Studied by 29 people
Psychosis
no universally agreed definition, but most agree that it is:
a mental state in which an individual experiences difficulty distinguishing between reality and fantasy
often referred to as losing contact with reality
often refers to the presence of hallucinations
Schizophrenia in the Early 1800s
John Haslam and Phillipe Pinel describe cases; the first mention of the disorder in professional writing
Schizophrenia in 1852
Benefict Morel coins the term dementia praecox (premature loss of mind) to describe condition; first to give it a name
Schizophrenia in the Late 1800s
Emil Kraepelin unifies subtypes of schizophrenia (hebephrenia, paranoia, catatonia); distinguishes between dementia praecox and manic depressive illness
Schizophrenia in the 1900’s
Eugen Bleuler coins term schizophrenia, meaning splitting of the mind
Associative Splitting
splitting of basic functions of personality; as if areas of the brain responsible for different functions do not communicate with each other
Positive Symptoms of Schizophrenia
Delusions (70%) - grandeur, persecution, reference, somatic
Hallucinations (60%-80%) - commonly auditory, but can be visual
Disorganized Speech and Thought - derailment, tangential speech, neologisms
Disorganized/Catatonic Behavior
Negative Symptoms of Schizophrenia
Avolition - lack of or decreased will/drive
Alogia - poverty of thought content
Anhedonia - lack of or decreased ability to experience pleasure or interest in life
Affective Flattening - ability to express emotion is totally gone or very weak
Asociality - lack of interest in social interactions
General Diagnostic Criteria for Schizophrenia
> 2 symptoms present for a significant portion of time during > 1 month; at least 1, 2, or 3 must be present:
delusions
hallucinations
disorganized speech
grossly disorganized or catatonic behavior
negative symptoms
Diagnostic Exceptions for Schizophrenia
patient is treated successfully, still receive the diagnosis
only 1 symptom needed if it is bizarre delusions or hallucinations
Disorganized Subtype of Schizophrenia
Hebephrenia
disorganized speech
disorganized behavior
flat or inappropriate affect
rule out catatonic type
Catatonic Subtype of Schizophrenia
Catatonia
motoric immobility
excessive motor activity
extreme negativism or mutism
catatonic posturing, stereotyped movement, prominent mannerisms, or prominent grimacing
echolalia or echopraxia
Paranoid Subtype of Schizophrenia
Paranoia
preoccupation with one or more delusions or frequent auditory hallucinations
disorganized speech, disorganized or catatonic behavior, and flat/inappropriate affect are not prominent
Undifferentiated Subtype of Schizophrenia
reserved for those who cannot be classified into three major subtypes, yet have major sx of schizophrenia
Residual Subtype of Schizophrenia
given to those who have had at least one episode of schizophrenia but no longer meets criteria; often displays less sever “leftover” or residual sx
New Diagnostic System for Schizophrenia
following symptoms are rated on a 0 (not present) to 4 (present and severe) scale for the past 7 days:
hallucinations
delusions
disorganized speech
abnormal psychomotor behavior
negative symptoms
Process versus Reactive Schizophrenia
process - slowly develops, no triggering event
reactive - symptoms appear quickly after an event occurs
Good versus Poor Premorbid Adjustment Schizophrenia
premorbid adjustment - how well adjusted the person was before they developed symptoms
Type I versus Type II Schizophrenia
type I - positive symptoms are most prominent
type II - negative symptoms are most prominent
Schizophreniform Disorder
meets criteria for schizophrenia for between 1-6 months; symptoms disappear after and person fully recovers
Schizoaffective Disorder
meets criteria for a mood disorder and, in the absence of mood symptoms, has delusions or hallucinations for at least 2 weeks
Delusional Disorder
person has a persistent belief that is contrary to reality for at least 2 month without other symptoms of schizophrenia; delusions are typically non-bizarre
Erotomanic Delusion Subtype
central theme of delusions is that another person is in love with the individual
Grandiose Delusion Subtype
central theme of the delusion is the conviction of having some great talent or insight or having made some important discovery
Jealous Delusion Subtype
central theme of delusion is that individual’s spouse or lover is unfaithful
Persecutory Delusion Subtype
central theme involves the individual’s belief that they are being conspired against, cheated, spied on, following, poisoned or drugged, maliciously maligned, harassed or obstructed in the pursuit of long-term goals
Somatic Delusions Subtype
central theme involves bodily functions or sensations
Mixed Delusions Subtype
no delusional theme predominates
Unspecified Delusion Subtype
dominant delusional belief cannot be clearly determined or is not described in the specific type
Brief Psychotic Disorder
person has one or more positive symptoms of Schizophrenia for at least one day, but less than one month
Shared Psychotic Disorder
person develops delusions as a result of a close relationship with an already delusional person
Lifetime Prevalence of Schizophrenia
.2%-1.5; about 1% of pop will develop schizophrenia
women tend to have more favorable outcomes than men
people w/ schizophrenia tend to live 10-15 years less than average
Gender Differences in Schizophrenia Onset
women - after age 35, onset is greater
men - between ages 16-35, onset is greater
Course of Schizophrenia
rule of thirds; 1/3 will recover fully, 1/3 will have multiple episodes but will be normal or almost normal between, 1/3 will have multiple episodes and less of a return to normality after each episode
Aging Affects on Symptoms
positive symptoms decrease in severity with an increase in age
negative symptoms increase in severity with an increase in age
may be due to:
long term hospitalization
long term medication use
natural course of disorder
Genetic Influences of Schizophrenia
clear evidence that being biologically related to someone with schizophrenia puts you at greater risk for developing schizophrenia
severity determines likelihood child will inherit disorder
Dopamine Hypothesis (Neurobiological Influences)
schizophrenia is caused by excessive dopamine activity
Brain Structure (Neurobiological Influences)
children of schizophrenics tend to show subtle neurological problems such as abnormal reflexes and inattentiveness
Viral Infection (Neurobiological Influences)
due to prenatal exposure to influenza virus (the flu)
Families and Relapse
high expressed emotion - emotional communication style involving criticism, hostility, and emotional over-involvement is a good predictor of relapse
feel like they are helping by having this attitude
Biological Treatments of Schizophrenia
antipsychotic medications (neuroleptics) - effective in treating symptoms of schizophrenia in approx 60% of those who take them
common side effects:
sedation (sleepy + tired)
extrapyramidal symptoms
tardive dyskinesia (repetitive, involuntary movements)
Psychosocial Treatments of Schizophrenia
token economy - designed to increase desirable behavior and decrease undesirable behavior with use of tokens (conditioning)
Social Skills Training Treatment of Schizophrenia
behavioral therapy used to improve social skills in people with mental disorders or developmental disabilities
Independent Living Skills Treatment of Schizophrenia
many skill areas including personal care, food prep, clothing management, money management, personal organization, and household maintenance
Civil Commitment
when a person can be legally declared to have a mental illness and be placed in a hospital for treatment
criteria:
has a mental illness and needs treatment
dangerous to self and/or others
has a grave disability, such that they are unable to care for themselves or others
Defining Mental Illness (Civil Commitment)
legal concept
usually refers to severe emotional or thought disturbances
can negatively affect a person’s health/safety
each state has its own definition
Dangerousness (Civil Commitment)
generally means person is a danger to themselves or others
Changes Affecting Civil Commitment
O’Conner v. Donaldson: states cant confine a non-dangerous person who is capable of surviving safely in freedom by himself or with help of willing and responsible family and friends
Addington v. Texas: raised burden of proof required to commit persons for psychiatric treatment from the usual civil burden of proof of “preponderance of the evidence” to “clear and convincing evidence”
Criminalization of the Mentally Ill
restrictions made it difficult to involuntarily commit the mentally ill who would sometimes be arrested and placed in jail because of their behavior
Criminal Commitment
process by which people are involuntarily held because:
they have been accused of committing a crime and are detained in a mental health facility until they can be assessed as fit or unfit to stand trial
they have been found not guilty of a crime by reasons of insanity
Insanity Defense
if person is found not guilty by reason of insanity, they are still probably going to be hospitalized
Patients’ Rights
right to treatment & right to refuse treatment (controversial)
informed consent
Research Participants’ Rights
to be informed about the study’s purpose prior to participation
their participation and data will remain private
researcher will treat them w/ respect and dignity
protected from physical/mental harm
freely choose to participate or not to participate without prejudice or reprisals
anonymity in reporting of results
their record of participation shall be safeguarded
informed consent
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