In this comprehensive collection, we explore the complex and fascinating aspects of schizophrenia, a severe mental disorder. We delve into the diagnostic criteria, symptoms, and subtypes of schizophrenia, providing an in-depth understanding of its clinical presentation. Gain insight into the neurob...
PSYC 300
Chapter 11 – Schizophrenia
1.1 Clinical Symptoms of Schizophrenia
- Symptoms of people with schizophrenia involve disturbances in several major areas:
Thought, perception, and attention
Motor behaviour
Affect or emotion
Life functioning.
- The range of problems of people diagnosed as schizophrenic is extensive only some problems
may be present at any given time.
- DSM determines how many problems must be present and in what degree to justify a diagnosis
Duration of the disorder is also important in diagnosis
- Heterogeneity suggests it may be appropriate to subdivide people with schizophrenia into types
that manifest various problems.
- The main symptoms of schizophrenia fit in two categories: positive and negative
Positive Symptoms
- Positive symptoms: schizophrenic symptoms and behavioural excesses, such as hallucinations
and bizarre behaviour
Positive symptoms are the presence of too much of a behaviour that is not apparent in
most people
Negative symptoms are the absence of a behaviour that should be evident in most
people.
- Disorganized speech
Also known as formal thought disorder, disorganized speech is a disorder in which the
client has problems in organizing ideas and in speaking so that a listener can understand.
o Disorganized speech: problems in organizing ideas and in speaking so that a
listener can understand (used to be known as formal thought disorder)
Incoherence sometimes forms in the conversation of individuals with schizophrenia.
o Incoherence: aspect of thought disorder wherein verbal expression is marked by
disconnectedness, fragmented thoughts, and jumbled phrases.
o Although the person may make repeated references to central ideas or a theme,
the images and fragments of thought are not connected
o Difficult to understand exactly what the person is trying to say.
Speech may also be disordered by loose associations (or derailment)
o Loose association: aspect of thought disorder where the client has difficulty
sticking to one topic and drifts on a train of association evoked by past ideas.
o Person may be more successful in communicating with a listener but has
difficulty sticking to one topic.
o Clients have themselves provided descriptions of this state.
Evidence indicates speech of schizophrenics is not disorganized and the presence of
disorganized speech does not discriminate well between schizophrenia and other
psychoses (e.g., some mood disorders)
o E.g., people in a manic episode exhibit loose associations as much as do people
with schizophrenia.
- Delusions
Delusions: beliefs contrary to reality firmly held despite evidence to the contrary
o Common in paranoid disorders
o Belief that one is being manipulated by some external force such as radar,
television, or a creature from outer space
, o Belief that one is an especially important or powerful person
o Belief that one is being plotted against or oppressed by others (persecutory
delusion)
Beliefs held contrary to reality are common positive symptoms of schizophrenia.
Persecutory delusions are found in 65% of a large, cross-national sample of people with
schizophrenia
Delusions may take several other forms
Kurt Schneider introduced some of the most important delusions.
o Person may be unwilling recipient of bodily sensations or thoughts imposed by
an external agency.
o People may believe their thoughts are broadcasted or transmitted others
know what they are thinking
o People may think their thoughts are being stolen from them, suddenly and
unexpectedly, by an external force.
o Some believe their feelings are controlled by an external force.
o Some believe impulses to behave in certain ways are imposed on them by some
external force
- Hallucinations (Distortions of Perception)
People with schizophrenia often report that the world seems different and unreal to them.
o A person may mention changes in how their body feels, or the person's body
may become so depersonalized it feels like a machine.
Kurt Schneider (German psychiatrist) proposed forms of hallucinations and delusions,
(first-rank symptoms) are central to defining schizophrenia.
Most dramatic distortions of perception are hallucinations sensory experiences in the
absence of any stimulation from the environment.
o More often auditory than visual
o Like delusions, hallucinations can be frightening experiences.
Some hallucinations are thought to be important diagnostically occur more often in
people with schizophrenia than other psychotic disorders, include:
o Report hearing voices and thoughts other than their own
o Some report they hear voices arguing
o Some report hearing voices commenting on their actions/behaviour
Negative Symptoms
- Negative symptoms: behavioural deficits in schizophrenia:
Apathy
o Negative symptom in which the individual lacks interest, energy, and drive.
o Apathy is a lack of energy and seeming absence of interest in usual routine
activities.
o Clients may become inattentive to grooming and personal hygiene
uncombed hair, dirty nails, and dishevelled clothes.
o Difficulty persisting at work, school, or household chores and may spend much
of their time sitting around doing nothing.
Alogia
o Negative symptom, marked by poverty of speech and of speech content.
o Poverty of speech sheer amount of speech is reduced.
o Poverty of content of speech amount of discourse is adequate but conveys
little or no information, tends to be vague and repetitive.
Anhedonia
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