assignement 4

7/29/2019 Assignement 4

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DanielleWilliams Psychology152

Assignment4

Name Symptoms

Disorganized

schizophrenia

Mainlyinvolvesdisintegrated,incoherent,irregular,and/or

inappropriatespeech,emotions,behavior,andflatorinappropriate

affectwithoutcatatonicbehavior.Someonewhohasdisorganized

schizophreniawouldbeveryhardtointerview,becausetheirwords

couldbedisorderedorhaveverylittlemeaningtothem.Ifthisisthe

casewithsomeone,thenthiscouldquiteeasilydemonstrateaverypoorlong-termprognosis,becausesocialinteractionsnormally

becomedisturbedwhensomeonehasdisorganizedschizophrenia.

Catatonic

Schizophrenia

Twoofthefollowingarepresent:

-Motoricimmobility(catalepsyorwaxyflexibility)orstupor.

-Excessivemotoractivity

-Extremepessimism,suchasresistancewhengiveninstructionsor

keepingarigidposture,ornotspeaking

-Characteristicsofvoluntarymovementsuchasadoptingstrange

postures,stereotypedmovements,andprominentmannerismsorgrimacing

-Echolaliaorechopraxia.-Disintegrated,incoherent,irregular,and/orinappropriatespeech,

behavior,aswellasemotions,allthesameassomeonewith

disorganizedschizophrenia.Peoplewhoareinacatatonicstatemaybeatahighriskforhurtingthemselvesorotherpeoplebecauseof

theseextraordinarymovements,sotheyhavetobecloselysupervisedbysomeone.

Paranoid

Schizophrenia

Normallyinvolvespersecutoryorextravagantdelusionsandauditory

hallucinationsbutfewproblems,buttheydonthaveproblemsputtingtheirthoughtstogether.Thelong-termprognosisofthisparticular

subtypeofschizophreniamaybebetterthanfortheothers,because

thethoughts,althoughtheyarestrangeones,continuetostay

relativelyintact,sothecommunicationofpeopleislargely

undisturbed,asopposedtocatatonicanddisorganizedschizophrenia.


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Undifferentiated

Schizophrenia

-Involvesacombinationofsymptomsthatdontclearlymatchthe

otherthreesubtypesofschizophrenia,butstillhavemanyfeaturesofschizophrenia,suchasdelusions,hallucinations,disorganizedspeech,

grosslydisorderedorcatatonicbehavior,andnegativesymptoms.

Name Schizophrenia

Subtypes:Paranoid,Disorganized,Catatonic,andUndifferentiated

Biological

Factors

Genetics

-Schizophreniaoccursin0.33to0.72percentofthegeneral

population,andthemedianageofonsetis22years.

-Itisalittlemorecommoninmalesthanfemales,andmaleswhohaveschizophreniatendtohavesymptomsatayoungeragethan

femaleswhohavethisdisorder.Thisalsomeansthatmentendto

havemoreoverallsymptomsaswell.

-Menmayhavemoreseveresymptomsofthedisorder,becausewomenmayhavespecificbiologicalfactors.Forinstance,protective

hormonesorlessseverechangesinthebrain,whichcanhelp

preventadvancementoftheveryseveresymptoms.

-Also,womentendtofunctionbetterinsocialsettingsandwork

settings,whichactuallydelaysonsetofsymptomsofthisdisorder.-Family,adoption,andtwinstudiesshowthatthisdisorderhasaverystronggeneticfoundation.

-Childrenwhohaveparentswiththedisorderare12timesmore

likelythanthegeneralpopulationtodevelopschizophrenia.The

riskfactorisevenhighforthemoredistantrelatives.

-Grandchildrenwiththedisorderarearound3timesaslikelythan

thegeneralpopulationtodevelopit.

-Similarityratesforthedisorderamongidenticaltwinsareusually

muchhigherthanforfraternaltwins.Adoptionstudiesdepictedsimilarresults.

-Kidsborntomotherwithschizophreniabutwhowereraisedby

parentswithoutitstillshowedahigherchanceofeventuallydevelopingitthancontrolgroups.Thisisespeciallytrueifparents

haveproblemscommunicatingwiththeiradoptedchildren.-Numerousresearchershaveseenlinkagestoschizophreniaon


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chromosomes1-11,13,15,18,20,22,andx,andthisseems

particularlytrueforchromosomes6,13,18,and22.

-Currentstudyportraysthatmanypeoplewiththedisorderhave

morethanonegenethatworkstogethertohelpproducethe

disorder,(thisisknownaspolygenicormultilocusmodel)howeversomepeoplewiththedisorderhaveindividualgenesthatarestrong

enoughtohelpproduceschizophrenia,buteventhesemostlikely

workwithothergenestohelpproducethedisorder.

-Geneticresearchalonedoesntexplainwhypeopledevelopthe

disorder,butitisinterestingastowhymostrelativesofpeoplewith

schizophrenia,evenidenticaltwinsofparentswhohavethedisorder,dontendupdevelopingit.Also,peoplewiththedisorder

dontnormallyhavekids,sothereisthequestionastohowthedisorderskipsgenerations.

BrainFeatures

-Somepeoplewiththedisorderhavespecificpartsoftheirbrain

thatmaycontributetoproducingthedisorder,onekeyfeaturebeingenlargedventricles,orspacesandgapsinthebrain.However

thisresearchisnotspecifictojustschizophrenia,itsbeenseenin

peoplewithcognitivedisordersaswell.Thisbrainfeatureisn

awfullyreplicatedbiologicalfindinginpeoplewiththisdisorder.

-Theenlargedventriclescouldbetheresultoffailureinnormal

braindevelopmentorinterruptionofpathwaysfromoneareaofthe

braintoanother.Asignificantinterruptionmightinvolveneuralconnectionsbetweenpartsofthebrainthatdealwithlanguageand

cognition.

-Peopleresearchingthisdisorderhavepaidcloseattentiontothe

temporallobeinthebrain,whichissomewhatresponsiblefor

auditoryprocessingandlanguage.Peoplewiththisdisordermay

timeshavenumerousproblemsintheseparticularareas,sothese

problemsmaybebecauseofthedifferencesseeninthetemporallobeofthebrain.

-Specifically,theamygdalaandhippocampusaresmallerinpeoplewithschizophreniathanincontrolgroups.Thehippocampusand

amygdalaaresomewhatresponsibleforspatialmemoryprocessing

andemotion,whicharealsoproblematicforpeoplewiththe

disorder.

-Anotherlinktoschizophreniaisareducedsizeinthesuperiorand


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middletemporalgyri,whichcanhaveanaffectonauditorymemory

andlanguage.

-Otherstudieshaveshownreductionsinthetotalsizeofonesbrain

andgraymatter,whichaffectthesizeofthedifferentlobesinthe

brain,affectingthecognition.Someofthesestudieshavepointedtomorespecificissuesrelatingtothefrontallove,whichisvery

involvedinthecomplexinformationprocessingandorganizationof

functioningandmaycloselyrelatetoauditoryhallucinations.

Someotherspecificdifferencesinthebrainofpeoplewith

schizophrenia,whichalsoseemtoinvolvesmallersize,include:

1).Thethalamusandparietal/occipitallobes,differencesinthesemayaffecttheconnectionbetweensensoryinformationandvisual

attention.2).Basalgangliaandcerebellum,inwhichdifferencesmightaffect

onesmotorbehaviorandoutputtohigh-orderareasofthebrain.3).CorpusCollosum,differenceswhichmayaffectoneslanguageandcommunicationbetweendifferentbrainhemispheres.

-Someothermajorfindingrelatedtochangesinthebrainandthis

disorderislackofasymmetryinparticularareas.Somepeoplewith

thedisordermayhavedissimilaritiesintheheteromodalassociationcortex,whichincludestwokeyareasofthebrainrelatingto

languageprocessing.Brocasareaandplanumtemporale.

-Lackofsymmetryintheplanumtemporalecanbeariskfactorfor

differentlearningdisorders,andasimilarfindinghasbeenfound

forpeoplewhohaveschizophrenia.-Therehavealsobeenotherfindingsforlackofasymmetryinother

areasofthebrain,includinganteriorcingulatecortex,whichis

somewhatresponsiblefordifferenttypesofdecisionmaking.

Althoughthesefindingscanleadtoadvancements,wehavetokeep

inmindthattheresultsarelessthanconclusive,andifthechanges

inthebrainarespecificallyleadingtoschizophreniaisnotaknown

fact.Thechangescouldbeduetomanydifferentthings,suchasgeneticpredispositionsforexample,sowecantbesure.

NeurochemicalFeatures-Oneofthemostcurrentandcommontheoriesregarding

schizophreniaisthatthesymptomsarearesultofcertain

neurotransmittersinthebrain,specificallydopamine.

Theexcessdopaminehypothesishasbeenlargelybecause:

1).Manypeoplewithpositivesymptomsofthedisorderhave

successfulresultswithdrugsthatlowerlevelsofdopamine.


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2).Inrealityantipsychoticdrugsmayproduceextremelylowlevels

ofdopamineandcreatesideaffectsthataresimilartothoseorParkinsonsdisease,whichiscausedbydeficientlevelsof

dopamine.

3).Excesslevelsofdopamine,frommethamphetamineintoxication

forinstance,cancausemotorproblemsandpsychoticproblems.

-L-dopaisadrugthatincreaselevelsofdopamineinpeoplewith

Parkinsonsdisease,andcanproducepsychoticsymptomsiftaken

inlargedosesandcanaggravatesymptomsofschizophrenia.

-Dopaminereceptors,especiallyD12receptors,maybethickerin

thebrainsofsomepeoplewithschizophrenia.

-Peoplehavecriticizedthisexcessdopaminetheoryasacompleteexplanationforschizophrenia,becauseitdoesntinvolvethe

numerousnegativesymptomssuchasavolitionandpoorspeech.Researchershavealsoreportedcontradictoryinformationastowhetherpeoplewiththedisorderhavemoredopaminereceptorsas

onemightexpect.

-Therehasbeenarevisedtheoryconnectingtodopamine,stating

thattheneurotransmitteritselfisntasimportantasitsroletohelp

controlinformationprocessinginthecortex.

-Otherneurotransmittershavebeensuspectedinschizophreniaas

well,suchasnoradrenaline,gammaaminobutyricacid,serotonin,

andglutamate.Itspossiblethattheseneurotransmitters,andspecificallyserotonin,connectwithdopamineanddeficitsinkey

partsofthebraintohelpproducesymptomsofthedisorder.Some

believethatlessserotonininthefrontalcortexactuallyleadstomoreactivityinthisbrainarea,leadingtomoredopamineactivity.

Cognitiveor

Behavioral

Factors

-Schizophreniausuallyconsistsoftwomaingroupsofsymptoms:

positiveandnegative.Thepositivesymptomsaretheexcessiveand

overtsymptoms,andincludedelusions,hallucinations,and

disorganizedspeechandbehavior.Thenegativesymptoms

representdeficitorcovertsymptoms,andincludelackofspeechor

emotion,aswellasfailuretotakecareofoneself.

-Peoplewithschizophreniamanytimes,butnotalways,progress

throughfourstagesofsymptoms.Manystartwithaprodromalphasethatcanlastdays,weeks,months,andsometimesevenyears.

Thisphaseisnoticedbystrangebehaviorsuchasdisturbancesinspeechorthoughtprocesses,oddsocialinteractions,perceptual


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distortions,memoryandattentionproblems,andalsosymptomsof

anxietyanddepression.Thisphaseisoftenmarkedbynegativesymptomsthatmakeithardtonoticeexactlywhatproblema

personmayhave,anditmayresembleseveredepression.

-Aftertheprodromalphaseisthepsychoticprophase,whichismarkedbythefirstfull0blownpositivesymptomofschizophrenia

suchasahallucination.Aspecificstressorcouldtriggerthis

psychoticprophase,anditusuallylastlessthan2months.

-Positiveandnegativesymptomsmustlast6monthsforadiagnosis

ofschizophrenia,whichmaycompletetheprodromalandpsychotic

phase.The6monthperiodhastoincludea1monthphasewhenthesymptomsareparticularlyintense,oractivephase.

-Whensomeoneisintheactivephaseheynormallyhavenumerous

fullblownpositiveandnegativesymptomsandneedshospitalization.

-Brainchangesandmanyotherbiologicalfactorsmayhelptoexplainwhymanypeoplewiththisdisorderhavemanysignificant

cognitivedeficits.Thesedeficitsinclude,memory,learning,

attention,language,andimportantfunctionssuchasproblem

solvingskillsandtheabilitytomakedecisions.

-Manypeoplewithschizophreniamayalsoexperienceattention

problemsthatcouldstartatadolescenceormaybeevenyounger.

Manycloserelativesofpeoplewiththisdisorderhaveproblemswithattentionandmemoryaswell.

-Peoplewiththedisordermayhavetroubleprocessingquickvisualinformation,trackingobjectswiththeireyes,andconcentratingon

onejustonesubject.Problemsprocessinginformationcouldleadto

sensoryoverload,whichcouldexplainthepositivesymptomsof

psychoticdisorders,suchasdelusionsandhallucinations.However,

negativesymptomscouldbeawithdrawalfromthesensoryoverload.

-Othershavereportedthattroublesprocessinginformationisconnectedtothedisorganizedspeechthathasbeenseeninpeople

withpsychoticdisorders.

PrenatalComplications

-Peoplewithschizophrenia,specificallyearly-onset,normallyhave

morecomplicationsduringprenataldevelopmentthantherestof


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thepopulation.Onecomplicationthatseemstobecloselyrelatedto

psychoticdisorderishypoxicischemia,whichislowbloodflowintheoxygentothebrain.Thiscaneventuallycauseenlarged

ventricles.Peoplewithhypoxicischemiamaybelowerinweight,

andhaveasmallerheadcircumference.

-Prenatalcomplicationscanalsocauseproblemswithvirusesand

infections.Researchershaveseenthatpeoplewithschizophrenia

arealotoftimesborndisproportionatelyinlatewinter,thespring,

andsummer,causingthefetustohaveahigherriskforinfluenza

andotherdiseases.Someresearchershavealsoseenthatthe

disorderismuchmorefrequentduringtimesoffamine.

-Exposuretorubella,viralencephalitis,severemalnutrition,and

lackofoxygencouldplaceafetusatmuchhigherriskforschizophreniaandotherdisorders.

SocialFactors -Thedisordercouldbemoreprevalentamongmalesthanfemalesbecausewomentendtofunctionbetterinsocialsettingsandwork

settings,whichactuallydelaysonsetofsymptomsofthisdisorder.

-Themostcommonmentaldisordersotherwiserelatedtoschizophreniaaremoodandsubstance-relateddisorders,especially

depression.Depressioncoulddevelopbeforeschizophreniaandbeathecauseforthepsychoticsymptoms,orthedevelopmentof

psychoticsymptomscouldleadtoadownwardspiralthatinvolves

difficulteventssuchasjobloss,whichthencausessomeonetolaterbecomesdepressed.

-Suicideismuchmorecommonissomeonewiththisdisorderthan

thegeneralpopulation,andsuicideinpeoplewiththisdisorder

usuallycloselyrelatestoonsetofthedisorder,depression,

substanceabuse,recentloss,agitation,andpoordevotionto

treatment.

-Peoplemostatriskforsuicideareusuallysingle,unemployed,and

malesthataresociallyisolated.

-Brainchangesandmanyotherbiologicalfactorsmayhelpto

explainwhymanypeoplewiththisdisorderhavemanysignificantcognitivedeficits.Thesedeficitsinclude,memory,learning,

attention,language,andimportantfunctionssuchasproblem

solvingskillsandtheabilitytomakedecisions.

ConflictingLifeEventsandSubstanceAbuse

-Manypeoplewithschizophreniaexperienceverystressfullife


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eventsinweeksandmonthsbeforetheonsetofpsychotic

symptoms,especiallyiftheyareanemotionallyreactiveperson.

-Peoplewithpsychoticdisorderssuchasschizophreniaaremuch

morelikelytousemarijuanathantherestofthepopulation,and

otherdrugscouldleadtopsychoticsymptomsaswell.Substanceabuseamongpeoplewhohaveschizophreniasymptomsisvery

common.

-Itsnotclearwhetherornotdistressinglifeeventsordruguse

triggerpsychoticsymptoms,butpeoplewiththedisordermayuse

marijuanaorotherdrugstocopewiththeirpsychoticsymptoms.

-Thereisoftenacorrelationbetweentraumaticlifeeventsanddrug

abuseinpeoplewithschizophrenia.

-Manywomenwiththedisorderwhoalsoabuseoraredependentonsubstanceshavealsoexperiencedepisodesofchildoradultmaltreatment,assault,caraccidents,andPTSD.

CulturalandEvolutionaryInfluences

-Schizophreniaseemstobemorecommoninpeoplewholivein

developingcountriesandinimmigrantandmigrantworkerthanin

peoplewholiveindevelopedcountriesandnativepopulations.

-HigherratesofthedisorderareseeninAfricanCaribbeanpeoplein

England,asopposedtonativesamples.

-Socialisolationandcompletelackofsocialsupportamongmigrant

workerscouldbeoneofthekeyriskfactorsforthedisorder.

-Socioculturalmodelsofschizophreniaalsofocusgreatlyonthe

issueoflabelingsomeonewithaseverementaldisorder.People

haveobservedthatbylabelingsomeonewithadiagnosissuchas

schizophrenia,couldeasilypredisposesomeonetoshowsymptoms

thatcouldbemisinterpretedassymptomsofthedisorder.

-Apersonrecentlydiagnosedwiththedisordermaywithdrawfrom

otherpeopletoavoidhatred,experiencelowself-esteemandqualityoflife,becomeenragedordepressed,andactstrangely.

-Labelingsomeonecanalsomanytimesaffecthowotherssee

someone.Rosenhancretedafamousstudyinwhichpeoplewithout

amentaldisorderwenttodifferenthospitalsandfakedthatthey

werehearingvoices.Allofthepseudopatientswerethen


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hospitalizedandkeptonaninpatientunit,inspiteofthefactthat

theyshowednormalbehaviorfortheunit.Therecordsatthehospitalshowedthatthestaffmemberswerejudgingtheirpatients

normalbehavior.Forinstance,theywouldtakenotesthatidentified

someoneaspathological,simplybecausethepersonwasinthe

inpatientunit.Thisparticularstudyshowedhowstrongsuchstigmacanbe,andalsohowitshardtochallengeoncethediagnosisofthe

mentaldisorderhasalreadybeenmade.

Treatment MilieuTherapyandTokenEconomy

-Thesetwotechniqueswerecreatedoninpatientpsychiatricunitsforwithwhohadacutepsychoticsymptoms.

-Milieutherapyinvolvescreatinganenvironmentwhereprosocial

andself-careskillsaregreatlyinspired.Mentalhealthprofessionals,

physicians,nurses,andotherstaffcontinuallyencourageaperson

withpsychoticsymptomstodress,eat,groom,attendtheirtherapy

sessions,andinteractaccordinglywithotherpeople,aswellaskeepinginvolvementwithotherpositivebehaviors.

-MilieutherapyissometimesconnectedtoaTokenEconomy,which

iswhereprosocialandself-careskillsarerewardedbypointsthatarelaterexchangedwiththepatientfordifferentprivileges,likeday

tripsoutsidethehospitalforinstance.Thismayinvolverewardsforbrushingonesteethandeatingdinnerwithotherpeople.

Cognitive-BehavioralSupportivePsychotherapies

-Createsaverystrongtherapeuticagreementwithaclientthatis

builtonacceptance,acornerstone,andcooperation.

-Educateaclientabouthispsychosis,aswellasreducingstigma

associatedwiththeirsymptoms.

-Decreaseclientsdelusionsandhallucinationsandchangeincorrect

expectanciesandthoughtstheyhaveaboutthem.

-Reducestressthatisconnectedtotheirpsychoticsymptoms.

-Talkaboutcomorbidconditionssuchasanxiety,depression,and

substanceabuse.

-Lowertheirchancesofrelapsebyrecognizingandgettingridof

triggerssuchasstress,forgottenmedication,andfamilyissues.

Medications

-Peoplewithschizophreniaandotherpsychoticdisordersmany


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timesneedtostayonmedicationtofunctiononadaytodaybasis,

sohelpingthemfollowagreementabouttheirmedicationisextremelyimportant.Behaviorstrategiesthathelpwiththisinvolve

talkingaboutthebenefitsthatcomefromtakingthemedicationas

wellasdisadvantagesfromnottakingit,educationabouttheside

effectsofthemedicationtheyreon,takingmedicationasadailyroutine,suchasatmealseveryday,puttingtheirmedicationbackin

thesameplaceeverytimetheytakeit,andrewardingappropriate

medicationuse,possiblybyusingatokeneconomy.

SocialSkillsTraining

-Thistraininghasoftenbeenusedtohelppeopleinteractwith

other,anddecreasetheirdistressandtopreventpossiblerelapse.

-Usuallyinvolvesrepeatedmodelingandpracticingfeedbackrelatingtosmallbehaviorsfirst.Forinstance,apersonwith

schizophreniacouldmaybewatchtwopeoplehaveanormalcivilizesconversationandthentrytodothesamethingwiththeirtherapist.Whileatthesametimethetherapistislookingforspecific

behaviors,suchaslackofeyecontact,disconnectedspeech,interruptions,lackofemotionalcontrol,andanyotherimportant

andobviousproblems.

CognitiveandVocationalRehabilitation

-MaingoalofCognitiveRehabilitationistoimproveperformancein

areassuchasmemory,attention,decisionmaking,andproblem

solvingskills.

-Examplesincluderepeatedinstructionstomaintainonesfocusand

guidetheirperformanceinsocialsituations,cautiouslisteningto

otherswordsandstatements,softwaretrainingofcertaintasksthatrequiresomeonesattention.Reinforcementofthesetasksarekey

aswell.Theyareshowntobeaffective,butthereisstillthequestion

ofwhetherornottheyhelpinthelongrun.

-ThemaingoalofVocationalrehabilitationistorenovateapersonwithapsychoticdisorderintoaconstructiveoccupational

environment.

-Itmostlyconcentratesonjobtraining,support,andemploymentin

anareathepersonismostmotivatedtowork.

-Otherareasofthistypeofrehabilitationincludepracticing

languageandcognitiveskillsinaworksetting,specificfeedbackon

theirworkperformance,andresolutionofjob-relatedproblems.


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Thiscanreallyincreasejobplacementforpeoplewithpsychotic

disorders.

FamilyTherapy

-Manypeoplewithschizophreniaturntotheirspousesorfamily

membersforcareandhelp,sofamilytherapyisanextremelyimportantpartoftreatmentforpeoplewithpsychoticdisorders.

-Thistypeoftherapynormallyinvolveseducatingthefamily

membersaboutthespecificdisorderthepatienthas,providing

muchneededsupport,loweringthehighlyemotional

communicationswithinthefamily,decreasingstressand

depression,helpingmembersofthefamilydealwithcaringfortherelativewiththedisorder,crisismanagement,andimprovingtheir

problemsolvingskills.

-Maybedirectedforasinglefamily,oritcouldbedonewithinasupportgroupofmultiplepeople.

-Itmayalsobedoneintheearlyorlaterstagesofsomeonewithapsychoticdisorder.

-Familytherapydoescorrelatewithlowerrelapseratesforpeople

withschizophrenia.

assignement 4

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