Abnormal Test 3: Chapters 9, 10, and 11Ch. 9 Schizophrenia and Other Psychotic DisordersSchizophrenia: 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 voicesSymptoms: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 poisonedb. 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 Christ3. 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 depressioni. depression is simply part of the schizophrenia ii. some persons who suffer from schizophrenia also suffer from depressive disorderiii. 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 differences1) 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 present2. Disorganized: symptoms include disorganized speech, disorganized behavior, and flat or inappropriate mood3. 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 bizarrepostures, 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 types5. 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 highesto The symptoms of schizophrenia often become worse following menopauseo 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 functioningThe CausesThe 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 deteriorationthat 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