Danielle

Williams Assignment 4 Name Symptoms

Psychology 152

Disorganized schizophrenia

Catatonic Schizophrenia

Paranoid Schizophrenia

Mainly involves disintegrated, incoherent, irregular, and/or inappropriate speech, emotions, behavior, and flat or inappropriate affect without catatonic behavior. Someone who has disorganized schizophrenia would be very hard to interview, because their words could be disordered or have very little meaning to them. If this is the case with someone, then this could quite easily demonstrate a very poor long-term prognosis, because social interactions normally become disturbed when someone has disorganized schizophrenia. Two of the following are present: -Motoric immobility (catalepsy or waxy flexibility) or stupor. -Excessive motor activity -Extreme pessimism, such as resistance when given instructions or keeping a rigid posture, or not speaking -Characteristics of voluntary movement such as adopting strange postures, stereotyped movements, and prominent mannerisms or grimacing -Echolalia or echopraxia. -Disintegrated, incoherent, irregular, and/ or inappropriate speech, behavior, as well as emotions, all the same as someone with disorganized schizophrenia. People who are in a catatonic state may be at a high risk for hurting themselves or other people because of these extraordinary movements, so they have to be closely supervised by someone. Normally involves persecutory or extravagant delusions and auditory hallucinations but few problems, but they dont have problems putting their thoughts together. The long-term prognosis of this particular subtype of schizophrenia may be better than for the others, because the thoughts, although they are strange ones, continue to stay relatively intact, so the communication of people is largely undisturbed, as opposed to catatonic and disorganized schizophrenia.

Undifferentiated -Involves a combination of symptoms that dont clearly match the Schizophrenia other three subtypes of schizophrenia, but still have many features of schizophrenia, such as delusions, hallucinations, disorganized speech, grossly disordered or catatonic behavior, and negative symptoms. Name Schizophrenia Subtypes: Paranoid, Disorganized, Catatonic, and Undifferentiated

Biological Factors

Genetics -Schizophrenia occurs in 0.33 to 0.72 percent of the general population, and the median age of onset is 22 years. -It is a little more common in males than females, and males who have schizophrenia tend to have symptoms at a younger age than females who have this disorder. This also means that men tend to have more overall symptoms as well. -Men may have more severe symptoms of the disorder, because women may have specific biological factors. For instance, protective hormones or less severe changes in the brain, which can help prevent advancement of the very severe symptoms. -Also, women tend to function better in social settings and work settings, which actually delays onset of symptoms of this disorder. -Family, adoption, and twin studies show that this disorder has a very strong genetic foundation. -Children who have parents with the disorder are 12 times more likely than the general population to develop schizophrenia. The risk factor is even high for the more distant relatives. -Grandchildren with the disorder are around 3 times as likely than the general population to develop it. -Similarity rates for the disorder among identical twins are usually much higher than for fraternal twins. Adoption studies depicted similar results. -Kids born to mother with schizophrenia but who were raised by parents without it still showed a higher chance of eventually developing it than control groups. This is especially true if parents have problems communicating with their adopted children. -Numerous researchers have seen linkages to schizophrenia on

chromosomes 1-11, 13, 15,18, 20, 22, and x, and this seems particularly true for chromosomes 6, 13, 18, and 22. -Current study portrays that many people with the disorder have more than one gene that works together to help produce the disorder, (this is known as polygenic or multilocus model) however some people with the disorder have individual genes that are strong enough to help produce schizophrenia, but even these most likely work with other genes to help produce the disorder. -Genetic research alone doesnt explain why people develop the disorder, but it is interesting as to why most relatives of people with schizophrenia, even identical twins of parents who have the disorder, dont end up developing it. Also, people with the disorder dont normally have kids, so there is the question as to how the disorder skips generations. Brain Features -Some people with the disorder have specific parts of their brain that may contribute to producing the disorder, one key feature being enlarged ventricles, or spaces and gaps in the brain. However this research is not specific to just schizophrenia, its been seen in people with cognitive disorders as well. This brain feature is n awfully replicated biological finding in people with this disorder. -The enlarged ventricles could be the result of failure in normal brain development or interruption of pathways from one area of the brain to another. A significant interruption might involve neural connections between parts of the brain that deal with language and cognition. -People researching this disorder have paid close attention to the temporal lobe in the brain, which is somewhat responsible for auditory processing and language. People with this disorder may times have numerous problems in these particular areas, so these problems may be because of the differences seen in the temporal lobe of the brain. -Specifically, the amygdala and hippocampus are smaller in people with schizophrenia than in control groups. The hippocampus and amygdala are somewhat responsible for spatial memory processing and emotion, which are also problematic for people with the disorder. -Another link to schizophrenia is a reduced size in the superior and

middle temporal gyri, which can have an affect on auditory memory and language. -Other studies have shown reductions in the total size of ones brain and gray matter, which affect the size of the different lobes in the brain, affecting the cognition. Some of these studies have pointed to more specific issues relating to the frontal love, which is very involved in the complex information processing and organization of functioning and may closely relate to auditory hallucinations. Some other specific differences in the brain of people with schizophrenia, which also seem to involve smaller size, include: 1). The thalamus and parietal/occipital lobes, differences in these may affect the connection between sensory information and visual attention. 2). Basal ganglia and cerebellum, in which differences might affect ones motor behavior and output to high-order areas of the brain. 3). Corpus Collosum, differences which may affect ones language and communication between different brain hemispheres. -Some other major finding related to changes in the brain and this disorder is lack of asymmetry in particular areas. Some people with the disorder may have dissimilarities in the heteromodal association cortex, which includes two key areas of the brain relating to language processing. Brocas area and planum temporale. -Lack of symmetry in the planum temporale can be a risk factor for different learning disorders, and a similar finding has been found for people who have schizophrenia. -There have also been other findings for lack of asymmetry in other areas of the brain, including anterior cingulate cortex, which is somewhat responsible for different types of decision making. Although these findings can lead to advancements, we have to keep in mind that the results are less than conclusive, and if the changes in the brain are specifically leading to schizophrenia is not a known fact. The changes could be due to many different things, such as genetic predispositions for example, so we cant be sure. Neurochemical Features -One of the most current and common theories regarding schizophrenia is that the symptoms are a result of certain neurotransmitters in the brain, specifically dopamine. The excess dopamine hypothesis has been largely because: 1). Many people with positive symptoms of the disorder have successful results with drugs that lower levels of dopamine.

Cognitive or Behavioral Factors

2). In reality antipsychotic drugs may produce extremely low levels of dopamine and create side affects that are similar to those or Parkinsons disease, which is caused by deficient levels of dopamine. 3). Excess levels of dopamine, from methamphetamine intoxication for instance, can cause motor problems and psychotic problems. -L-dopa is a drug that increase levels of dopamine in people with Parkinsons disease, and can produce psychotic symptoms if taken in large doses and can aggravate symptoms of schizophrenia. -Dopamine receptors, especially D12 receptors, may be thicker in the brains of some people with schizophrenia. -People have criticized this excess dopamine theory as a complete explanation for schizophrenia, because it doesnt involve the numerous negative symptoms such as avolition and poor speech. Researchers have also reported contradictory information as to whether people with the disorder have more dopamine receptors as one might expect. -There has been a revised theory connecting to dopamine, stating that the neurotransmitter itself isnt as important as its role to help control information processing in the cortex. -Other neurotransmitters have been suspected in schizophrenia as well, such as noradrenaline, gamma aminobutyric acid, serotonin, and glutamate. Its possible that these neurotransmitters, and specifically serotonin, connect with dopamine and deficits in key parts of the brain to help produce symptoms of the disorder. Some believe that less serotonin in the frontal cortex actually leads to more activity in this brain area, leading to more dopamine activity. -Schizophrenia usually consists of two main groups of symptoms: positive and negative. The positive symptoms are the excessive and overt symptoms, and include delusions, hallucinations, and disorganized speech and behavior. The negative symptoms represent deficit or covert symptoms, and include lack of speech or emotion, as well as failure to take care of oneself. -People with schizophrenia many times, but not always, progress through four stages of symptoms. Many start with a prodromal phase that can last days, weeks, months, and sometimes even years. This phase is noticed by strange behavior such as disturbances in speech or thought processes, odd social interactions, perceptual

distortions, memory and attention problems, and also symptoms of anxiety and depression. This phase is often marked by negative symptoms that make it hard to notice exactly what problem a person may have, and it may resemble severe depression. -After the prodromal phase is the psychotic prophase, which is marked by the first full0blown positive symptom of schizophrenia such as a hallucination. A specific stressor could trigger this psychotic prophase, and it usually last less than 2 months. -Positive and negative symptoms must last 6 months for a diagnosis of schizophrenia, which may complete the prodromal and psychotic phase. The 6 month period has to include a 1 month phase when the symptoms are particularly intense, or active phase. -When someone is in the active phase hey normally have numerous full blown positive and negative symptoms and needs hospitalization. -Brain changes and many other biological factors may help to explain why many people with this disorder have many significant cognitive deficits. These deficits include, memory, learning, attention, language, and important functions such as problem solving skills and the ability to make decisions. -Many people with schizophrenia may also experience attention problems that could start at adolescence or maybe even younger. Many close relatives of people with this disorder have problems with attention and memory as well. -People with the disorder may have trouble processing quick visual information, tracking objects with their eyes, and concentrating on one just one subject. Problems processing information could lead to sensory overload, which could explain the positive symptoms of psychotic disorders, such as delusions and hallucinations. However, negative symptoms could be a withdrawal from the sensory overload. -Others have reported that troubles processing information is connected to the disorganized speech that has been seen in people with psychotic disorders. Prenatal Complications -People with schizophrenia, specifically early-onset, normally have more complications during prenatal development than the rest of

Social Factors

the population. One complication that seems to be closely related to psychotic disorder is hypoxic ischemia, which is low blood flow in the oxygen to the brain. This can eventually cause enlarged ventricles. People with hypoxic ischemia may be lower in weight, and have a smaller head circumference. -Prenatal complications can also cause problems with viruses and infections. Researchers have seen that people with schizophrenia are a lot of times born disproportionately in late winter, the spring, and summer, causing the fetus to have a higher risk for influenza and other diseases. Some researchers have also seen that the disorder is much more frequent during times of famine. -Exposure to rubella, viral encephalitis, severe malnutrition, and lack of oxygen could place a fetus at much higher risk for schizophrenia and other disorders. - The disorder could be more prevalent among males than females because women tend to function better in social settings and work settings, which actually delays onset of symptoms of this disorder. -The most common mental disorders otherwise related to schizophrenia are mood and substance-related disorders, especially depression. Depression could develop before schizophrenia and be a the cause for the psychotic symptoms, or the development of psychotic symptoms could lead to a downward spiral that involves difficult events such as job loss, which then causes someone to later becomes depressed. -Suicide is much more common is someone with this disorder than the general population, and suicide in people with this disorder usually closely relates to onset of the disorder, depression, substance abuse, recent loss, agitation, and poor devotion to treatment. -People most at risk for suicide are usually single, unemployed, and males that are socially isolated. - Brain changes and many other biological factors may help to explain why many people with this disorder have many significant cognitive deficits. These deficits include, memory, learning, attention, language, and important functions such as problem solving skills and the ability to make decisions. Conflicting Life Events and Substance Abuse -Many people with schizophrenia experience very stressful life

events in weeks and months before the onset of psychotic symptoms, especially if they are an emotionally reactive person. -People with psychotic disorders such as schizophrenia are much more likely to use marijuana than the rest of the population, and other drugs could lead to psychotic symptoms as well. Substance abuse among people who have schizophrenia symptoms is very common. -Its not clear whether or not distressing life events or drug use trigger psychotic symptoms, but people with the disorder may use marijuana or other drugs to cope with their psychotic symptoms. -There is often a correlation between traumatic life events and drug abuse in people with schizophrenia. -Many women with the disorder who also abuse or are dependent on substances have also experienced episodes of child or adult maltreatment, assault, car accidents, and PTSD. Cultural and Evolutionary Influences -Schizophrenia seems to be more common in people who live in developing countries and in immigrant and migrant worker than in people who live in developed countries and native populations. -Higher rates of the disorder are seen in African Caribbean people in England, as opposed to native samples. -Social isolation and complete lack of social support among migrant workers could be one of the key risk factors for the disorder. -Sociocultural models of schizophrenia also focus greatly on the issue of labeling someone with a severe mental disorder. People have observed that by labeling someone with a diagnosis such as schizophrenia, could easily predispose someone to show symptoms that could be misinterpreted as symptoms of the disorder. -A person recently diagnosed with the disorder may withdraw from other people to avoid hatred, experience low self-esteem and quality of life, become enraged or depressed, and act strangely. -Labeling someone can also many times affect how others see someone. Rosenhan creted a famous study in which people without a mental disorder went to different hospitals and faked that they were hearing voices. All of the pseudopatients were then

Treatment

hospitalized and kept on an inpatient unit, in spite of the fact that they showed normal behavior for the unit. The records at the hospital showed that the staff members were judging their patients normal behavior. For instance, they would take notes that identified someone as pathological, simply because the person was in the inpatient unit. This particular study showed how strong such stigma can be, and also how its hard to challenge once the diagnosis of the mental disorder has already been made. Milieu Therapy and Token Economy -These two techniques were created on inpatient psychiatric units for with who had acute psychotic symptoms. -Milieu therapy involves creating an environment where prosocial and self-care skills are greatly inspired. Mental health professionals, physicians, nurses, and other staff continually encourage a person with psychotic symptoms to dress, eat, groom, attend their therapy sessions, and interact accordingly with other people, as well as keeping involvement with other positive behaviors. -Milieu therapy is sometimes connected to a Token Economy, which is where prosocial and self-care skills are rewarded by points that are later exchanged with the patient for different privileges, like day trips outside the hospital for instance. This may involve rewards for brushing ones teeth and eating dinner with other people. Cognitive-Behavioral Supportive Psychotherapies -Creates a very strong therapeutic agreement with a client that is built on acceptance, a cornerstone, and cooperation. -Educate a client about his psychosis, as well as reducing stigma associated with their symptoms. -Decrease clients delusions and hallucinations and change incorrect expectancies and thoughts they have about them. -Reduce stress that is connected to their psychotic symptoms. -Talk about comorbid conditions such as anxiety, depression, and substance abuse. -Lower their chances of relapse by recognizing and getting rid of triggers such as stress, forgotten medication, and family issues. Medications -People with schizophrenia and other psychotic disorders many

times need to stay on medication to function on a day to day basis, so helping them follow agreement about their medication is extremely important. Behavior strategies that help with this involve talking about the benefits that come from taking the medication as well as disadvantages from not taking it, education about the side effects of the medication theyre on, taking medication as a daily routine, such as at meals every day, putting their medication back in the same place every time they take it, and rewarding appropriate medication use, possibly by using a token economy. Social Skills Training -This training has often been used to help people interact with other, and decrease their distress and to prevent possible relapse. -Usually involves repeated modeling and practicing feedback relating to small behaviors first. For instance, a person with schizophrenia could maybe watch two people have a normal civilizes conversation and then try to do the same thing with their therapist. While at the same time the therapist is looking for specific behaviors, such as lack of eye contact, disconnected speech, interruptions, lack of emotional control, and any other important and obvious problems. Cognitive and Vocational Rehabilitation -Main goal of Cognitive Rehabilitation is to improve performance in areas such as memory, attention, decision making, and problem solving skills. -Examples include repeated instructions to maintain ones focus and guide their performance in social situations, cautious listening to others words and statements, software training of certain tasks that require someones attention. Reinforcement of these tasks are key as well. They are shown to be affective, but there is still the question of whether or not they help in the long run. -The main goal of Vocational rehabilitation is to renovate a person with a psychotic disorder into a constructive occupational environment. -It mostly concentrates on job training, support, and employment in an area the person is most motivated to work. -Other areas of this type of rehabilitation include practicing language and cognitive skills in a work setting, specific feedback on their work performance, and resolution of job-related problems.

This can really increase job placement for people with psychotic disorders. Family Therapy -Many people with schizophrenia turn to their spouses or family members for care and help, so family therapy is an extremely important part of treatment for people with psychotic disorders. -This type of therapy normally involves educating the family members about the specific disorder the patient has, providing much needed support, lowering the highly emotional communications within the family, decreasing stress and depression, helping members of the family deal with caring for the relative with the disorder, crisis management, and improving their problem solving skills. -May be directed for a single family, or it could be done within a support group of multiple people. -It may also be done in the early or later stages of someone with a psychotic disorder. -Family therapy does correlate with lower relapse rates for people with schizophrenia.