Abnormal Psychology Chapter Thirteen Notes Schizophrenia page 453 455 Schizophrenia characterized by an array of diverse symptoms including extreme oddities in perception thinking action sense of self and manner of relating to others hallmark of schizophrenia is psychosis a significant loss of contact with reality Origins of the Schizophrenia Construct o Eugen Bleuler was the one who gave us the diagnostic term we still used today schizo means to split or crack and phren refers to the mind he believed the condition was characterized primarily by disorganization of thought processes a lack of coherence between thought and emotion and an inward orientation away split off from reality o No split in personalities instead there is a split within the intellect and external reality Epidemiology o Lifetime risk is 0 7 o People with higher risk if parent has schizophrenia people whose fathers were 45 50 years old or older at the time of their birth having a parent who works as a dry cleaner and people of Afro Caribbean origin living in the United Kingdom o Majority of cases begin in late adolescence and early adulthood 18 30 peak age o Tends to begin earlier in men than in women o Men tend to have more cases and more severe forms of schizophrenia for every three men that develop it only two women do o Female sex hormones estrogen may help protect against schizophrenia Clinical Picture page 455 462 Delusions o Delusion an erroneous belief that is fixed and firmly held despite clear contradictory evidence o Delusions involve a disturbance in the content of thought o 90 of schizophrenic patients have delusions o Prominent types of delusions made feelings or impulses thought broadcasting thought insertion and thought withdrawal Hallucinations o Hallucination a sensory experience that seems real to the person having it but occurs in the absence of any external perceptual stimulus o Auditory hallucinations are the most common type 75 of patients other hallucination types are visual 39 olfactory tactile and gustatory o Hallucinating patients show increased activity in the Broca s area o Research findings suggest that auditory hallucinations occur when patients misinterpret their own self generated and verbally mediated thoughts inner speech or self talk as coming from another source o Auditory hallucinations are really a form of misperceived subvocal speech Disorganized Speech and Behavior o Disorganized speech is the external manifestation of a disorder in thought form o Words and word combinations sound communicative but the listener is left with little or no understanding of the point the speaker is trying to make o Neologisms completely new made up words o Formal thought disorder a term clinicians use to refer to problems in the way that disorganized thought is expressed in disorganized speech o Catatonia patient shows a virtual absence of all movement and speech and may be in what is called a catatonic stupor Positive and Negative Symptoms o Disorganized symptoms bizarre behavior and disorganized speech o Positive symptoms reflect an excess or distortion in a normal repertoire of behavior and experience exs hallucinations and delusions o Negative symptoms reflect an absence or deficit of behaviors that are normally present exs flat affect blunted emotional expressiveness alogia very little speech avolition the inability to initiate or persist in goal directed activities asociality apathy anhedonia o Preponderance of negative symptoms in the clinical picture is not a good sign for the patient s future o Even though patients with schizophrenia may sometimes not look very emotionally expressive they are nonetheless experiencing plenty of emotion Other Psychotic Disorders o Schizoaffective disorder hybrid because it is used to describe people with features of schizophrenia and severe mood disorder person has psychotic symptoms that meet criteria for schizophrenia but also has marked changes in mood for a substantial amount of time Two subtypes bipolar and unipolar Clinicians often do not agree about who meets the criteria for the Long term outcome is much better when compared to patients with diagnosis schizophrenia o Schizophreniform disorder schizophrenia like psychoses that last at least a month but do not last for six months and so do not warrant a diagnosis of schizophrenia Prognosis is much better when compared to patients with schizophrenia o Delusional disorder patients hold beliefs that are considered false and absurd by those around them but may otherwise behave quite normally Subtype is erotomania theme of delusion is great love for a person usually of higher status o Brief psychotic disorder involves the sudden onset of psychotic symptoms or grossly disorganized or catatonic behavior great emotional turmoil but the episode usually lasts only a matter of days and then the person returns to his or her former level of functioning and may never have another episode again Often triggered by stress o Shared psychotic disorder a delusion that develops in someone who has a very close relationship with another person who is delusional Risk and Causal Factors page 462 485 Genetic Factors o Risk of developing schizophrenia increases as how genetically close you are to an individual with it o Schizophrenia concordance rates for identical twins are routinely and consistently found to be significantly higher than those for fraternal twins or ordinary siblings 28 versus 6 o Finnish Adoptive Family Study has provided strong confirmation of the diathesis stress model as it applies to the origins of schizophrenia strong interaction between genetic vulnerability and unfavorable family environment o Viral infections more people with schizophrenia are born between January and March than would be expected by chance risk of schizophrenia seems to be greatest when the mother gets the flu in the fourth to seventh month of gestation o Rhesus incompatibility o Patients with schizophrenia are much more likely to have been born following a pregnancy or delivery that was complicated in some way Prenatal Exposures o Early nutritional deficiency o Maternal stress Treatments and Outcomes page 485 490 Before the 1950 s when antipsychotics were introduced there weren t really any treatments and instead patients were put in institutions Clinical Outcome o 38 of people with schizophrenia will be thought of as recovered can function well after 15 to 25 years o Only 16 recover to the point that they no longer need