Psych 127 - Psych 127-class notes 2:00:00 PM schizophrenia...

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Psych 127-class notes 09/01/2008 17:00:00 2/4/08 – schizophrenia Schizophrenia (SZ) – one of the psychotic disorders Major disturbances in: thought, emotion, behavior Disordered thinking Faulty perception and attention Inappropriate or flat emotions Bizarre motor activity Disrupted interpersonal relationships Disorder impacts families and friends Difficult to live w/ someone w/ schizo Social skills deficits Symptoms impact employment History of SZ and psychosis Benedict Morel – introduced dementia praecox Emil Kraepelin – used demntia praecox o Combined previously separate subtypes o Differentiated from bipolar o Used onset/degenerative course to identify disorder Eugene Bleuler – introduced “SZ” Phenomenology of SZ SZ vs psychosis Clinical description of SZ – no single essential symptoms, heterogeneity of symptoms across patients Positive, negative and disorganized symptoms Summary SZ – spectrum of dysfunctions o Effecting cognitive, emotional/social and behavioral domains 1
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o Positive negative and disorganized symptoms o Best thought of as a continuum/dimension Dsm-IC and dsm-IV-TR o 5 subtypes (know) several bio-psycho-social variables involved successful treatment rarely includes complete recovery Positive symptoms = active manifestations of abnormal behavior, behavioral excess Distortions of normal behavior Delusions = gross misrepresentations of reality, delusions of grandeur or persecution o Firmly held beliefs o Contrary to reality o r Hallucinations = primarily auditory and usually voices o Experience of sensory events w/o environmental input o Can involve all senses but auditory most common o Visual hallucinations when they occur are more like shadows at periphery of vision o Findings from SPECT studies show speech productions areas (broac’s area) not speech comprehension (wernicke) light up during hallucination Negative symptoms = absence or insufficiency of normal behavior Spectrum of symptoms Avolition Alogia Anhedonia Flat affect Asocialtiy Disorganized symptoms = severe and excessive disruptions Speech, behavior and emotion Disorganized affect – inappropriate emotional behavior 2
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Disorganized behavior – catatonia, unusual dress Catatonia Catatonic immobility Waxy flexibility Inappropriate affect DSM At least 2 of 5 of following symptoms Persist for at least 6 months, at least 1 month of symptoms that meet criteria a Also test for: o Schizoaffective and mood disorder exclusion o Substance/general medical condition exclusion Classifications Process vs reaction distinction Good vs poor premorbid functioning in schizophrenia Type I vs Type II distinction Differential diagnosis Mania Depression w/ psychotic features Personality disorders Drug induced psychosis Extreme OCD PTSD Etc Subtypes – 5 types Paranoid type o Intact cognitive skills and affect o John nash 3
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