Unit 4 Learning Objectives Schizophrenia and Related Psychotic Disorders 1 What are the positive and negative symptoms of Schizophrenia Positive Symptoms Refers to the fact that symptoms are salient added experiences Characterized by the presence of unusual perceptions thoughts or behaviors Include delusions hallucinations disorganized thought and speech disorganized or catatonic behavior Negative refers to the absence of behaviors feelings experiences etc Characterized by losses or deficits in certain domains 3 types recognized as core negative symptoms 1 Affective flattening No emotional response to environment 2 Alogia Poverty of speech reduction in speaking 3 Avolition Lack of motivation for anything Much harder to treat don t respond well to medications Better off with only positive symptoms 2 Describe the characteristics of delusions hallucinations and catatonic behavior Delusions Bizarre delusions involves a phenomenon that the person s culture would regard as totally implausible Non bizarre delusions CIA or FBI out to get you highly unlikely but still plausible Persecutory being persecuted watched conspired against Reference random events are directed at oneself Ex Watching TV and thinking messages are being directed to them through the show Grandiose great power knowledge talent or is a famous powerful person Guilt or Sin committed a terrible act or responsible for a terrible event Ex Believing you might have killed someone Somatic appearance or part of body is diseased altered Ex thinking your intestines are snakes Being controlled thoughts feelings behaviors are imposed controlled by an external force Ex Others can read or see your thoughts Thoughts are being either inserted or taken away Delusions are different from thoughts we tell ourselves in at least 3 ways 1 Bizarreness of the thought these delusions are not possible 2 Preoccupation with delusion thoughts 3 Resistance thinking someone s out to get you and wont change mind Usually multiple different types of delusions are woven together in a complex belief system One delusion leads to another Specific content of delusions differs across cultures and cohorts Thinking you are secretly on a reality TV show Cultural relativism important to consider when diagnosing delusions Are they thinking and communicating because of their beliefs Do others in their religion have same symptoms Hallucinations impairing Unreal perceptual experiences Hallucinations in schizophrenia are bizarre and are extremely distressing and 1 Auditory Hallucinations Are most common and more common in women than men Voices talk to each other can be aggressive threatening and or give orders Hearing things that aren t really there Command Hallucinations Told to kill or hurt yourself or someone else Visual Hallucinations Seeing things Catatonic Behavior Catatonia Group of disorganized behaviors that reflect extreme lack of responsiveness stuck in a random position Catatonic Excitement wild agitation that is difficult to subdue 3 What are the cognitive deficits in Schizophrenia Deficits in working memory cognition and attention may cause Difficulty suppressing unwanted irrelevant information Difficulty paying attention to relevant information Overall difficulties in reasoning communication and problem solving Occur prior to development of schizophrenia disorder seems to run in families 4 What are prodromal and residual symptoms Prodromal symptoms present before full criteria is met Changes in behaviors thoughts and speech slowly progress Residual symptoms present after acute phase 5 What are the subtypes of Schizophrenia and in what ways might these subtypes be problematic Paranoid Most researched type Prominent delusions and hallucinations Involves themes of persecution everyone s out to get you and grandiosity God like Often do not have disorganized speech or behavior 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 Catatonic Very rare environment Motor behaviors and ways of speaking that suggest unresponsiveness to Clinical picture dominated by at least two or more of the following 1 Motoric immobility 2 Excessive purposeless motor activity 3 Extreme negativism or mutism 4 Odd voluntary movement 5 Echolalia Ex repeating things when told do something Time to go brush your teeth Only response from patient teeth teeth teeth or Echopraxia Ex 2 making the movements of brushing your teeth but don t actually brush your teeth Undifferentiated Doesn t fit in to another type Early onset Chronic Difficult to treat Residual Have had one acute episode of positive symptoms Do not have prominent positive symptoms currently Have negative symptoms and mild positive symptoms left Chronic 6 Why might scientists consider Schizophrenia a heterogeneous disorder it is considered heterogeneous because two people could receive a diagnosis of schizophrenia but look very different in terms of their symptoms The way the criteria is set you need two types of symptoms which means one person might have hallucinations and delicious and someone else might have negative symptoms and disorganized behaviors These individuals might both have the same diagnosis but they actually are experiencing completely different symptoms and might actually have a different prognosis or outcome 7 What are the similarities and differences among psychotic disorders Schizoaffective A mix of schizophrenia and a mood disorder Schizophreniform Requires that individuals meet Criteria A D and E for schizophrenia but show symptoms that last only 1 to 6 month Brief Psychotic Disorder Show a sudden onset of delusions hallucinations disorganized speech and or disorganized behavior Delusional Disorder Have delusions lasting at least 1 month regarding situations that occur in real life such as being following being poisoned being deceived by a spouse or having a disease Shared psychotic disorder have a delusion that develops from a relationship with another person who already has delusions 8 What How do biological factors play a role in the development in of Schizophrenia Genetics 50 concordance rate with Monozygotic twins vs 14 with Dizygotic 50 likelihood of having schizophrenia if both parents have the disorder Brain abnormalities Enlarged ventricles Smaller brain matter Prefrontal cortex Smaller and less active lead to cognitive deficits Limbic system
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