Section 4 Learning Objectives Chapter 8 Schizophrenia and Related Psychotic Disorders 1 What is the prevalence of schizophrenia and how does it vary by gender and ethnicity lecture and textbook a Lecture b Textbook i Gender ii Ethnicity Culture 1 Men with schizophrenia tend to show more severe deficits in language than do women with schizophrenia possibly because language is controlled more bilaterally that is by both sides of the brain in women than in men 2 Women have a better prognosis than men 3 In both men and women functioning seems to improve with age 1 As with delusions the types of hallucinations people experience in different cultures appear similar but the content of the hallucinations can be culturally specific 2 Clinicians must understand hallucinations in their cultural context 3 Schizophrenia tends to have a more benign course in developing countries than in developed countries 2 What are the primary symptoms of schizophrenia How are positive and negative symptoms different lecture and textbook a Lecture i Schizophrenia 1 Social Occupational Dysfunction 2 Duration continuous signs of the disturbance for 6 months 3 At least 2 for greater than 1 month a Delusions b Hallucinations c Disorganized speech d Grossly disorganized or catatonic behavior e Negative symptoms 4 Positive Symptoms Characterized by the presence of unusual perceptions thoughts or behaviors Positive refers to the fact that symptoms are salient added experiences normal experience something else a Psychotic delusions hallucinations b Disorganized speech thought behavior 5 Negative Symptoms Characterized by the losses or deficits in certain domains Negative refers to the absence of behaviors feelings experiences etc normal experience something else a Negative symptoms are less obvious and not exactly bizarre but negative symptoms are associated with more impairment and are less responsive to medication b Textbook i Primary Symptoms of Schizophrenia 1 Psychosis is its core diagnostic symptom a Psychosis state involving a loss of contact with reality as well as an inability to differentiate between reality and one s subjective state 2 Schizophrenia Spectrum the set of psychiatric disorders related to schizophrenia that varies along a severity continuum a DSM 5 refers to schizophrenia spectrum to reflect the fact that there are five domains of symptoms to define psychotic disorders and their number severity and duration distinguish psychotic disorders from each other b The five domains include four kinds of positive symptoms delusions hallucinations disorganized thought speech disorganized or abnormal motor behavior including catatonia and negative symptoms e g restricted emotional expression or affect 3 People with schizophrenia often show numerous cognitive deficits that are linked to declines in functioning though cognitive symptoms are not part of the diagnostic criteria ii Positive Negative Symptoms 1 Positive Symptoms in schizophrenia hallucinations delusions and disorganization of thought and behavior Described as positive because they represent overt expressions of unusual perceptions thoughts and behaviors a Delusions ideas that an individual believes are true but that are highly unlikely and often simply impossible i Most people occasionally hold beliefs that are likely to be wrong such as the belief that they will win the lottery 1 These kinds of self deceptions differ from delusions in at least three ways a First self deceptions are at least possible whereas delusions often are not b Second people harboring self deceptions may think about these beliefs occasionally but people harboring delusions tend to be preoccupied with them i Delusional people look for evidence in support of their beliefs attempt to convince others of these beliefs and take actions based on them such as filing lawsuits against the people they believe are trying to control their mind c Third people holding self deceptions typically acknowledge that their beliefs may be wrong but people holding delusions often are highly resilient to arguments or compelling facts that contradict their delusions i They may view the argument as a conspiracy to silence them b Hallucinations unreal perceptual experiences that is not real i E g such as thinking you saw someone when no one was near thinking you heard a voice talking to you or feeling as though your body was floating through air ii Tend to be more frequent persistent complex sometimes more bizarre and often entwined with delusions than healthy college students hallucinations 2 Negative Symptoms in schizophrenia deficits in functioning that indicate the absence of a capacity present in people without schizophrenia such as restricted affect Loss of certain qualities of the person rather than behaviors or thoughts that the person expresses overtly a More difficult to treat because negative symptoms tend to be more persistent 3 What are the common types of delusions and hallucinations What are the disorganized thought speech and behavior symptoms of schizophrenia What is the difference between disorganized and catatonic behavior lecture and textbook a Lecture i Psychotic 1 Types of Delusions against a Persecutory being persecuted watched conspired i E g the FBI is watching me b Reference random events are directed at oneself c Grandiose great power knowledge talent or is a famous powerful person d Guilt or Sin committed a terrible act or responsible for a e Somatic appearance or part of body is diseased terrible event altered f Being controlled thoughts feelings behaviors are being imposed controlled by an external force i E g aliens 2 Types of Hallucinations a Auditory Hallucinations i Most common ii More common in women than men iii Voices talk to each other iv Can be aggressive threatening and or give orders b Visual Hallucinations i Second most common ii Often accompanied by auditory hallucinations c Tactile Hallucinations i Outside the body ii More rare iii E g bugs crawling all over the skin d Somatic Hallucinations Inside the body i ii E g feeling an animal in their body ii Disorganized speech thoughts behaviors 1 Speech thought a Formal Thought Behavior i Loosening of Associations or Derailment ii Word Salad saying words in a random jumbled way not forming coherent sentences iii Neologisms making up their own words 2 Disorganized or Catatonic Behavior a Disorganized unpredictable and un triggered b This can explain i Disheveled appearances inappropriate hygiene clothing ii
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