Chapter 10 - Schizophrenia Flashcards
-schizophrenia is among the most
puzzling and disabling clinical syndromes. Schizophrenia touches every facet of an afflicted persons life
Acute episodes are characterized
by delusions, hallucinations, illogical thinking (thought disorder), incoherent speech and bizarre behavior.
-Social stigma
plays a large role as well
Between episodes
people may still be unable to think clearly and my lack appropriate emotional responses to people and events in their lives
Schizophrenia
a chronic psychotic disorder characterized by acute episodes involving a break with reality, as manifested by such features as delusions, hallucinations, illogical thinking, incoherent speech, and bizarre behavior
-Emil Kraeplin (1856 – 1926)
- Dementia Praecox - “out of one’s mind” - refers to premature impairment of mental abilities
- “the loss of inner unity of thought, feeling, and acting” and results in ”disintegration of the personality:
- progressive disease process
- hallucinations , motoring abnormalities
-Eugen Bleuler (1857 – 1939) – the 4 A’s
- Associations (loose) - ideas are strung together with little or no relationship between them and the person does not appear to be aware of the lack of connectedness
- Affect (blunted of inappropriate) - emotional response of affect becomes flattened or inappropriate.
- Ambivalence - hold ambivalent or conflicting feelings towards others, such as loving and hating them at the same time
- Autism – withdrawal into a private fantasy world that is not bound by principles of logic, different than the disorder of childhood
- delusions represent “secondary symptoms” that accompany the primary symptoms but do not define the disorder
- introduced the term schizophrenia (Sz)
- “split brain”
- recognized variability in the course of the disorder
- introduced the term schizophrenia (Sz)
-Kurt Schneider (1887 – 1967)
-thought the 4 A’s overlapped too much with other disorder and wanted better differential criteria
- First-Rank Symptoms: - central to diagnosis of Sz, initially thought to be unique to Sz - ABCD - pathognomonic indicator’s (he believed) - Auditory hallucinations - Broadcasting of thought - distinctly to other people - Controlling of thought (Echo, Insertion, Withdrawal) - hearing their own thoughts out loud, transmitted thoughts into their heads, someone can remove their thoughts - Delusions - irrational, but firmly held beliefs - Second-Rank Symptoms - frequently associated with Sz, but not exclusively - mood problems - non-auditory hallucinations (visual, olfactory, haptic, gustatory)
Prevalence and Cost of Schizophrenia
-1% of the the population; fifth leading cause of disability. Left untreated, it is a highly debilitating disorder
-social isolation
-early onset, few cases spontaneously enter remission permanently
– highly dependent on early diagnosis and treatment
-consequences can be devastating in virtually all main functional areas
-homelessness and victimization are common
-properly treated individuals with Sz are no more harmful that members of the general population
-often suspicious of family members and professionals, so to avoid Tx
-delusions may lead to fear that medications are poison or thought control agents
-medication side effects can be nasty
-poor compliance with social services and our reach workers make it permanency planning difficult
-may be reluctant to allow others into their residence to assess safety of home environment
-about 20x as likely as members of the general population to commit suicide
-more often to be victims than perpetrators of violence, most are withdrawn
Hallucinations
-there is clearly a cultural aspect to what people will see when they hallucinate
-hallucinations are not the same for everyone
-most common form of perceptual disturbance in Sz
-auditory are the most common 60-80% of cases
-tactile hallucinations (feeling like snakes crawling all over body) are also common
-visual hallucinations
-gustatory hallucinations – tasting things not present
-olfactory hallucinations – smelling things that are not present
-command hallucinations – being told to do something by the hallucination
Other types:
-grief induced
-drug induced
-lack of stimulation – dark room, float tanks
Phases of Sz – cyclic
- usually afflicts young people at the very time they are making their way from the family into the outside world, develops in late teens to early 20s
- sometimes there is an acute onset, where the disorder hits fast (within weeks or months)
- Prodromal Phase
- clinical config. that comes ahead of it
- characterized by waning interest in social activities, increasing difficulty in meeting the responsibilities of daily life. Fail to bathe, wear same clothes repeatedly, increasingly odd or eccentric behavior, speech becomes vague or strange
- may start gradually and then rise to a level of concern among family and friends
- socially withdrawn, hard to perform day to day tasks, talking to themselves (not hallucinations yet), starting to look odd and eccentric
- Acute Phase
- this is where we see more elaborative symptoms. Hallucinations, thought disorder, disorganized speech,
- talking to oneself of the street, collecting garbage, hoarding food
- Residual Phase
- a bit of a retraction of the primary symptoms, there is still an element of the thought disorder
- closer to that of the prodromal phase
- continued to be impaired due to a deep sense of apathy, difficulties in thinking or speaking clearly, harboring unusual ideas
-Prodromal Phase
- clinical config. that comes ahead of it
- characterized by waning interest in social activities, increasing difficulty in meeting the responsibilities of daily life. Fail to bathe, wear same clothes repeatedly, increasingly odd or eccentric behavior, speech becomes vague or strange
- may start gradually and then rise to a level of concern among family and friends
- socially withdrawn, hard to perform day to day tasks, talking to themselves (not hallucinations yet), starting to look odd and eccentric
-Acute Phase
- this is where we see more elaborative symptoms. Hallucinations, thought disorder, disorganized speech,
- talking to oneself of the street, collecting garbage, hoarding food
Residual Phase
- a bit of a retraction of the primary symptoms, there is still an element of the thought disorder
- closer to that of the prodromal phase
- continued to be impaired due to a deep sense of apathy, difficulties in thinking or speaking clearly, harboring unusual ideas
Major Features of Sz
-Disturbances of thought and Speech
Disturbances in the Content of thought
- seem to be unshakable, no matter how much evidence to the contrary is presented
- delusions of persecution - police are out to get me
- delusions of being controlled - demons controlling them or others
- delusions of grandeur - believing themselves to be Jesus or something similar - delusions of reference – people on the bus are talking about me
-Thought broadcasting
my thoughts leave my head on a type of mental-ticker tape. A person only needs to pass through the tape to know my thoughts
-Thought insertion
people are inserting their thoughts into my mind
-thought withdrawal -
people are sucking the thoughts out of the person’s head, leaving their mind empty
-Disorganized speech
people with Sz, tend to think in disorganized, illogical fashion which is reflected in their speech patterns. Labelled as a thought disorder
Thought disorder
recognized by a breakdown in the organization, processing and control of thoughts. Speech in people with Sz is often disorganized and jumbled as a result. Usually unaware of the abnormalities
-Neologisms
-are made up words and they are confident in what it means but if asked, they struggle to answer
-Perseveration
-is that they keep returning to certain things, even when challenged, they can’t easily let it go
