10-30-07 Schizophrenia
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Schizophrenia
Psychosis
• Psychosis – a significant impairment in reality testing, as evidenced by:
o Hallucinations – false sensory perception in absence of stimulus (any of 5 senses)
o Delusions – false belief based on incorrect inference despite obvious evidence to contrary, and not part of one’s culture
o Thought Disorganization – loose associations, racing thoughts
o Grossly Disorganized Behavior – meaningless/chaotic speech, bizarre behavior, catatonic
Delusion Types
• Persecutory – belief that one is being malevolently treated in some way
• Referential – neutral occurrences are seen as directed toward oneself… “TV talking to me!”
• Religious – delusional beliefs of a spiritual or religious nature
• Control – thoughts, feelings, or body will feel controlled or manipulated
• Grandiose – inflated sense of worth, power, accomplishment, etc.
• Somatic – belief that one’s body is defective/altered/diseased
• Jealous – belief that one’s sexual partner is unfaithful
• Erotomanic – belief that another (often famous) person is in love with one
Schizophrenia
• QUIZ: Schizophrenia – defined as an active psychosis accompanied by a functional deterioration
• Diagnostic Criteria – psychotic symptoms causing social/occupation dysfunction lasting > 6 months:
o Psychotic symptoms – at least 2 (hallucinations, delusions, disorganized thought/behavior)
o Social/occupational dysfunction – symptoms are impairing life & relationships
o Six month duration – symptoms last for at least 6 months
o Exclusion criteria met – not schizoaffective, not mood disorder, not substance abuse/medical condition, not pervasive developmental disorder (e.g. autism)
Schizophrenia Subtypes
• Paranoid – preoccupied with delusions/hallucinations all the time, but no prominent disorganized speech/behavior, not catatonic, no flat affect; main symptom is active psychosis, but often able to maintain some level of function
o Paranoia? Does not actually need to have paranoia to be paranoid schizophrenic
• Disorganized – prominent disorganized speech/behavior and flat/inappropriate affect; main problem is functional deterioration
• Catatonic – characteristic movements/speech:
o Immobility – motoric immobility, catalepsy (waxy flexibility), or stupor, or…
o Excessive mobility – purposeless motor activity
o Negativism – motiveless resistance to instructions, or mutism
o Peculiarities of movement/posture – stereotyped movements, prominent mannerism, grimacing
o Echolalia/Echopraxia – mimicking words/gestures
• Undifferentiated – no one element predominates (some disorganization/catatonia/delusions)
• Residual – nothing immediately apparent about patients; no delusion/hallucination/disorganization, but…
o Evidence of disturbance – still there, can show flat affect, impaired function, attenuated psychosis, odd beliefs, unusual perceptions
Schizophrenia Descriptions
• Positive Symptoms – presence of delusions, hallucinations, thought disorganization
• Negative Symptoms – characterized by absences:
o Blunted affect – decreased expression, vocal inflection, eye contact, gestures
o Alogia – reduced speech/ideas, thought blocking
o Avolition/apathy – poor grooming/hygiene, low energy
o Anhedonia/Asociality – loss of recreational interests, low sexual activity, absence of intimacy
o Inattention – socially uninvolved, “spacey”
• Cognitive Impairment – poor memory, language, attention, and poor executive function (doing tasks); IQ ................
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