Abnormal Test 3 Chapters 9 10 and 11 Ch 9 Schizophrenia and Other Psychotic Disorders Schizophrenia a disorder that occurs in about 1 of population and it is probably the most frightening of all the psychiatric disorders Betty sees monks bleeding faces covers her forehead believes police are out to get her Dennis emptiness occasional voices Symptoms 1 Hallucinations perceptual experiences that do not have a basis in reality hear see smell feel or taste things that are not really there 2 Delusions incorrect beliefs that are held despite overwhelming evidence to the contrary Betty s belief that thoughts are printed on her forehead a Nonbizarre delusion a belief concerning something that is conceivable but for which there is no evidence belief that you are being followed or poisoned b Bizarre delusion a belief in something that is clearly implausible Betty s belief that her thoughts run across her forehead 3 Christs three patients all believed they were Christ 3 Disorganized Speech disruption of the individual s underlying thought processes 4 Disorganized and Catatonic Behavior usually involves greatly reduced motor activity sit motionless for hours waxy flexibility 5 Flat Mood and Apathy depression 60 of people with schizophrenia also have depression a 3 reasons for depression i depression is simply part of the schizophrenia ii some persons who suffer from schizophrenia also suffer from depressive disorder iii depression is a secondary effect of the symptoms 6 Decline in functioning can t work maintain normal interpersonal relationships or take care of themselves Stimulus overload cognitive flooding not in DSM generally attributed to a breakdown of the filter or gate that we normally use to eliminate extraneous stimulation Positive Symptoms hallucinations delusions bizarre behaviors and problems with thinking involve additions to an individual s normal behaviors betty s case Negative Symptoms flat mood inability to experience pleasant feelings apathy cognitive emptiness lack of motivation and inattentiveness reflect absence of things people should have Dennis 3 differences 1 both have different patterns of development Positive symptoms develop rather quickly negative come on slowly 2 prognosis positive symptoms can be treated negative can t some people may have positive and negative symptoms this means they are suffering from both types of schizophrenia symptoms of depression can be mistaken for negative symptoms of schizophrenia Diagnosis only symptoms necessary is a decline in social or occupational functioning and ANY TWO OF THE FOLLOWING Delusions Hallucinations Disorganized speech Grossly disorganized behavior Negative symptoms only one symptom is necessary if the delusions are bizarre and the hallucinations involve a voice constantly 12 different possible combinations diagnosis of schizophrenia is arrived at by exclusion can only be made after all other possible causes have been ruled out certain medications can show these symptoms 5 Subtypes of Schizophrenia 1 Paranoid symptoms include delusions or auditory hallucinations Delusions usually revolve around persecution or grandiosity None of the other symptoms associated with schizophrenia are present 2 Disorganized symptoms include disorganized speech disorganized behavior and flat or inappropriate mood 3 Catatonic symptoms revolve primarily around motor activity and must include at least two of the following a motoric immobility b excessive motor activity that is purposeless c extreme negativism such as resistance to instructions or mutism d peculiar voluntary movements such as bizarre postures strange mannerisms grimacing e repeating in parrotlike fashion statements made to them or imitation of the movements of others this is extremely rare today 4 Undifferentiated individuals with this type have hallucinations and delusions but they do not qualify for any of the other subdiagnoses This is essentially a catch all diagnosis for individuals who do not fit any of the other types 5 Residual do not have prominent delusions hallucinations disorganized speech disorganized behavior or catatonic behavior They do show minor evidence of previous symptoms may have odd beliefs or unusual perceptual experiences Gender men are usually diagnosed first at a younger age than women because Men are more likely than women to suffer from negative symptoms negative symptoms develop earlier Estrogen may suppress the disorder in women because o Symptoms of schizophrenia in women are less pronounced during the period of the menstrual cycle when estrogen levels are highest o The symptoms of schizophrenia often become worse following menopause o Women who are given estrogen in addition to their antipsychotic medication show greater improvement than women who are only given the antipsychotic medication estrogen reduces the activity of a neurotransmitter called dopamine Social Economic Class individuals in the lower social economic class are more likely to be diagnosed as suffering from schizophrenia than individuals from middle or upper class Downward social drift it is difficult for individuals with schizophrenia to maintain their social economic positions in society because their symptoms result in greatly reduced levels of social and intellectual functioning The Causes The early approaches Kraepelin vs Bleuler Emil Kraepelin in Germany suggested that schizophrenia began early in life and that the symptoms reflected a progressive and irreversible intellectual deterioration that was like that of senility Called the disorder dementia praecox Believed disorder had a physiological cause and that the individuals would not recover Eugen Bleuler in Switzerland argued that the disorder could develop at any point in life and that it was due to a breakdown of the connections between words thoughts and feelings More optimistic view believed they could recover both were studying two different people with different types of schizophrenia Kraepelin with negative symptoms and Bleuler with positive Bad Mothering and Learning of Symptoms 1940s was said that bad parenting was cause of schizophrenia no evidence that child rearing strategies are related to the development of schizophrenia also it was said that schizophrenia was learned through operant conditioning The Physiological Approach 2 pathways One begins with a biochemical problem in the brain that produces positive symptoms Thorazine used to calm patients reduces activity of dopamine in the brain o Electrical