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VHS Study Guide Psychology WEEK 1: Psychology as a Science The goal of this week is to distinguish between "Pop Psychology" (myths) and "Empirical Science" (facts). 1. The Philosophical Roots & "Big Names" Wilhelm Wundt: Established the first psychology lab (1879). He used Structuralism, trying to map the "structure" of the mind through Introspection (having subjects report every tiny sensation they felt). Sigmund Freud: Founded Psychoanalysis. He believed behavior is driven by the Unconscious mind and childhood traumas. He used dream analysis and "free association." Behaviorism (Watson & Skinner): They rejected Freud. They argued psychology must be an Empirical Science, meaning we only study what we can see and measure. Watson: Famous for the "Little Albert" study (fear conditioning). Skinner: Focused on how rewards/punishments shape behavior (Operant Conditioning). Ivan Pavlov: A physiologist who discovered Classical Conditioning (associating a neutral stimulus, like a bell, with a natural reflex, like drooling). Maslow’s Hierarchy of Needs: A Humanist theory. It’s a pyramid starting with basic survival (food/water) and moving up to Self-actualization (reaching your full potential). 2. The "Brain Traps" (Critical Thinking & Myths) Word-of-Mouth: We believe things just because we’ve heard them a lot (e.g., "We only use 10% of our brain"—FALSE). Desire for Easy Answers: People prefer a "quick fix" (like a 5-minute cure for anxiety) over complex scientific reality. Selective Perception: We only notice things that confirm our existing beliefs. Post Hoc, Ergo Propter Hoc: "After this, therefore because of this." The logical error of assuming that because Event B followed Event A, Event A must have caused it. Inferring Causation from Correlation: The most common exam trap. Just because two variables move together (like heat and crime), it doesn't mean one causes the other. Reasoning by Representativeness: Stereotyping. Thinking a person "looks like" a certain role, so they must be that role (the "Finance Bro" vest example). WEEK 2: Scientific Inquiry and Research This is the "How-To" of psychology. You need to know the difference between just watching people and running a real experiment. 1. Research Methods Naturalistic Observation: Watching subjects in their natural habitat without interfering. High "real world" accuracy, but you have zero control. Case Study (Clinical): An intensive, detailed look at one unique individual (e.g., a person with a rare brain injury). Great for detail, but you can't apply the results to everyone. Archival Research: Looking at old records, newspapers, or medical files to find patterns. Longitudinal vs. Cross-Sectional: Longitudinal: Following the same group of people for 20+ years. (Expensive, but shows true change). Cross-Sectional: Comparing different ages at the same time (e.g., testing 10-year-olds and 50-year-olds today). 2. The Experimental Design (The "Gold Standard") Inductive vs. Deductive: Inductive: Starting with observations $\rightarrow$ forming a theory (Bottom-up). Deductive: Starting with a theory $\rightarrow$ testing it with an experiment (Top-down). Independent Variable (IV): The variable the researcher manipulates (The "Cause"). Dependent Variable (DV): The variable being measured (The "Effect"). Control vs. Experimental Group: The experimental group gets the "treatment"; the control group gets a placebo or nothing. Random Assignment: Every participant has an equal chance of being in either group. This prevents Bias. Single-Blind vs. Double-Blind: Single: Participants don't know which group they are in. Double: Neither the participants nor the researchers know. This prevents the researcher from accidentally giving "cues." WEEK 3: Biology and Behavior The "Hardware" section. How the physical brain creates the "Pink Slime" experience. 1. The Nervous System Map Central (CNS): Brain and Spinal Cord. Peripheral (PNS): Everything else. Somatic: Voluntary movements (walking). Autonomic: Involuntary (heartbeat). Sympathetic: "Fight or Flight" (Eyes dilate, heart speeds up, digestion stops). Parasympathetic: "Rest and Digest" (Calms the body down). 2. The Neuron (The Building Block) Dendrites: Receive messages. Soma (Cell Body): Process info. Axon: Sends the electrical signal. Myelin Sheath: Fatty tissue that speeds up the signal. Synapse: The tiny gap between neurons where chemicals travel. Neurotransmitters: Agonist: A chemical that mimics a neurotransmitter (enhances the effect). Antagonist: A chemical that blocks a neurotransmitter. 3. Brain Tools & Anatomy EEG: Measures electrical brain waves (good for sleep studies). MRI vs. fMRI: MRI shows structure (a picture); fMRI shows function (where blood is flowing). PET Scan: Uses radioactive "tracer" sugar to see which parts of the brain are active. The Endocrine System: Uses Hormones (slow-acting chemicals) released into the bloodstream by Glands (like the Adrenal or Pituitary). 4. The "Hidden" Biological Details (Week 3) Refractory Period: After a neuron fires, it needs a tiny "recharge" break before it can fire again. Think of it like a camera flash or a toilet flushing—you can't do it twice in a split second. Broca’s Area vs. Wernicke’s Area: * Broca’s: Controls Speech Production (Frontal Lobe). If damaged, you know what you want to say but can't get the words out. Wernicke’s: Controls Language Comprehension (Temporal Lobe). If damaged, you can speak, but it's "word salad"—it makes no sense. WEEK 4: Consciousness Consciousness is your awareness of yourself and your environment. It’s not an "on/off" switch; it’s a spectrum. 1. Processing Levels Conscious Processing: Tasks that require focused attention (e.g., learning a new TikTok dance or solving a math problem). Automatic Processing: Tasks we do "without thinking" once they are learned (e.g., walking or an experienced driver steering a car). 2. Altered States Hypnosis: A state of extreme self-suggestion where a person is highly open to direction. Meditation: A practice of focused attention to achieve mental clarity and emotional calm. Daydreaming: A shift in attention away from the current task toward internal thoughts and "mental movies." 3. Psychoactive Drugs (The "Drug Cabinet") Depressants (Alcohol, Barbiturates): Slow down the Central Nervous System (CNS). They decrease heart rate and reaction time. Stimulants (Caffeine, Nicotine, Cocaine, ADHD meds): Speed up the CNS. They increase heart rate and energy. Opiates (Heroin, Morphine, Vicodin): Specifically target pain receptors. They mimic Endorphins to stop pain and create euphoria. Hallucinogens (LSD, Marijuana, Psilocybin): Distort perceptions and evoke sensory images in the absence of sensory input. WEEK 5: Sleep and Dreams Sleep is a biological necessity, not a luxury. Your brain is incredibly active during this "downtime." 1. Stages of Sleep (The Cycle) Stage 1 (NREM-1): Light sleep. You might experience "hypnagogic sensations" (feeling like you are falling). Stage 2 (NREM-2): Deep relaxation. Characterized by Sleep Spindles (bursts of rapid brain activity). Stage 3 & 4 (NREM-3): Deepest sleep. This is when the body repairs itself. If you wake up here, you’ll feel very groggy. REM (Rapid Eye Movement): The "Dream Stage." Your brain waves look like you are awake, but your motor cortex is blocked—meaning your body is paralyzed so you don't act out your dreams. 2. Dream Theories (Why do we dream?) Freud’s Wish Fulfillment: Dreams are a "safety valve" for unacceptable feelings. Manifest Content: The actual storyline of the dream (e.g., being chased by a giant Pink Slime). Latent Content: The hidden psychological meaning (e.g., you are running away from your final exam stress). Activation-Synthesis: The brain's attempt to make sense of random neural static. The brain "synthesizes" a story from random "activation." Information Processing: Dreams help us sort out the day's events and consolidate memories. Threat Simulation Theory: Dreaming allows us to "practice" surviving dangerous situations in a safe environment. WEEK 6: Thinking and Processing This is about "Cognition"—how we use our "Pink Slime" to solve problems and make decisions. 1. Building Blocks of Thought Concepts: Mental groupings of similar objects (e.g., the concept of "Dogs"). Prototype: The best example of a category. (If I say "Bird," you probably think of a Robin, not a Penguin. The Robin is your prototype). Schemata (Schema): A mental framework that helps us organize and interpret information (e.g., your "School Schema" includes desks, teachers, and bells). 2. Problem-Solving Tactics Trial-and-Error: Trying random solutions until one works. (Slow and inefficient). Algorithms: A step-by-step, logical rule that guarantees a solution. (e.g., a math formula or checking every single aisle in a store to find milk). Heuristics: A mental shortcut or "rule of thumb." It's faster than an algorithm but can lead to errors. (e.g., looking at the signs above the aisles to find the milk). 3. The Biases (Why we make mistakes) Confirmation Bias: Searching for information that supports our preconceptions and ignoring everything else. Hindsight Bias: After an event occurs, believing we "knew it all along." Anchoring Bias: Getting "stuck" on the very first piece of information offered. (e.g., if a shirt is "on sale" for $50 down from $100, you think $50 is a deal, even if the shirt is only worth $10). Availability Heuristic: Estimating the likelihood of events based on how easily they come to mind. (e.g., being afraid of a plane crash because you saw one on the news, even though car crashes are more common). Mental Set: The tendency to approach a problem in one particular way, often a way that has worked in the past but may not work now. WEEK 7: Memory Memory is the persistence of learning over time. 1. The Three Stages of Memory Encoding: Getting information into our brain. Semantic Encoding: Encoding the meaning of words (Deepest processing). Visual Encoding: Encoding images. Acoustic Encoding: Encoding sounds. Storage: Retaining that information. Retrieval: Getting the information back out. 2. Types of Storage Short-Term Memory (STM): Holds about 7 items (plus or minus 2) for about 20 seconds. Long-Term Memory (LTM): Unlimited capacity and can last a lifetime. Explicit (Declarative): Facts and experiences (Semantic = facts; Episodic = your life stories). Implicit (Procedural): Skills (like riding a bike or typing). 3. Memory Sins & Failures Schacter’s Seven Sins: Includes Transience (fading over time), Absent-mindedness (forgetting your keys), and Persistence (unwanted memories that won't go away). Amnesia: Anterograde: You can't form new memories. Retrograde: You can't remember the past. 4. Enhancement Techniques Chunking: Organizing items into familiar, manageable units. Spaced Repetition: Studying small amounts over a long time rather than cramming. Mnemonic Devices: Memory aids like "PEMDAS" for math. 5. The "Subtle" Memory Sins (Week 7) The Serial Position Effect: You are most likely to remember the beginning of a list (Primacy Effect) and the end of a list (Recency Effect), but you’ll probably forget the middle. Pro-Tip: This is why you should study the "middle" weeks (Week 4, 5, 6) extra hard! Misinformation Effect: This is why eyewitness testimony is shaky. If someone asks, "How fast was the car going when it smashed into the pole?" you will remember the car going faster than if they said "hit." WEEK 8: Lifespan Development Developmental psychology examines how we change physically, cognitively, and socially from "womb to tomb." 1. Cognitive Development (Jean Piaget) Piaget believed children think differently than adults and move through four stages: Sensorimotor (0–2 years): Exploring the world through senses. Key milestone: Object Permanence (realizing things still exist even if you can't see them). Preoperational (2–7 years): Symbolic thought (make-believe) but lacks logic. Key trait: Egocentrism (thinking everyone sees the world exactly as they do). Concrete Operational (7–11 years): Logical thinking about physical objects. Key milestone: Conservation (understanding that volume stays the same even if the shape of the glass changes). Formal Operational (12+ years): Abstract reasoning and hypothetical "what if" thinking. 2. Psychosocial Development (Erik Erikson) Erikson focused on "crises" we face at each age. Trust vs. Mistrust (Infancy): Is the world safe? Identity vs. Role Confusion (Adolescence): "Who am I?" (This is the most common exam question). Integrity vs. Despair (Late Adulthood): Looking back on life with satisfaction or regret. 3. Moral Development (Lawrence Kohlberg) Pre-conventional: Doing the right thing to avoid punishment or get a reward. Conventional: Doing the right thing because it's the law or to fit in. Post-conventional: Doing the right thing based on universal ethical principles (even if it breaks the law). 4. Parenting Styles Authoritative: High warmth, high rules. (The "Goldilocks" style—best outcomes). Authoritarian: Low warmth, high rules. ("Because I said so!"). Permissive: High warmth, low rules. (More like a friend than a parent). Uninvolved: Low warmth, low rules. (Neglectful). WEEK 9: Learning Learning is a relatively permanent change in behavior due to experience. 1. Classical Conditioning (Ivan Pavlov) Learning by association (connecting two stimuli). Unconditioned Stimulus (UCS): The natural trigger (Food). Unconditioned Response (UCR): The natural reflex (Drooling for food). Neutral Stimulus (NS): A trigger that means nothing yet (A Bell). Conditioned Stimulus (CS): The bell after it has been paired with food. Conditioned Response (CR): Drooling for the bell alone. 2. Operant Conditioning (B.F. Skinner) Learning by consequences (Rewards and Punishments). Positive Reinforcement: Adding something good to increase behavior (A gold star for working). Negative Reinforcement: Removing something bad to increase behavior (The car stops beeping when you buckle your seatbelt). Positive Punishment: Adding something bad to stop behavior (A speeding ticket). Negative Punishment: Taking away something good to stop behavior (Taking away your phone). 3. Observational Learning (Albert Bandura) Learning by watching others. Famous study: The Bobo Doll Experiment, where kids imitated adults punching a doll. 4. The "Fine Print" of Learning (Week 9) Spontaneous Recovery: After a behavior has been "extinct" (gone away) for a while, it suddenly reappears out of nowhere. (Like Pavlov's dog suddenly drooling at a bell weeks after he stopped). Generalization vs. Discrimination: Generalization: Fearing all dogs because one bit you. Discrimination: Only fearing the specific dog that bit you. WEEK 10: Social Influences This is the study of how the "situation" and "group" overpower the individual. 1. The Stanford Prison Experiment (Zimbardo) Demonstrated the power of Social Roles and Scripts. Ordinary students became abusive "guards" or submissive "prisoners" simply because of the role they were assigned. 2. Influence & Conformity Normative Social Influence: Conforming to fit in and be liked (Dressing like your friends). Informational Social Influence: Conforming because you think the group has more info than you (Following the crowd in a new city). Obedience (Milgram): Following orders from an authority figure, even if it hurts someone else. 3. Group Dynamics Social Loafing: Working less hard in a group than when alone (The "Billy" effect). Deindividuation: Losing self-awareness and self-restraint in a large crowd or behind an anonymous screen. Group Polarization: When group discussion leads to more extreme opinions. Bystander Effect: People are less likely to help if others are around due to a Diffusion of Responsibility. 4. Thinking Patterns Fundamental Attribution Error: Blaming someone's personality for their behavior while ignoring the situation. Cognitive Dissonance: The "icky" feeling when our actions don't match our beliefs (e.g., you hate lying, but you just lied to your mom). We usually change our beliefs to match our actions to feel better. 5. Social Psych "Secret" Terms (Week 10) Self-Serving Bias: When we succeed, we take the credit ("I'm a genius"). When we fail, we blame the situation ("The test was unfair"). Foot-in-the-Door vs. Door-in-the-Face: Foot-in-the-Door: Ask for something tiny first, then the big thing. Door-in-the-Face: Ask for something HUGE (get rejected), then ask for the smaller thing you actually wanted. They are more likely to say yes because it feels like a "compromise." WEEK 11: Multiculturalism & Diversity This is the study of how culture, identity, and group values shape our behavior and how we interact with others. 1. Cultural Values Individualism: Cultures that value personal independence and "Me" goals (e.g., USA). Success is based on personal achievement. Collectivism: Cultures that value group harmony and "We" goals (e.g., Latin America, Asia). Success is based on doing what is best for the family or community. 2. Acculturation (How we adapt to new cultures) Integration: The "Best of Both Worlds." Keeping your original culture while participating in the new one. Assimilation: Giving up your original identity to fully "blend in" with the new culture. Separation: Keeping your original culture and avoiding the new one. Marginalization: Feeling like you don't belong to either culture (The "lonely" state). 3. Metaphors for Society The Melting Pot: The old idea that everyone should blend together and lose their differences to become one "American" identity. The Salad Bowl: The newer idea where cultures live together but stay distinct. You can see the "tomatoes" and the "lettuce"—everyone keeps their unique flavor. 4. Social Barriers Microaggressions: Small, daily slights or "backhanded compliments" toward marginalized groups (e.g., "You’re so articulate for someone from your neighborhood"). Prejudice vs. Discrimination: Prejudice is the thought/feeling (pre-judging), while Discrimination is the action (treating someone differently). WEEK 12: Stress & Health This is the study of how our brain's "appraisal" of the world affects our physical and mental health. 1. The Appraisal Process (Lazarus) Primary Appraisal: Judging if a stressor is a Threat (harmful) or a Challenge (potential for growth). Secondary Appraisal: Evaluating your tools. "Do I have the resources to handle this?" If yes, stress stays low. If no, panic sets in. 2. The Body’s Response (Selye’s GAS) General Adaptation Syndrome (GAS): The three stages of how your body reacts to stress: Alarm: Fight-or-Flight. Heart races, adrenaline hits. Resistance: Staying on "high alert" to cope. This is where you grind through the week. Exhaustion: Your battery dies. Your immune system crashes, and you get sick (The Cohen Cold Study). 3. Types of Stress Eustress: "Good stress." The kind that motivates you to finish a project or perform well in a game. Distress: "Bad stress." Chronic pressure that leads to burnout, fatigue, and health problems. 4. Coping Strategies Problem-Focused Coping: Attacking the problem directly. (Example: Time-Blocking your homework so it isn't overwhelming). Emotion-Focused Coping: Managing the feelings. (Example: Going to the Gym or meditating to stop feeling anxious). 5. Stress "Secret" Terms Cortisol: The primary stress hormone. Great for emergencies, but too much of it "eats" your memory and weakens your heart. Psychoneuroimmunology: The fancy word for the study of how your brain (stress) talks to your immune system. WEEK 13: Mental Wellness & The Science of Happiness The goal of this week is to identify the psychological frameworks and empirical studies that explain how humans build resilience and long-term well-being. 1. The Three Dimensions of Happiness (Module 14.5) According to the textbook, happiness is an enduring state consisting of joy and contentment. It is built through three "lives": The Pleasant Life: Attaining and savoring daily pleasures that add joy to the moment (e.g., the aroma of coffee or the feeling of sunshine). The Good Life: Identifying your unique skills and using them to enrich your life. This is where you find the state of Flow—being so "in the zone" that you lose track of time. The Meaningful Life: Using your talents and efforts in the service of the greater good or to help others, which provides a deeper sense of fulfillment than pleasure alone. 2. The Four Pillars of Well-Being (Wellness Studies) Based on Dr. Richard Davidson’s research, well-being is a "trainable skill" rather than a fixed trait. It is built on: Awareness: Noticing what your mind is doing in the present moment (meta-awareness). Connection: Cultivating kindness and healthy social relationships, which are the #1 predictor of long-term health. Insight: Having curiosity about how your own mind works and not believing every negative thought as a "fact." Purpose: Having a clear sense of direction or a "life compass" that guides your daily actions. 3. Empirical Evidence: The Creswell et al. Study (2014) This study provided scientific proof that mental training has biological effects: The Setup: An experimental design where students were randomly assigned to either a mindfulness group or an analytic control group. The Independent Variable: Brief 3-day mindfulness meditation training (25 mins/day). The Dependent Variable: Biological stress markers (Cortisol levels) and self-reported stress. The Result: The mindfulness group showed significantly lower cortisol levels, proving that meditation fosters biological resilience to stress. 4. Scientifically Proven Benefits of Gratitude Research shows that gratitude is a powerful "reset" for the nervous system: Physical: Improved sleep quality and duration; fewer reported aches and pains. Psychological: Reduces "toxic" emotions (envy, resentment) and increases mental strength. Studies of 9/11 survivors showed gratitude was a major factor in preventing PTSD. Social: Encourages "pro-social" behavior, making people more likely to form and maintain new relationships. 5. Mindfulness vs. Meditation (The State vs. The Practice) It is critical to distinguish between these two often-confused terms: Mindfulness: A state of being. It is the quality of being fully present, aware of where we are and what we’re doing, without being overly reactive or overwhelmed. Meditation: The formal practice or "mental gym" used to train the brain. It is the intentional time set aside to practice techniques that eventually lead to a consistent state of mindfulness. 6. Key Terminology & Cognitive Traps Affective Forecasting: The human tendency to overestimate how much future events (both good and bad) will affect our long-term happiness. We assume milestones like "perfect grades" will provide permanent joy, but they usually don't. Optimism & Resilience: Optimism is the general tendency to expect good outcomes. It is the "engine" of resilience—the ability to "bounce back" from major life stressors (like those listed on the SRRS). Problem-Focused vs. Emotion-Focused Coping: * Problem-Focused: Dealing with the stressor directly (e.g., studying for the test). Emotion-Focused: Managing the feelings associated with the stressor (e.g., taking a nap or exercising)

TEMA 2: ESQUIZOFRENIA Los trastornos del espectro de la esquizofrenia y otros trastornos psicóticos son la esquizofrenia, otros trastornos psicóticos y el trastorno esquizotípico (de la personalidad). Se definen por anomalías en uno o más de los siguientes cinco dominios: delirios, alucinaciones, pensamiento (discurso) desorganizado, comportamiento motor muy desorganizado o anómalo (incluida la catatonía) y síntomas negativos (expresión emotiva disminuida, abulia, anhedonia, alogia, asocialidad). Generalidades ● La esquizofrenia es el trastorno psicótico más frecuente que afecta a 1 de cada 100 personas a lo largo de la vida. ● Se considera multicausal, con la interacción entre diversos genes y el entorno, índice de heredabilidad del 50-80 % ● Uso de sustancias psicoactivas, particularmente cannabis, incrementa el riesgo de desarrollarla. ● Usualmente, inicia en la adolescencia (usualmente antes de los 25 años) ● Involucrado diversos sistemas de neurotransmisores, mecanismos asociados a neuroinflamación, estrés oxidativo y segundos mensajeros. Historia "esquizofrenia" proviene del griego y fue acuñada en 1908 por el psiquiatra suizo Eugen Bleuler. Está formada por los términos "schizein" que significa "separar" y "phren" que se traduce como "mente" o "alma". Epidemiología ● Tiene la misma prevalencia tanto en hombres como en mujeres. ● Las personas que consumen gran cantidad de cannabis presentan riesgo 6 veces más elevado de sufrir esquizofrenia. Etiología ● Factores genéticos ● Factores biológicos: 1. DOPAMINA: plantea que este trastorno tiene su origen en una actividad dopaminérgica excesiva, la teoría se elaboró a partir de eficacia y la potencia de muchos antipsicóticos (es decir, los antagonistas del receptor de la dopamina) y las sustancias que aumentan la actividad dopaminérgica (en concreto, la cocaína y las anfetaminas) son psicomiméticas. 2. SEROTONINA: Las hipótesis actuales plantean que el exceso de serotonina es la causa de los síntomas tanto positivos como negativos de la esquizofrenia. La fuerte actividad antagonista de la serotonina de la clozapina y otros antipsicóticos de segunda generación lo confirman. 3. NORADRENALINA: La anhedonia en la esquizofrenia se podría explicar por el deterioro neuronal selectivo dentro del sistema neural de refuerzo de la noradrenalina. 4. GABA: algunos pacientes con esquizofrenia presentan una pérdida de neuronas gabaérgicas en el hipocampo y la pérdida de neuronas gabaérgicas inhibidoras podría provocar la hiperactividad de las neuronas dopaminérgicas. 5. GLUTAMATO: Las hipótesis propuestas sobre el glutamato son la hiperactividad, la hipoactividad y la neurotoxicidad que provoca. 6. ACETILCOLINA Y NICOTINA: la reducción de los receptores muscarínicos y nicotínicos en los núcleos caudado-putamen, el hipocampo y ciertas regiones de la corteza prefrontal. Estos receptores desempeñan un papel en la regulación de los sistemas neurotransmisores implicados en la cognición, que se ve afectada en la esquizofrenia. 7. NEUROPÉPTIDOS: Los neuropéptidos, como la sustancia P y la neurotensina, se localizan con los neurotransmisores catecolamina e indolamina, e influyen en la acción de estos. Tipos de Esquizofrenia 1. Tipo paranoide ● Se caracteriza por la presencia de uno o más delirios, especialmente de persecución o grandeza, y alucinaciones auditivas frecuentes. ● Se presenta en edades mas avanzadas, mantienen cierto grado de funcionamiento social ● Pueden parecer nerviosas, desconfiadas o reservadas, hostiles o agresivas. 2. Tipo desorganizado ● Manifiesta por un comportamiento regresivo, primitivo, desorganizado y desinhibido. ● Pensamiento muy alterado, escaso contacto con la realidad, aspecto descuidado, y respuestas afectivas inadecuadas. ● Antes de los 25 años de edad ● Suelen reír sin motivo aparente, sonríen de manera burlona, hacen muecas 3. Tipo catatónico ● Alteraciones motoras importantes como estupor, rigidez, negativismo, posturas extrañas, mutismo o estados de excitación ● presentan movimientos repetitivos, manierismos y flexibilidad cérea ● pueden alternar rápidamente entre agitación y parálisis ● Durante la fase de excitación catatónica, puede requerirse atención médica urgente para evitar autolesiones o daño a otros. ● Alteraciones motoras importantes como estupor, rigidez, negativismo, posturas extrañas, mutismo o estados de excitación catatónica. 4. Tipo Indiferenciado ● Útil para describir casos mixtos o atípicos. ● Paciente presenta síntomas claros de esquizofrenia, pero no encaja del todo en ninguno de los subtipos anteriores. 5. Tipo residual ● Persisten signos como retraimiento social, afecto embotado, pensamiento ilógico, comportamientos extraños y una leve desorganización del pensamiento. ● Se refiere a pacientes que han tenido episodios esquizofrénicos previos, pero que actualmente no presentan síntomas activos intensos. Otros subtipos 1. Bouffée délirante: aparición de síntomas psicóticos de menos de 3 meses. El 40% evolucionan a esquizofrenia. Se asemeja al trastorno esquizofreniforme. 2. Esquizofrenia latente: Describía casos con síntomas leves o atípicos que no cumplían los criterios actuales, hoy se diagnosticarían con trastornos límite, esquizoides o esquizotípicos. 3. Esquizofrenia Oniroide: está completamente absorto en sus alucinaciones y se desconecta del entorno. Suele incluir desorientación y perplejidad. 4. Parafrenia: sinónimo de esquizofrenia paranoide poco útil en la práctica clínica moderna. 5. Esquizofrenia Seudoneurótico: inicialmente presentan ansiedad, fobias u obsesiones, pero que luego desarrollan psicosis o trastornos del pensamiento. Ahora se le llama trastorno limite 6. Trastorno delirante simple: pérdida gradual de motivación, iniciativa e interés social, sin alucinaciones o delirios persistentes. 7. Trastorno depresivo psicótico: Ocurre cuando, tras un episodio agudo de esquizofrenia, el paciente entra en un estado depresivo. 8. Esquizofrenia de inicio temprano: Aparece durante la infancia y suele confundirse inicialmente con autismo o discapacidad intelectual. 9. Esquizofrenia de Inicio tardío: principalmente en mujeres mayores de 45 años. Sintomas paranoides, mejor pronostico Criterios diagnosticos A. Dos o más de los siguientes síntomas, cada uno debe estar presente durante una parte significativa del tiempo durante un periodo de un mes (o menos si se trató con éxito). Al menos uno debe ser del 1, 2 o 3: 1. Delirios 2. Alucinaciones 3. Discurso desorganizado (p. ej., incoherencia) 4. Comportamiento muy desorganizado o catatónico 5. Síntomas negativos (disminución de expresión emocional o abulia) B. El funcionamiento en uno o más ámbitos principales (trabajo, relaciones interpersonales, autocuidado) ha estado claramente por debajo del nivel previo desde el inicio del trastorno. En niños o adolescentes: fracaso para alcanzar el nivel esperado en relaciones interpersonales, académicas o laborales. C. Los síntomas persisten por al menos seis meses, incluyendo al menos un mes de síntomas del criterio A (fase activa). Este periodo puede incluir síntomas prodrómicos o residuales. D. Se han descartado trastornos esquizoafectivo, depresivo o bipolar con características psicóticas porque: ● No han ocurrido episodios mayores del estado de ánimo concurrentes con los síntomas de fase activa ● Si han ocurrido, han estado presentes solo por una minoría del tiempo total de la enfermedad activa y residual. E. El trastorno no es atribuible a los efectos fisiológicos de una sustancia o a otra afección médica. F. Si hay antecedentes de trastorno del espectro autista o trastorno de la comunicación en la infancia, solo se puede hacer diagnóstico adicional de esquizofrenia si hay delirios o alucinaciones notables, además de los otros síntomas requeridos, por al menos un mes. Especificar el tipo de episodio y curso (si aplica): Tipo de episodio Descripción ● Primer episodio, actualmente en episodio agudo Primera manifestación que cumple criterios sintomáticos, diagnósticos y de tiempo. ● Primer episodio, actualmente en remisión parcial Se mantiene mejoría tras episodio anterior, pero persisten algunos síntomas. ● Primer episodio, actualmente en remisión total No hay síntomas activos tras episodio anterior. ● Episodios múltiples, actualmente en episodio agudo Nuevo episodio después de un periodo mínimo de remisión. ● Episodios múltiples, actualmente en remisión parcial tras múltiples episodios previos. ● Episodios múltiples, actualmente en remisión total Remisión completa tras múltiples episodios. ● Continuo, Síntomas cumplen los criterios diagnósticos durante la mayor parte del tiempo. ● No especificado, No se especifica el patrón del curso. Especificar la gravedad actual: La gravedad debe clasificarse evaluando cuantitativamente cinco síntomas principales de psicosis: ● Ideas delirantes ● Alucinaciones ● Discurso desorganizado ● Comportamiento psicomotor anormal ● Síntomas negativos Cada síntoma debe calificarse en una escala de 0 a 4: ● 0: Ausente ● 4: Grave Cuadro clínico ● Durante la adolescencia, pueden carecer de relaciones cercanas o haber evitado las citas ● Es común que los pacientes hayan mostrado desde la infancia una personalidad esquizoide o esquizotípica ● También pueden surgir intereses inusuales por temas abstractos, religiosos o esotéricos ● Los síntomas y signos premórbidos de la esquizofrenia aparecen antes de la fase prodrómica cefalea, mialgia, fatiga, problemas digestivos ● Alteraciones motoras y cuidado personal: Rigidez, torpeza motora, ropa inadecuada, tics, ecopraxia ● Catatonia y signos asociados: Mutismo, negativismo, obediencia automatica, manerismos, aveces flexibilidad cerea ● Trastornos del pensamiento: contenido y forma ● Trastornos del proceso del pensamiento en esquizofrenia ● Fuga de Ideas ● Bloqueo del pensamiento ● Déficit de atención ● Pobreza de contenido ● Dificultad para abstraer ● Perseveración y asociaciones raras (ecolalia, fonéticas) ● Circunstancialidad ● Ideas de control o difusión del pensamiento Comorbilidad somática 1. Signos neurológicos: ● Disdiadococinesia: dificultad para hacer movimientos rápidos y alternados. ● Estereognosia alterada: dificultad para reconocer objetos solo con el tacto ● Reflejos primitivos (como el de prensión) presentes en adultos. ● Disminución de la destreza motora. 2. Exploración ocular: ● Aumento en la frecuencja del parpadeo ● Alteración del seguimiento ocular 3. Lenguaje y alteraciones cognitivas: ● dificultad para percibir la entonación y ritmo del lenguaje Solo el 10% al 20% de los pacientes que ingresan e inician tratamiento mejoran a los 5 a 10 años. Mas del 50% tienen mal pronóstico. Tratamiento Efectos secundarios: extrapiramidales (acatisia, distonías, discinesia tardía), sedación, hipotensión ortostática, hiperprolactinemia (galactorrea, amenorrea, osteoporosis,) supresión de la GnRH (disminución de líbido), sindrome metabolico. Aportes del Dr: Contacto social: aislados, poco sociales, no tienen pareja. Paciente no puede seguir con sus estudios No es curable, es una enfermedad del pensamiento. Pensamiento se estudia: Forma, contenido, control, Robo o inserción de pensamiento solo se da en esta patología Ideas comunes en esquizofrenia ● Ideas delirantes de grandeza en esquizofrenia paranoide ● Ideas de vigilancia o persecución ● Brujería ● Ideas de Contaminación de la comida o que los están envenenando Episodio psicótico agudo polimorfo con o sin síntomas de esquizofrenia: regala todo su dinero, su ropa, no duerme ● Enfermedades del pensamiento: todo lo que tenga que ver con esquizofrenia ● Enfermedades afectivas: depresión y trastorno bipolar Fumar marihuana acerca a padecer esquizofrenia, ya que estimula a la sobreproducción de dopamina, la cual es la misma causa de esquizofrenia ● Acatisia: trastorno del movimiento que se caracteriza por una sensación de inquietud interna y la necesidad incontrolable de moverse, especialmente en las extremidades inferiores. ● Discinesia tardía: movimientos motores provocado por el uso crónico de antipsicóticos, sobretodo los típicos. Normalmente son movimientos orofaciales Antipsicóticos atípicos producen resistencia a la insulina, aumento de peso. La nicotina les ayuda a calmarse. Un enfermo mental difícilmente ataca. Presentan miedo, se esconden Extrapiramidalismo tiene que ver con la vía Nigroestriada: acatasia, discinesia tardia ● Episodio psicótico agudo de 1-30 días con o sin síntomas de esquizofrenia ● Episodio psicótico mayor al mes: Episodio esquizofreniforme Criterio A: 1 mes con ideas delirantes o comportamiento psicótico, con tratamiento menor a 1 mes ● Características de psicosis: Ideas delirantes, alucinaciones auditivas, comportamiento desorganizado y lenguaje desorganizado ● Delirium: alucinaciones visuales, complicacion metabólica donde el paciente tiene trastornos de o Alucinaciones visuales o Alteraciones del estado de conciencia ● Alucinaciones auditivas completas. Voces que hablan entre sí sobre los comportamientos de la persona, son patognomónicas de esquizofrenia ● Alucinaciones auditivas incompletas son patognomónicas de los trastornos afectivos ● Catatonia: escuchan, entienden bien, pero no hay mimética ni habla. ● Catatonia agitada: Hiperactividad motora, es muy rara. ● Esquizofreniforme siempre termina en esquizofrenia ● Esquizofrenia paranoide: debuta a los 25-28 años Tratamiento 1. Antipsicóticos típicos: desde 1950 desde la clorpromazina, decanoato de flufenazina Decanoato de flufenazina: inyectable, es de depósito y se utiliza cuando el paciente es inconsistente con el medicamento. Se utiliza cada 15 días o 1 cada mes, ampolla de 25 mg. Tiene muchos efectos secundarios extrapiramidales: parkinsonismo, sialorrea, torción cervical. Se acompaña de diperideno (2mg al día) ya que hace efecto contrario en vía nigroestriada (en esta vía estan los ganglios basales) o Haloperidol: ampolla 5mg en 1ml, tambien hay en tableta 5mg. o Clorpromazina: 5 ml Dañan mucho la vía nigroestriada pero no tienen daños metabólicos como aumento de peso 2. Antispsicoticos atipicos Dañan menos la vía nigriestriada, pero si hacen que aumente de peso, resistencia a la insulina, diabetes Ningún ansiolitico o antipsicótico se retira de espontáneamente, se van rebajando manualmente En esquizofrenia puedo usar de 5-10 mg de haloperidol en las noches y decanoato de flufenazina debe estar acompañado de Aquineton (biperideno) 2mg diario ( en la mañana). Alergil no funciona 3. Benzodiacepinas: • Prozapina, olanzapina, quetiapina, risperidona: Producen sueño • Flurazidona, olanzapina, pariperidona, quetiapina, olanzapina hay en Honduras. Risperidona ya no • Hiperprolactinemia: prozapina ( Este aumenta apetito) • Para aumento de apetito: Quetiapina ( da mucho sueño), entonces olanzapina • Medicamento que bloquea potentemente al H1 es la Clozapina, por lo que da más sueño • Medicamento que daña más a 5HT2A y 5HT2C es Olanzapina, por lo que está contraindicado en pacientes obesos