Unit 4 Learning ObjectivesSchizophrenia and Related Psychotic Disorders1. What are the positive and negative symptoms of Schizophrenia?Positive:-characterized by the presence of unusual perceptions, thoughts or behaviors-positive refers to the fact that the symptoms are salient, added experiences-delusions-hallucinations-disorganized thought and speech-disorganized or catatonic behaviorNegative:-characterized by losses or deficits in certain domains-negative refers to the absence of behaviors, feelings, experiences, etc-3 types are core negative symptoms:-affective flattening-alogia-avolition2. Describe the characteristics of delusions, hallucinations, and catatonic behavior.delusions-ideas that an individual believes are true, but are highly unlikely or simply impossible -types-persecutory: being persecuted, watched and conspired against-reference: random events are directed at oneself-grandiose: great power, knowledge, talent or is a famous/powerful person-guilt or sin: committed a terrible act or responsible for a terrible event-somatic: appearance or part of a body is diseased, altered -delusions are different from thoughts we tell ourselves in at least 3 ways: bizarreness, preoccupation, and resistance -usually multiple different types of delusions are woven together in a complex belief system-specific content of delusions differs across cultures and cohorts-cultural relativism is important to consider when diagnosing delusions hallucinations-unreal perceptual experiences-hallucination in schizophrenia are bizarre and extremely distressing and impairing -types:-auditory hallucinations: most common; more common in women than men; voices talk to each other (can be aggressive, threatening and/or give orders)disorganized thought and speech and catatonic behavior-formal thought disorder-loosening of associations or derailment-word salad-neologisms-disorganized: unpredictable and untriggered -this can explain disheveled appearances, inappropriate hygiene/clothing, shouting, swearing, pacing -catatonia: group of disorganized behaviors that reflect extreme lack of responsiveness-catatonic excitement: wild agitation that is difficult to subdue 3. What are the cognitive deficits in Schizophrenia?-difficulty suppressing unwanted, irrelevant information-difficulty paying attention to relevant information-overall difficulties in reasoning, communication and problem solving 4. What are prodromal and residual symptoms?-prodromal phase: symptoms present before full criteria is met-residual phase: symptoms present after acute phase; after the symptoms have dissipated a lit-tle but are still present5. What are the subtypes of Schizophrenia and in what ways might these subtypes be problematic?-paranoid:-most researched type-prominent delusions and hallucinations-involved themes of persecution and grandiosity-often do not have disorganized speech or behavior -associated features: anxiety, anger, argumentativeness-tend to predispose people to suicidal or violent tendencies-later onset-disorganized:-do not have well-formed delusions or hallucinations-very disorganized-odd, stereotyped behaviors-poor hygiene-early onset, continuous course-often unresponsive to treatment-most disabled by disorder-these people tend to be the most disabled by schizophrenia -catatonic:-motor behaviors and ways of speaking that suggest unresponsiveness to environment -clinical picture dominated by 2 or more of the following-motoric immobility-excessive purposeless motor activity-extreme negativism or mutism-odd voluntary movement-echolalia (senseless repetition of words) or echopraxia (repetitive movement)-puts you at risk for malnutrition and self harm -undifferentiated:-doesn’t fit into any other type-early onset-chronic-difficult to treat-residual: -have to have had one acute episode of positive symptoms-do not have prominent symptoms currently-have negative symptoms and mild positive symptoms left-chronic 6. Why might scientists consider Schizophrenia a heterogenous disorder?7. What are the similarities and differences among psychotic disorders?-schizoaffective: criteria mixed of schizophrenia and mood disorder before or after mood dis-order permits -schizophreniform: schizophrenic symptoms that last between one and six months (all the same symptoms before the 6 months)-brief psychotic disorder: sudden onset of delusions, hallucinations, positive symptoms; very brief and can last from one day to a month-delusional disorder: person has delusions that last at least a month but they are not bizarre and might occur in real life; they have no trouble in functioning and it is rare and usually a later onset in life than more psychotic disorders 8. What/How do biological factors play a role in the development in of Schizophrenia?Genetics:-50% concordance rate monozygotic twins vs 14% dizygotic twins -50% likelihood of having schizophrenia if both parents have the disorder; which means that 50% is also due to environmental influences Structured Brain Abnormalities:-enlarged ventricles-prefrontal cortex, limbic system, hippocampus Causes of Abnormalities -birth complications: perinatal hypoxia-prenatal virus exposure: high rates of schizophrenia associated with the flu; second trimester-neurotransmitters: overactive DA in mesolimbic pathway-underactive DA in prefrontal areas 9. Describe the two-hit hypothesis-not just vulnerability and a stressor but two vulnerability factors or ‘hits’ that lead to it -genetic/environmental influences that affect in uterus (these problems will make the person more vulnerable to the second ‘hit’) and the second part is a psychosocial stress or drug abuse that happens later in life 10. What type of family interaction patterns might play a role in Schizophrenia?-expressed emotion: idea within family; high conflict and over involvement in hostile and critical environments; there is a high risk of relapse11. How do psychosocial theories explain Schizophrenia?-schizophrenia is associated with low SES; people with it tend to have a lower SeS than parents-drift to lower status because of the symptoms-social drift vs urban birth-social selection results in lower class relative to family-stressful circumstances at birth-urban is associated with schizophrenia because there is stress and overcrowding whichmay make it easier to develop infectious disease and to transmit viruses -schizophrenogenic mother: early theories that place blame on mother for development and thatmothers were over
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