Halgin6e ppt ch09

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  • Dementia praecox: The term coined by Kraepelin to describe what is currently known as schizophrenia. According to Kraepelin, this condition involves a degeneration of the brain that begins at a young age and ultimately leads to a disintegration of the entire personality.
  • Bleuler’s ideas about schizophrenia are still influential.
  • Prodromal phase: A period in the course of schizophrenia, prior to the active phase of symptoms, during which the individual shows progressive deterioration in social and interpersonal functioning. Active phase: A period in the course of schizophrenia in which psychotic symptoms are present. Residual phase: A period in the course of schizophrenia, following the active phase, in which there are continuing indications of disturbance, evidenced by the same kinds of behaviors that characterize the prodromal phase.
  • Some instances are not as dramatic. Instead, the schizophrenic might speak in a peculiar way and use awkward speech, odd intonations. Schizophrenics may lack normal expressiveness and gestures. Or they may spent hours or days without talking.
  • Positive symptoms are viewed as direct lead-ins to full expression of psychosis. Clinicians often find it difficult to diagnose negative symptoms, because most people at one time or another act in these ways, as when they are fatigued or depressed.
  • Delusions: Beliefs that are grossly out of touch with reality. Hallucinations: A false perception not corresponding to the objective stimuli present in the environment. Affective flattening: A symptom of schizophrenia in which an individual seems unresponsive and which is reflected in relatively motionless body language and facial reactions as well as minimal eye contact. Alogia: Speechlessness or a notable lack of spontaneity or responsiveness in conversation. Avolition: Lack of initiative and unwillingness to act. Affective flattening: A symptom of schizophrenia in which an individual seems unresponsive and which is reflected in relatively motionless body language and facial reactions as well as minimal eye contact. Anhedonia: A loss of interest in or ability to experience pleasure from activities that most people find appealing.
  • Examples of extreme negation: Rigid posturing or resistance to instruction. Example of peculiar movement: Bizarre posture. Echolalia: Senseless repetition of words or phrases. Echopraxia: Repetition by imitation of another’s movements.
  • Onset tends to occur earlier in life and interferes with personality development.
  • This is the most common type of schizophrenia.
  • The individual may show symptoms such as delusions, hallucinations, incoherence, or disorganized behavior, but does not meet the criteria for the paranoid (systematic bizarre delusions), catatonic (abnormalities of movement), or disorganized (disturbed or flat affect) types.
  • Schizophrenia, residual type: A type of schizophrenia in which people who have previously been diagnosed as having schizophrenia may no longer have prominent psychotic symptoms but still show some lingering signs of the disorder, such as emotional dullness, social withdrawal, eccentric behavior, or illogical thinking.
  • Many researchers and clinicians feel the subtypes do not capture the essential dimensions underlying individual differences in symptoms. The DSM-IV-TR has proposed an alternate three-factor model to rate individuals for the degree to which their symptoms are psychotic, negative, or disorganized.
  • In the most serious cases, the individual experiences continuous positive symptoms with no remission. Recurring episodes: Other people have episodes of positive symptoms, but between these episodes, only negative symptoms are evident. Some have had a single episode of schizophrenia, then live the rest of their lives without a recurrence of the disorder.
  • Premorbid functioning: How well the person functioned during the period prior to the onset of the individual's symptoms. Acute onset: The more abruptly the condition began, the better the prognosis is. Additional factors include: A precipitating event associated with onset of symptoms. The presence of an associated mood disorder. A family history of mood disorder. Treatment with antipsychotic medication soon after onset of disorder.
  • Each is a form of psychosis representing a serious break with reality. The condition is not caused by a disorder of cognitive impairment like Alzheimer’s. Mood disturbance is not a primary symptom. Further, each has a different set of proposed causes, symptom picture, and recommended course of treatment.
  • For at least a day but less than a month, the individual experiences at least one major psychotic symptom not attributable to another disorder, substance, or medical condition. Experts believe most cases result from psychological factors. The nature of the treatment depends on the nature of the stressor, when one is evident.
  • Researchers have found people with this disorder to have larger ventricles in the brain, a phenomenon also observed with schizophrenia. Most need medication to help bring their symptoms under control. For some, the symptoms go away spontaneously.
  • Schizoaffective disorder: A psychotic disorder involving the experience of a major depressive episode, a manic episode, or a mixed episode while also meeting the diagnostic criteria for schizophrenia. Clinicians are sometimes reluctant to use this diagnosis, because it has no systematic treatment protocol. Pharmacological intervention is trial-and-error.
  • People with erotomanic type have a delusion that another person is deeply in love with them. Grandiose type is characterized by the delusion they are extremely important. Jealous type is characterized by the delusion that one’s sexual partner is unfaithful. People with persecutory type believe they are being harassed or oppressed. People with somatic type believe they have a dreaded disease or are dying.
  • The nonpsychotic person gets caught up in the delusions of the psychotic person and becomes similarly consumed by the irrational belief. Typically two people are involved: folie a deux (folly of two). Example: Members of the Heaven’s Gate cult shared the delusions of their leader Marshall Applewhite, who convinced them they should commit suicide in order to board a spacecraft traveling to a higher plane of existence. These people rarely seek treatment.
  • Theories accounting for the origin of schizophrenia have traditionally fallen into two categories: biological and psychological. Cortical atrophy: A wasting away of tissue in the cerebral cortex of the brain. Loss of brain volume is particularly pronounced in the front and temporal lobes as well as the relay centers in the thalamus. Reduced brain activation: Functional deficits have been found in brain centers involved in the pleasant sensations of smell. Other areas are being explored. The dopamine hypothesis attributes the psychotic symptoms to overactivity of dopamine neurons. Antipsychotic medications reduced the frequency of hallucinations and delusions by blocking dopamine receptors. Drugs biochemically related to dopamine (such as amphetamines) increase frequency of psychotic symptoms.
  • The closer a relative is to an individual with schizophrenia, the greater the likelihood of concordance. Biological markers: Measurable characteristics or traits whose patterns parallel the inheritance of a disorder or other characteristic. Sustained attention: People with schizophrenia typically do poorly at tasks that require sustaining attention, especially when task demands are increased. Smooth pursuit eye movements: Unlike normal individuals, schizophrenics do not move their eyes smoothly when watching a moving target.
  • There is no credible theory that proposes that psychological phenomena such as life experiences, developmental difficulties, interpersonal problems, or emotional difficulties directly cause schizophrenia.
  • Behavioral theorists first advanced these ideas in the 1960s in light of evidence from early experiments, showing that people with schizophrenic symptoms could, through proper reinforcements, behave in socially appropriate ways.
  • Expressed emotion (EE): An index of the degree to which family members speak in ways that reflect criticism, hostile feelings, and emotional overinvolvement or overconcern with regard to the schizophrenic individual.
  • Neuroleptics: antipsychotic medications; major tranquilizers: Lowest potency- Chlorpromazine (Thorazine) and Thioridazine (Mellaril). Middle level of potency- Trifluoperazine (Stelazine) and Thiothixine (Navane). Most potent - Haloperidol (Haldol) and Fluphenazine (Prolixin). Tardive dyskinesia: involuntary, repetitive movements
  • The most common psychological interventions are derived from the behavioral perspective. Token economy: A form of contingency management in which a client who performs desired activities earns chips or tokens that can later be exchanged for tangible benefits. Cognitive-behavioral techniques may help reduce distorted thinking. Milieu therapy: A treatment approach, used in an inpatient psychiatric facility, in which all facets of the milieu, or environment, are components of the treatment. Family-managed individuals show greater ability to maintain improvements over time. Biopsychosocial approach: Integrative method, combining medication with psychosocial intervention.
  • Halgin6e ppt ch09

    1. 1. Richard P. Halgin Susan Krauss Whitbourne University of Massachusetts at Amherst slides by Travis Langley Henderson State University Abnormal Psychology Clinical Perspectives on Psychological Disorders 5e Clinical Perspectives on Psychological Disorders 6e Richard P. Halgin Susan Krauss Whitbourne slides by Travis Langley Henderson State University Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
    2. 2. Chapter 1 Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 9 Chapter
    3. 3. <ul><li>A disorder with a range of psychotic symptoms involving disturbances in content of thought, form of thought, perception, affect, sense of self, motivation, behavior, and interpersonal functioning. </li></ul>Schizophrenia Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
    4. 4. Bleuler <ul><li>Bleuler coined the term schizophrenia . The four fundamental features are still referred to as Bleuler’s Four A’s: </li></ul><ul><li>Association (thought disorder) </li></ul><ul><li>Affect (emotional disturbance) </li></ul><ul><li>Ambivalence (inability to make or follow through on decisions) </li></ul><ul><li>Autism (idiosyncratic style of egocentric thought and behavior) </li></ul>Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
    5. 5. Phases of Schizophrenia Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Residual Prodromal Active Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
    6. 6. Schizophrenic Symptoms <ul><li>Perception </li></ul><ul><ul><li>Hallucinations </li></ul></ul><ul><li>Thoughts </li></ul><ul><ul><li>Lack cohesiveness and logic </li></ul></ul><ul><li>Language </li></ul><ul><ul><li>Incomprehensibility </li></ul></ul><ul><li>Actions </li></ul><ul><ul><li>Odd and disturbing </li></ul></ul>Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Disturbances can be seen in . . . Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
    7. 7. Schizophrenic Symptoms Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Negative - + Positive Exaggerations or distortions of normal thoughts, emotions, and behavior. Symptoms that involve functioning below the level of normal behavior. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Positive symptoms: Negative symptoms:
    8. 8. Schizophrenic Symptoms Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Negative - + Positive Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. <ul><li>delusions </li></ul><ul><li>hallucinations </li></ul><ul><li>disturbed speech </li></ul><ul><li>disturbed behavior </li></ul><ul><li>affective flattening </li></ul><ul><li>alogia </li></ul><ul><li>avolition </li></ul><ul><li>anhedonia </li></ul>
    9. 9. <ul><li>Characterized by at least two bodily movement abnormalities: </li></ul><ul><li>Motor immobility or stupor </li></ul><ul><li>Purposeless motor activity </li></ul><ul><li>Mutism or extreme negation </li></ul><ul><li>Peculiarities of movement or odd mannerisms and grimacing </li></ul><ul><li>Echolalia or echopraxia </li></ul>Types of Schizophrenia Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Catatonic Type
    10. 10. <ul><li>Characterized by a combination of symptoms, including disorganized speech and behavior and flat or inappropriate affect. </li></ul><ul><li>Even delusions and hallucinations lack a coherent theme. </li></ul>Types of Schizophrenia Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Disorganized Type
    11. 11. <ul><li>Characterized by preoccupation with one or more bizarre delusions, or with auditory hallucinations that are related to a particular theme of being persecuted or harassed. </li></ul><ul><li>Without disorganized speech or disturbed behavior. </li></ul>Types of Schizophrenia Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Paranoid Type
    12. 12. Types of Schizophrenia <ul><li>Characterized by a complex of schizophrenic symptoms that does not meet the criteria for other types of schizophrenia. </li></ul>Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Undifferentiated Type
    13. 13. <ul><li>Applies to people previously diagnosed as schizophrenic if they no longer show prominent psychotic symptoms but still show lingering signs of the disorder. </li></ul>Types of Schizophrenia Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Residual Type
    14. 14. Dimensions of Schizophrenia <ul><li>Psychotic </li></ul><ul><li>Negative </li></ul><ul><li>Disorganized </li></ul>Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Alternate three-factor model:
    15. 15. Courses of Schizophrenia <ul><li>Continuous </li></ul><ul><li>Recurring episodes </li></ul><ul><li>Single episode </li></ul>Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
    16. 16. Factors Associated With More Favorable Prognosis <ul><li>Good premorbid functioning </li></ul><ul><li>Acute onset </li></ul><ul><li>Later age at onset </li></ul><ul><li>Good insight </li></ul><ul><li>Being female </li></ul><ul><li>Consistent in medication usage </li></ul><ul><li>Brief active-phase symptoms </li></ul><ul><li>Good functioning between episodes </li></ul><ul><li>Absence of structural brain abnormalities </li></ul><ul><li>Normal neurological functioning </li></ul><ul><li>No family history of schizophrenia </li></ul>Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
    17. 17. Other Psychotic Disorders Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
    18. 18. <ul><li>Serious break with reality </li></ul><ul><li>Not caused by cognitive impairment </li></ul><ul><li>Not primarily affective </li></ul>Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. The schizophrenia-like disorders share three features:
    19. 19. Brief Psychotic Disorder <ul><li>A disorder characterized by the sudden onset of psychotic symptoms that are limited to a period of less than a month. </li></ul>Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. <ul><li>with marked stressor(s), </li></ul><ul><li>without marked stressor(s), or </li></ul><ul><li>with postpartum onset </li></ul>
    20. 20. Schizophreniform Disorder Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. A disorder with essentially the same symptoms as schizophrenia, but that lasts less than 6 months (and more than 1).
    21. 21. Schizoaffective Disorder Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Schizophrenia with co-occurring mood disorder.
    22. 22. Delusional Disorders Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. People with delusional disorders have a single striking psychotic symptom: an organized system of nonbizarre false beliefs.
    23. 23. Delusional Disorders Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. People with delusional disorders have a single striking psychotic symptom: an organized system of nonbizarre false beliefs. Erotomanic Grandiose Jealous Persecutory Somatic
    24. 24. Shared Psychotic Disorder <ul><li>In shared psychotic disorder, the person develops a delusional system as a result of a close relationship with a psychotic person who is delusional. </li></ul>Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. <ul><li>Separating them. </li></ul><ul><li>Focusing on personal issues related to this person’s vulnerability to being dominated. </li></ul><ul><li>Bolstering the client’s self-esteem. </li></ul>Intervention calls for:
    25. 25. Biological Theories <ul><li>Brain Structure and Function </li></ul>Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. <ul><li>Lines of Evidence for Dopamine Hypothesis </li></ul><ul><ul><li>Antipsychotic medications </li></ul></ul><ul><ul><li>Effects of drugs like amphetamines </li></ul></ul><ul><ul><li>Cortical atrophy </li></ul></ul><ul><ul><li>Reduced brain activation </li></ul></ul><ul><ul><li>Dopamine hypothesis </li></ul></ul><ul><ul><li>Possible serotonin deficit </li></ul></ul>                                                                                                
    26. 26. <ul><li>endophenotypes </li></ul>Biological Theories Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. <ul><li>In other words, they are </li></ul><ul><li>heritable traits or characteristics that are not direct symptoms of the disorder but </li></ul><ul><li>have been found to be associated. </li></ul><ul><ul><li>biobehavioral abnormalities linked to genetic and neurobiological causes of mental illness </li></ul></ul>
    27. 27. Biological Theories Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Three measures of cognitive functioning stand out as particularly important in the search for biological markers: <ul><ul><li>Sustained attention </li></ul></ul><ul><ul><li>Smooth pursuit eye movements </li></ul></ul><ul><ul><li>Antisaccade eye movements </li></ul></ul>
    28. 28. Psychological Perspective Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. No credible theory proposes that schizophrenia develops exclusively as the result of psychological phenomena.
    29. 29. Psychological Perspective Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. However, behavioral psychologists have found factors influencing whether the likelihood the schizophrenic individual will act in a “normal” way or not.
    30. 30. <ul><li>Failure to learn important social cues. </li></ul><ul><li>Lack of attention from others. </li></ul><ul><li>Retreat into fantasy world. </li></ul><ul><li>Behaviors become odd and eccentric. </li></ul><ul><li>Being labeled as odd or schizophrenic. </li></ul><ul><li>Hospitalization exacerbates maladaptive behaviors. </li></ul>Psychological Perspective Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
    31. 31. <ul><li>Focus on the Family System </li></ul><ul><ul><li>Faulty modes of behavior and communication </li></ul></ul><ul><ul><li>High degree of expressed emotion </li></ul></ul><ul><ul><li>Cognitive distortions </li></ul></ul><ul><li>Social Class and Income </li></ul><ul><ul><li>Onset may be associated with environmental stressors of poverty. </li></ul></ul><ul><ul><li>Contracting the disease leads to social and economic “downward drift.” </li></ul></ul>Sociocultural Perspective Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
    32. 32. Biological Treatment <ul><li>Neuroleptics </li></ul><ul><li>Vary in potency </li></ul><ul><li>All block dopamine receptors </li></ul><ul><li>Side effects: </li></ul><ul><ul><li>Tardive dyskinesia </li></ul></ul><ul><ul><li>Compromise of immune system </li></ul></ul>Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.                                                                                                
    33. 33. Psychosocial Treatment <ul><li>Psychological </li></ul><ul><ul><li>Token economy </li></ul></ul><ul><ul><li>Social skills training </li></ul></ul><ul><ul><li>Cognitive behavioral techniques </li></ul></ul><ul><li>Sociocultural </li></ul><ul><ul><li>Milieu therapy </li></ul></ul><ul><ul><li>Family therapy </li></ul></ul><ul><li>Biopsychosocial Approach </li></ul>Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
    34. 34. <ul><li>For more information on material covered in this chapter, visit our Web site: </li></ul>Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. http:/ www.mhhe.com/halgin6e

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