Chapter 14: Term Definition Schizophrenia A psychotic disorder in ...

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o Poverty of speech, blunted and flat affect, loss of volition, and social withdrawal o Such deficits greatly affect one's life and activities. Poverty of speech.

Chapter 14: Term Schizophrenia

Psychosis Positive Symptoms Delusions Formal Thought Disorder Loose Association

Hallucination Inappropriate Affect Negative Symptoms Alogia Flat Affect Avolition Catatonia

Dopamine Hypothesis Antipsychotic Drugs Phenothiazine

Definition A psychotic disorder in which personal, social, and occupational functioning deteriorate as a result of strange perceptions, unusual emotions, and motor abnormalities A state in which a person loses contact with reality in key ways Symptoms of schizophrenia that seem to be excesses of or bizarre additions to normal thoughts, emotions, or behaviors A strange false belief firmly held despite evident to the contrary A disturbance in the production and organization of thought A common thinking disturbance in schizophrenia, characterized by rapid shifts from one topic of conversation to another. (Also known as derailment) The experiencing of sights, sounds, or other perceptions in the absence of external stimuli Display of emotions that are unsuited to the situation; a symptom of schizophrenia Symptoms of schizophrenia that seem to be deficits in normal thought, emotions, or behaviors A decrease in speech or speech content; a symptom of schizophrenia. (Also known as poverty of speech) A marked lack of expressed emotions; a symptom of schizophrenia A symptom of schizophrenia marked by apathy and an inability to start or complete a course of action A pattern of extreme psychomotor symptoms found in some forms of schizophrenia, which may include catatonic stupor, rigidity, or posturing The theory that schizophrenia results from excessive activity of the neurotransmitter dopamine Drugs that help correct grossly confused or distorted thinking A group of antihistamine drugs that became the 1st group of effective antipsychotic medications

Atypical Antipsychotic Drugs

Schizophrenogenic Mothers

A relatively new group of antipsychotic drugs whose biological action is different from that of the traditional antipsychotic drugs A type of mother—supposedly cold, domineering, and uninterested in the needs of others— who was once thought to cause schizophrenia in her child

Note:

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Taking LSD or abusing amphetamines or cocaine may produce psychosis Most commonly, psychosis appears in the form of schizophrenia Sufferers have an increased risk of suicide and of physical- often fatal- illness Downward drift theory: o Could be that schizophrenia causes its victims to fall from a higher to a lower socioeconomic level or remain poor because they are unable to function effectively

Symptoms of Schizophrenia: • Positive Symptomso Pathological excesses, bizarre additions to a person’s behavior o Delusions, disorganized thinking and speech, heightened perceptions and hallucinations  Delusions: o Ideas that they believe wholeheartedly but have no basis in fact 1. Delusions of persecution- believe they are being plotted or discriminated against, spied on, slandered, threatened, attacked, or deliberately victimized 2. Delusions of reference- they attach special and personal meaning to the actions of others or to various objects or events 3. Delusions of grandeur- believe themselves to be great inventors, religious saviors, or other specially empowered person 4. Delusions of control- believe their feelings, thoughts, and actions are being controlled by other people  Disorganized thinking and speech: o May not be able to think logically and may speak in peculiar ways. These formal thought disorders can cause the sufferer great confusion and make communication extremely difficult 1. Loose association- shift from one topic to another believing that their incoherent statements make sense 2. Perseveration- repeat their words again and again 3. Clang- rhyme their sentences (thinking or expressing themselves) o Some people with schizophrenia use neologisms, made up words that typically have meaning only to the person using them o Appears long before a full pattern of schizophrenia  Heightened perception and hallucinations

o People with schizophrenia showed deficiencies in smooth pursuit eye movement, weaknesses that may be related again to attention problems o Another kind of perceptual problem is hallucinations o People who have auditory hallucinations (very common in this disorder), hear sounds and voices that come from outside their heads o Voices give them commands, or warnings of dangers o Research suggested that blood flow in Broca’s area, the region of the brain that helps people produce speech may be responsible o PET scans revealed increased activity near the surfaces of the brains  Inappropriate affect o Person with this disorder may smile when making a serious statement or they may become upset in situations that should make them happy o May be responding instead to another of the many stimuli flooding their senses, perhaps a joke coming from an auditory hallucination •

Negative Symptomso Pathological deficits, characteristics that are lacking in the individual o Poverty of speech, blunted and flat affect, loss of volition, and social withdrawal o Such deficits greatly affect one’s life and activities  Poverty of speech o Reduction in speech or speech content o People with this negative kind of formal thought disorder think and say very little o Others might say quiet a lot but still give very little meaning  Restricted affect o Many people with schizophrenia have a blunted affect- which means they show less anger, sadness, joy and other feelings than most people o The people who show NO emotions at all have a condition called flat affect o People with these problems may have anhedonia, a general lack of pleasure and enjoyment  Loss of volition o Feeling drained of energy and of interest in normal goals and unable to start to follow through on a course of action o Common with people who had schizophrenia for many years and appear to be worn down by it o People with this disorder display ambivalence, or conflicting feelings about most things  Social withdrawal o Withdraw from their social environment and attend only to their own ideas and fantasies o Breakdown of social skills, including the ability to recognize other people’s needs and emotions accurately



Psychomotor Symptoms­ o Awkward movements or repeated grimaces and off gestures o Extreme forms referred to as catatonia

 Catatonic stupor o Stop responding to their environment, remaining motion-less and silent for long stretches of time  Catatonic rigidity o Maintain a rigid, upright posture for hours and resist efforts to be moved  Catatonic posturing o Assuming awkward, bizarre positions for long period of time  Catatonic excitement o A different form of catatonia, move excitedly, sometimes with wild waving of arms and legs Course of Schizophrenia: • Sufferers seem to go through three phases—prodromal, active, and residual  Prodromal phase o Symptoms are not yet obvious, but the individuals are beginning to deteriorate o Withdraw socially, speak in vague or odd ways, develop strange ideas, or express little emotion  Active phase o Symptoms become apparent o This phase is triggered with stress or trauma in a person’s life  Residual phase o They return to a prodromal-like level of functioning • Each of these phases may last for a few days or years • Full recovery from schizophrenia is more likely in a person who functioned quite well before the disorder • Relapses are apparently more likely during times of life stress Diagnosing Schizophrenia: • DSM-5 states a diagnosis of schizophrenia only after symptoms of the disorder continue for 6 months or more o At least one of those months have to be an active phase, marked by delusions, hallucinations, or disorganized speech o People with this disorder must show a deterioration in their work, social relationships, and ability to care for themselves • Type I schizophrenia o Dominated by positive symptoms o Delusions, hallucinations, and certain formal thought disorders o May be linked closely to biochemical abnormalities in the brain • Type II schizophrenia o Display more negative symptoms o Restricted affect, poverty of speech, and loss of volition o May be tied largely to structural abnormalities in the brain Explanation of Schizophrenia • Biological Views

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o Genetic factors: 1. The more closely related the relatives are to the person with schizophrenia, the greater their likelihood of developing the disorder 2. If one identical twin develops schizophrenia; there is a 48% chance that the other twin will do so as well 3. Researchers found that biological relatives of adoptees with schizophrenia are more likely than their adoptive relatives to experience schizophrenia or a schizophrenia-like disorder 4. Different kinds of schizophrenia are linked to different genes a. Polygenic disorder caused by a combination of gene defects  Biochemical Abnormalities o Dopamine hypothesis  Certain neurons that use neurotransmitters dopamine fire too often and transmit too many messages, therefore producing the symptoms of the disorder o Antipsychotic drugs  Medications that help remove the symptoms of schizophrenia o Phenothiazine  First group of antipsychotic medications Researchers soon learned that these early antipsychotic drugs often produce trouble some muscular tremors, symptoms that are identical to the central symptoms of Parkinson’s disease Scientists found out that by lowering dopamine activity it will help remove the symptoms of schizophrenia The L-dopa (a medication that raises dopamine levels in patients) raises the dopamine activity so much that it produces psychosis People who take high doses of amphetamines may develop amphetamine psychosis- a syndrome very similar to schizophrenia o Antipsychotic drugs can reduce the symptoms of amphetamine psychosis  Role of Dopamine o People whose attention is severely disturbed by excessive dopamine activity might well be expected to suffer from the problems of attention, perception, and thought found in schizophrenia o Larger than usual number of dopamine receptors, particularly D-2 receptors, or their dopamine receptors may operate abnormally o Challenging the theory above:  Atypical antipsychotic drugs- new drugs that bind not only to D-2 dopamine receptors like the traditional, or conventional, antipsychotic drugs, BUT also to many D-1 receptors and to receptors for other neurotransmitters such as serotonin  Abnormal Brain Structure o Many people with schizophrenia have enlarged ventricles- the brain cavities that contain cerebrospinal fluid o Patients who have enlarged ventricles tend to experience poorer social adjustment prior to the disorder, greater cognitive disturbances, and poorer responses to conventional anti-psychotic drugs









o Enlarged ventricles are actually a sign that nearby parts of the brain have not developed properly or have been damaged, and perhaps these problems are the ones that help produce schizophrenia  Viral Problems o What causes the biochemical and structural abnormalities found in many cases of schizophrenia:  Research points to genetic factors, poor nutrition, fetal development, birth complications, immune reactions, and toxins o Brain abnormalities may result from exposure to viruses before birth o Investigation of fingerprints showed that people with schizophrenia often have significantly more or fewer ridges that their nonschizophrenic identical twin (2nd trimester of pregnancy) Psychological Views  Psychodynamic explanations- 2 psychological processes 1. Regression:  When their parents have been cold or unnurturing or when they have experienced severe trauma  Individuals regress to the earliest point in their development, to the pre-ego state of primary narcissism, in which they recognize and meet only their own needs 2. Reestablish o Schizophrenic mothers Behavioral Views o Operant conditioning- principles of reinforcement as the cause of schizophrenia o Some people are not reinforced for their attention to social cues either because of unusual circumstances or because important figures in their lives are socially inadequate  They stop attending to such cues and focus instead on irrelevant cues Cognitive Views o Features of the disorder emerge when the individuals attempt to understand their unusual experiences  Example: when 1st confronted by voices or other troubling sensations, these people turn to friends and relatives. Naturally the friends and relatives deny the reality of the sensations, and eventually the sufferers conclude that the others are trying to hide the truth. Therefore, they start rejecting all feedback, and some develop beliefs (delusions) that they are being prosecuted o People with schizophrenia do indeed experience sensory and perceptual problems Sociocultural Views o The course and outcome of the disorder may vary considerably worldwide o Patients who live in developing countries have better recovery rates than patients in Western and other developed countries  Social labeling o Society assigns the label “schizophrenic” to people who fail to conform to certain norms of behaviors  Family dysfunctioning

o Parents repeatedly communicate pairs of mutually contradictory messages that place children in so-called double blind situations  Nothing they do is right • Example: “im glad to see you”—frowns when they say that o Schizophrenic mothers are overprotective and rejecting at the same time, she was in fact describing someone who is likely to send double-blind messages o Family stress  Display more conflict  Have greater difficulty communicating with one another  More critical of and overinvolved with their children than other parents  High expressed emotions  R.D. Laing’s View o Human beings must be in touch with their true selves in order to give meaning to their lives o Other people’s expectations, demands, and standards require us to develop a false self rather than a true one o Out of desperation the person withdraws from others and attends to increasingly to their own inner cues in order to recover their wholeness as a human beings

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