, schizoaffective, schizophreniform, brief psychotic and delusional disorder- schizoaffective disorder: mix of schizophrenia and a mood disorder, simultaneously experience psychotic symptoms and prominent mood symptoms meeting the criteria for a major depressive or manic episode. mood symptoms must be present for the majority of the period of illness. required at least 2 weeks of hallucinations or delusions without mood symptoms- schizophreniform disorder: symptoms last only 1 to 6 months, the 1-6-month duration requirement is intermediate between that for brief psychotic disorder and schizophrenia, functional impairments aren’t necessary for a diagnosis of schizophreniform disorder, about two-thirds of individuals with schizophreniform disorder will eventually receive a diagnosis of schizophrenia or schizoaffective disorder- delusional disorder: have delusions lasting at least 1 month regarding situations that occur in real life, they do not show any other psychotic symptoms, appears to more females, happens later in life, and is rare- brief psychotic disorder: show a sudden onset of delusions, hallucinations, disorganized speech, and/or disorganized behavior. the episode lasts only between 1 day and 1 month, after which symptoms completely remitPrevalence (race, gender, age, cultural factors), onset, and course of and prognosis for schizophrenia- Lifetime prevalence rate in general population is .3-.7%- High comorbidity with Substance Use Disorders- 60% have a substance abuse problem that is not related to tobacco- The course of schizophrenia varies widely:• 1/3 of patients improve significantly• 1/3 of patients stay the same and/or relapse• 1/3 of patients become chronically and severely disabled- Age of onset: - Men = 18-25 - Females = 26-45-Very rare in children- Premorbid social functioning (better for women)- Typical symptoms (men have more negative symptoms)- Course of illness & Response to treatment (men more chronic and poorer response to treatment)- has a more benign course in developing countries than in developed countriesEtiology: biological factors (genes, prenatal environment, neurotransmitters, brain abnormalities), social factors (social causation