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psychopathology 2


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essential features of schizophrenia
1. presence of psychotic features during active phase
2. characteristic symptoms involving multiple psychological processes
3. deterioation from a previous level of functioning
4. onset before age 45
5. duration of at least 6 months
Content of thought
- first symptom
- various delusions (i.e. grossly peculiar, wrong beliefs)
types of delusions
1.persecutory delusions
2. delusions of reference
3. thought broadcasting
4. thought insertion
hallucinations (usually auditory)
- most commonly speak directly to them in form of criticisms
form of thought: loose associations
key, essential disorder in schizophrenia
- natural word association
- people go awry in associations with schizophrenia
types of loose associations
1. derailment of thought
2. circumstantial thinking
3. tangetial thinking
4. illogical thinking
5. neologisms
attention deficits
1. hypervigilance to extraneous stimuli
2. cognitive flooding
Emotional disturbances
1. blunt affect
2. flat affect
3. inappropriate affect
volition disturbances
1. pronounced ambivalence
2. inadequate interest or drive
relationship to outside world disturbances
1.withdrawl fom involvement with others
2. preoccupation with egocentric, illogical ideas and fantasies (autism)
psychomotor behavior disturbances
1. catatonic stupor, or rigidity, or excitement
2. waxy flexibility
prevalence of schizophrenia
1. in adults: 1.3%
2. 1 million in US treated each yr
3. 15% of all treated for behavioral problem
4. occupy 50% of the beds in facilities for mentally disordered and retarded
5. occupy 25% of all hospital beds
Disorganized schizophrenia
1. frequent incoherence (neologisms)
2. absence of systematized delusions ( set of beliefs that fit together)
3. blunted, inappropriate or silly affect
catatonic schizophrenia
1. stupor
3. rigidity
4. excitement
5. posturing
Paranoid schizophrenia
1. persecutory delusions
2. grandiose delusions
3. delusional jealousy
4. hallucinations with persecutory or grandiose content
Type I Schizophrenia
1.positive symptoms (i.e. hallucinations)
2. abrupt onset
3. preserved intelligence
4. more favorable response to anti-psychotic drugs
Type II Schizophrenia
1.negative symptoms(i.e. apathy, withdrawl)
2. gradual onset
3. greater chronicity and intellectual impairment
4. poorer response to anit-psychotic drugs
Familial and twin studies
1. incidence 4x greater in first degree relatives of a schizophrenic than in general population
2. the closer the genetic relationship between a schizophrenic and a relative, the higher in the concordance rate
concordance rates among family and twins
spouses 1-2%
fraternal twins (DZ) 14%
identical twins (MZ) 47%
Adoption studies
adopted at high risk (HR) children are more likely to develop schizophrenia than adopted (LR) children
cross-fostering studies
HR & LR children placed in families in which:
1. a parent is subsequently diagnosed as schizophrenic
2. both parents are not schizophrenic
cross-fostering study findings
1. HR children are twice as likely as LR children to develop schizophrenia regardless of adoptive parents
2. LR children at no increased risk when raised by a schizophrenic parent
hypotheses about sociocultural factors in schizophrenia
there is 5x more schizophrenia in lowest social class than in highest
1. sociogenesis hypothesis
2. downward drift hypothesis
Drug treatments
1. anti-psychotic drugs introduced in 1950s
2. referred to a neuroleptic
3. phenothiazines is main class
4. don't affect "negative" symptoms
5. 75% of patients improve with phenothiazines
6. non-compliance in nonhospitalized patients up to 50%
7. serious side effects (40%)
Atypical neuroleptics
1. cozaril is best known
2. more selective in dopamine receptors blocked
3. also increases serotonin activity
4. is more effective than phenothiazines on both positive symptoms and even has impact on neg. symptoms
5. has potentially fatal side effect
6. costs $9000/yr
7. used sparingly on treatment resistant patients
abstract thought, concrete thought, affliation, attachment
sexual behavior, emotional reactivity, motor regulation
"arousal", appetite/satiety, sleep
blood pressure, heart rate, body temperature
cortical modulation ratio
the relative "power" of the cortical and limbic brain regions to modulate the more primitive, reactive, output of the brainstem and midbrain
a conversation between two or more people with therapeutic intent
ratio with optimal developmental experience
limbic= 8 ______ 20
midbrain= 6
brainstem= 4 ______10
ratio= 2.0
Developmental trauma (domestic violence, physical abuse) will alter the coritcol modulation ratio
Corticol= 12
limbic= 8 ______ 20
midbrain= 8
brainstem= 6 _____ 14
ratio= 1.4
developmental neglect (emotional or experiential deprivation) will alter the ratio
corticol = 10
limbic = 6 ______ 16
midbrain = 6
brainstem = 4_____ 10
ratio= 1.6
neglect and trauma: a malignant combination
corticol= 10
limbic= 6 _____ 16
midbrain = 8
brainstem= 6 _____14
ratio= 1.1
works closely with troubled individuals, families, or groups of individuals to promote change.

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