KHA 305 Lecture Notes - Lecture 7: Multidisciplinary Approach, Clang, Substance Abuse
30 Jun 2018
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Clinical Psychology week 7: Schizophrenia and spectrum disorders
Psychosis:
- A generic term
- A break with reality
- Effects the functioning of the brain
- General and collective name for all these symptoms:
oHallucination, delusions etc.
- Schizophrenia spends a majority of time in psychosis
oBut there are other times as well
- Psychosis is not unique to schizophrenia
oSubstance induced psychosis: amphetamines etc.
- Delirium and dementia
- Caused by a variety of conditions that affect the functioning of the brain
oIncludes hallucination, delusions and thought disorder
- Wrongly used interchangeably with schizophrenia
Schizophrenia:
- Most known about this disorder
- Broad covering of this: not enough time to describe it all
- Schizophrenia spectrum disorders:
oCharacterised in general by fundamental and characteristic distortions
oThinking:
Thought processing problems
oPerception
Processing problem
oAffect
Mood related issue
Inappropriate or blunted
oThoughts and perception are the main focus of today
- DSM-5 diagnostic criterion:
oDX: diagnosis
oTwo or more of the following:
Delusions
Hallucinations
Disorganized speech
MOST HAVE TWO OF THESE
Grossly disorganized or catatonic behaviour
Negative symptoms
Diminished emotional expression
Each present for a significant portion of time during a one
month period
Or less if successfully treat
oImpaired social, interpersonal, functioning
In childhood or adolescence: failure to achieve expected level
of interpersonal, academic or occupational functioning
oContinuous signs of the disturbance for a least six month
oSchizoaffective disorder and depressive and bipolar disorders with
psychotic features
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Difficult to tease
Need specific tests
oNot solely due to a substance
Trying to map out a time line
Have you had this when not induced by drugs
All about the time course, issues here
oSeparate from other disorders such as autism spectrum disorders
If so, only make a schizophrenic diagnosis if it is severe
- History of schizophrenia as a psychological concept:
oConcepts of madness existed for millennia
oSchizophrenia only classified as distinct by Kraepelin
Distinction in the psychotic disorders between dementia
praecox and manic depression
Believed it to be a dementia for young people:
neurodegenerative disease
oThe term itself was first used by Morel
oEarly dementia
Early onset
Illness develops relatively early and its course is deteriorating
and chronic
Cognitive symptoms parallel dementia
No organic changes to the brain- maybe don’t have the ability
to test that
oWrong:
Not deteriorating throughout the lifespan
oBleuler: schizophrenia
1911
the name dementia is misleading, it is not similar
doesn’t always lead to deterioration- they can recover
like other mental disorders like depression
Cognitive impairment that might have
Breaking of associative threads between the reality and
the person
Cannot perceive reality reasonably
Four fundamental symptoms:
Affective blunting
oFlatten affect, emotionally neutral
Disturbance of association
oFragmented thinking
Autism:
oSocial impairment
Ambivalence:
oFragmented emotional response
Believed hallucination etc. not as important as these
oCan appear in many other disorders
oMostly bipolar disorders
Doesn’t make sense
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oThese hallucination and delusions are key to the
disorder
oSchneider and the first rank symptoms:
Four forms: psychotic symptoms that differentiate it from other
conditions
Delusions of being controlled by external force
Belief that thoughts are being inserted into or withdrawn from
one’s conscious mind
Thoughts are being broadcasted to others
Hearing hallucinatory voices that comment on one’s thought or
actions or that have a conversation with other hallucinated
voices
The reliability is questioned
Though the term might be
oOther theorists:
Assessment tools for the disorder
Positive symptoms:
Added
Most individuals do not normally experience, but are
present in people with schizophrenia
Hallucination
Negative symptoms:
Loss or absence of normal traits or abilities
Affective flattening
Anhedonia
Attentional impairment
Disorganization syndrome:
Third grouping
Includes chaotic speech, thought and behaviour
Evidence for a number of other classifications
- Symptomatology:
oDelusions:
False beliefs
Based on false beliefs held despite evidence of the contrary
Incorrect inference
Firmly held, absolute certainty
Karl Jaspers defined three main:
Certainty
Incorrigibility
Impossibility or falsity of content
oDifferent to religious beliefs
Bizarre vs. non-bizarre:
Clearly implausible
Within the same culture, cannot be explained
Not derived from ordinary
Non-bizarre: although its weird, it can actually happen
Mood congruent: in relation to current mood state
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