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Abnormal psychology

ài.e. well-being

àin some cultures, epileptics are holy!

àvery culture-based

àtoday, skinny = beautiful

ànorms change cause change in disorders

Depression

• Weight goes up
• Efficacy/S.E. goes down
• Less concentration/self-tipuach
• Bad mood
• Less sleep
• Jealousyàthen guilt
• Alcohol
• Exaggerated reactions
• Escape from thoughts

àdepart from imp.objects.

1. Current symptoms: what she is currently feeling
2. Personality disorder: what person was carrying throughout her life (i.e. loss of dad = dependency) ànot always clear (i.e. we can say r/o [rule out] dependent personality).

-rule out: ‘perhaps’

3. Medical problems: I.e. menopause/diabetic/cancer àanything that could infl. b/h
4. The situational causes which caused the outbreak (i.e. divorce/moving house)
5. The Global assessment of functioning: 0-100 scale
• 100 = no symptoms in function
• 50 = severe impairment of function: i.e. shoplifting/suicide thoughts
• 0 = serious danger to oneself. No minimal hygiene/clear suicide attempt w/ expectation to die

Purpose of DSM

1. to organize
2. To give a measuring stick for testing a certain thing
3. Compare b/w ivchunim
4. To know how to treat the thing
5. Insurance claims (to know how much to give to each person who needs $ for psychologist)
6. Research

Oct 21, 2002

àbeing sick = symptom/b/h mold related to functional prob. of some sort

àit is either a prob. Or not àdiscrete.

Medical approach

àobjective/measured àyes-or-no

• clear/simple/all-inclusive

Disadvantage

• doesn’t include one theory àdoesn’t help us know the reasons for the symptoms
• political: homosexual excluded/ -included PTSD – b/c of Vietnam

• theories of the self – kohot
• psychosexual drive theories, i.e. Freud
• Obj. relations – i.e. M. Klein
• Cognitive: we were taught wrong ways of thinking
• I.e. depressed: gross overgeneralization/low self-worth
• B/h: wrong stimulus association

• Orderiness/speech patterns
• chief complaint
• psychological testing i.e. bender test/MMPI2

àhe might be psychotic/deaf/anxious/depressed?

àcan’t put ideas into person’s head, i.e. by asking in a certain direction that is not where patient came from

• defense/splitting
• cognitive prob: minimizing
• bad self-schema
• antisocial àbad relations w/parents

àthe interviewers give him the benefit of the doubt

àPerseverance= prob. of inhibition = frontal lobe prob.?

• can’t remember if you dreamt something, or it really happened
• when you’re drunk
• unexplained memory less
• amnesia

= you’re dissociative.

àalcohol/drugs/tired

àprob. only when it comes often and it effects normal functioning

àin denial, you continue to function in reality. In dissociation, some perception of reality is faulted

• identity confusion and alteration:
• identity confution: he doesn’t know exactly who he is
• identity alteration: his whole self, including name, is change
• amnesia: something important disappears from memory – i.e. your name
• derealization: feel detached from outside reality. Physical things are not real. Sounds are diff àmaybe scary!!! Their shapes are totally out of wack: people’s shape are weird.
• depersonalization: feel detached from themselves. I.e. if you take drugs, you have an out-of-body reaction.

-sometimes they’re aware of the other alters

• 1/10,000
• starts at childhood. Gender case # is equal
• by adolescents, it is already set. Women might have additional sexual conflicts at this time
• no sociality, since he is always going to diff. crowds at diff. times àthey get tired of him
• startle response
• lack of attention

• mostly are women in 30s
• men tend to get involved w/ the law instead

• complain to be unconnected/people speak to them and they think about something else

• at young ages, gender is equal #.
• They feel strange= they are spoken to, yet are wondering somewhere else, therefore, kids don’t befriend them.
• Low marks = can’t concentrate on stuff
• Dreaming
• Negative relations – i.e. he promised something, then was in a diff. alter

Cardena and Spiegel questionnaire

àgiven after the bridge fell in the earth quake.

àgave them right after traumatic event\a while after.

• repeat trauma
• feeling irregular feeling in body
• numbness in body
• time expands
• confusion àdon’t know what to do
• unusually sensitive startle

àsome alters are kids

• The persecutor (opposite of the good one) who punishes everyone else (all other alters)àthe attempt to do something
• there is one alter who knows/organizes all other alters – he knows them all

àpsychotherapy: integrate the diff. alters

àb/w there are other symptoms as well, and when they came for treatment, the therapists induced it(?)

-Spanos: dissociative is a result of poor hypnosis of the psychotherapists

-hypnosis: when asked person to fill out a questionnaire when ‘person behind the wall’: diff. answers

àshows that you can come to this b/c hypnosis

-people who undergo trauma, are more able to hypnotize themselves, many times, unintentional

àhypnotism: an altered conscious, where you can suggest to him what to do. Perceptions can change – i.e. pain

àperhaps, kids who found a way to hypnotise themselves made alters in stressful situation

àless than Hispanics in US

• war
• rape
• religious redifot

àtakes the whole personality, not only some of it, and not only some of it. Goes to new place for extended periods

Dissociative amnesia

àcould also be exciting/overload of stimuli ànot only traumatic situation

à(which is amnesia but not dissociative)

• organic: i.e.drugs/accident
• psychological amnesia:
• dissociative amnesia: info from the past: i.e. forget the trauma.
• Localized amnesia: we forgot some of the info for some of the time (the whole info for some time) àcould be psych
• Selective amnesia: we forget some of the info (some info forgotten): purely psychological

1. anterograte amnesia
2. retrograde amnesia: general or personal info. Remember key stuff: i.e. name/name of kids

• generalized amnesia: forgets everything
• continuous amnesia: from the trauma and until now

• school
• Court

Depersonalization disorder

àcould only be momentary, but as long as it is disturbing, it is a prob.!

• tired
• drugs
• psych issues
• any adolescents experience this

• neurophysiological àhippocampus damage?
• hard trauma (i.e. adolescance – puberty)

1. could be a defense mechanism for internal feeling?
• Dissociative peopleàeasier to hypnotize
2. Reaction to trauma (external issue)
3. Disparity b/w personality of kid and his environment
4. Surroundings that does not protect the kid

www.issd.org àinternational society for studying of dissociation

ài.e. hysteria

ài.e. person who saw her son drown = blinded àcould be brought back from psych reasons

àhysteria: less today, since it is well known phenomenon, so people use it less as a defense.

àbody speaks when person doesn’t

• words to organize our feeling àwe’re in-tuned to our feelings

ài.e. if hand was hurt once, it would be used in hysteria/blinded person

àdissociation b/w prob. and how it is expressed.

1. factitious diseases: give diseases falsely
• manchhousen’s: they know that they are faking it, but they don’t know why they are doing it àthey usually are asking for surgery

àmight want attention through the surgery treatment?

àregain lost attention in childhoodàcan’t see the trauma that he had, so he tries to manipulate others àcontrol others as others controlled him when he was young

• manchhausen’s byproxy: when you make stories to others: i.e. mothers almost kill their kids, giving them too much medicine: i.e. get their kids into hospital: they help kids in hospital extremely so much, getting sop much attention, yet give kid poison in IV. They the kid gets rehospitalized, and she gets attention again. àshe is aware of what she is doingbut not why
• they often get caught since they can’t stop àthey want to maintain the attention situation

2. conversions disorders: hysterias: they convert a psych thing to body: i.e. willful movements/sensorimotoric/visceral prob.
• pseudo-epilepsy: a person elegantly falls, and is not hurt: shows that it is not real ànot seen in EEG

àDSM changed it to conversions, for Politically Correct reasons

• case of anna O.: fell in love w/ breuer, after he discharged her: later told him she was pregnant w/ a baby: fake pregnancy: initial cases of transference

3 kinds of conversions:

1. sensory: can’t feel (anesthesia) hand: but the the thing is that the nerve is the whole hand (hand=called glove anathesia)
2. motoric: can’t move, i.e. hand: can’t speak [usually in certain place/certain tone]

• Aphonia = wispers

• Selective mutism = sometimes can’t speak.
• Mutism = always can’t speak

3. visceral: internal feeling

• psychodynamic: understand/solve the basic conflicts
• behavioristic: give rewards for doing the right thing
• rapist said: don’t are tell anyone = mutism:
• give more rewards for speaking àslowly get to the point of speaking about the trauma
• behavioristic works best for 1 clear/simple symptom

Nov 4, 2002

• if a medical reason, it is minimal cause
• other cases, are a combo of medical/psych, yet the psych cause is stronger.

àpsychiatric patients

• psychoanalytical theory: painful memories expressed this way
• cognitive theory: one is oversensitive to pain and makes it long-term
• as seen in depression: oversensitive to negative, and exaggerates it

• at least 4 diff areas
• 2 symptoms in the digestive system
• 1 sexual symptoms
• neurological (double vision)

• must start b/f 30
• hypochondria: after 30
• many times, they go to many dr. and don’t get a clear diagnosis
• often, speak lots to dr.
• can’t find medicine for them

àb/c men have a way to deal w/ it: alcohol/aggression

• s. America/Asiatic/older US = more Americans
• those cultures not taught to speak about prob.

àdepression àsomatization àmore intensity of symptoms

àpeople express their prob. on the weak part of the body.

ài.e. ear infection every time one is nervous àb./c she had a weak ear

àb/c immune system is down

àpsych snxiety/depression which gives legirtimacy to it

àmight or might not be medical, but has a psych syndrome

àoften goes together w/ somatization

• many allergies
• gets addicted to coffee, yet feels allergies to it
• hard to work
• hard to get up from bed

àin smaller prob. b/h approach is better, since it doesn’t do anything. If it is a tougher prob àneed psychoanalytical since it is a deep rooted prob.

àyou have to ask if the pain is connected: i.e. if one has an operation, and the painkillers stopped, then it is not a pain disorder – it is natural

• runs in family:
• socialization not to speak, so the body speaks instead.
• more in women
• goes in anxiety/depression
• antisocial/alcohol/aggression in men
• cognitive exaggeration: every thing little thing makes them thing that they have cancer àattention to tiniest things in body (i.e. heartbeat in ear)
• comorbility: PSTD à52% of people –also somatization

1. not dilussion
2. not related to how he looks
3. causes distress
4. minimum 6 months

àcould be after age 30

ànot specific symptoms

àthe symptoms aren’t clear.

àthey can’t specifically explain what they are feelings

àor things like excess vitamins

àthe prob. is in cognition: he thinks that he is sick

àbased n anxiety/depression

àbased on stress expressed in the body

àdon’t want treatment (takes away their defense emchanism

àexaggeration of it.

• goes together w/ OCD
• tries to change this organ
• no diff. b/w men and women
• women speak of weight
• men speak of too much/little hair
• hours in front of mirror
• no free energy to learn in school
• 5 cosmetic operations àshows underlying prob.
• stopped asking friends since the answer in not what they want
• grow hair to cover organ
• work at night
• tries to hide organ (i.e. long hair to cover ‘ugly’/ ‘misformed’ ear)
• will feel bad when someone actually sees this organ
• 98% avoid social contact 30% stay home; 20% suicide attempts
• starts in adolescence and b/c chronic if untreated

àunclear if a subcategory or not a body delusion i.e. eating disorder

Kinds of treatment

• cognitive-behaviorist treatment could help
• psychiatrist: anti-depressive: usually SSRI (serotonin uptake)

ànot immediate things of axis 1 of DSM

1. dramatic
1. Borderline
2. Antisocial: DSM speaks of men (i.e. but there are abusive women!!!)
3. Narcissistic
4. Hysterical

2. odd-eccentric
1. Schizoid
2. Schizotypic
3. Paranoid: doesn’t like to be recorded: doesn’t trust what people will use w/ it/feels that world is against him/always set to assume that people are against him/look at smallest details to try to support his thoughts. If won’t find them, then the other is just hiding the facts well

àrare to come to treatment: he’s fine, but everyone is against him!!! (even psych!)

àparanoia b/c more acute in stress

àin less stress: not ‘everyone against him’

Psychoanalytic

àAnger that I feel guilt about: conflict inside that he can’t acceptàproject outside

àneed to get him in touch his anger and channel it better

àif w/I his social context: and it is w/i his soc. = no probs.

• ½-4% (x3 more men)
• often you can find major depression/substance abuse/even psychotic episodes
• schizophreic families
• therefore you can assume that it is shizogenic?
• not in tune w/ his own emotions: projects them inside
• primitive defense mechanisms (thus also cognitive therapy doesn’t work)
• parents who are over-critical/no tolerance/can’t accept weakness: can dev. paranoia: my [small] world is against me

1. diff contexts:
1. suspects that others are harming/exploiting him
2. unjustified distrust of friends
3. unwarranted distrust to tell others stuff, so that they won’t be used against him
4. reads negativity into neutral stuff
5. consistently grudges/keeps angers
6. indifference To praise/criticism
7. emotional coldness

3. anxious/fearful
1. OCD
2. Masochist
3. Dependant
4. Avoidant:

àcan’t diagnose based on what he said:

• the patient could manipulate
• one could exaggerate about himself
• selective memories
• b/c of history, he thinks that he’s a failure, though in various situations he isn’t like that: i.e. family thinks that he is stupid, yet when he’s w/ GF, he forgets those memories
• the situation could have brought a reaction!!! It might not be part of his personality
• i.e. medical student b/c obsessive: learns smallest of details

• when he said what he and others think and therefore, get more info
• sometimes hard to exactly define: might be one of many

• Antisocial: speaks more of men, yet there are abusive women
• Though women express it in diff. ways
• Hysteria/dependant: spoken about women, when also men are hysteric
• OCS is seen as a men thing, yet women clean the house obsessively

• always in center
• lack of emotion to others
• never pressured
• need others to always value him

• those who make it to the top vs. those who didn’t
• those who succeed don’t see the fact that their relationships w/ others is very flat
• no real friends
• though they have followers

• over-grandiosity
• need for admiration
• lack of empathy
• beginning of adoluthood/many contexted

• need achievement
• preoccupied w/ fantasies of ideal love/boundless power/beauty/success
• believes that she is special/unique: need only to be dealing w/ other of those ‘special’ people
• needs excessive admiration
• sense of entitlement
• unreasonable expectation of automatic compliance
• interpersonally exploitative
• lacks empathy/can’t see others’ feelings
• often envious of others, and thinks that others are envious of him
• shows argent b/h or attitudes

-->then he is not perfect

-->this is despite apparent assertiveness/high SE

-->i.e. h. his family relations work

-->anything not 100% is ugly

-->perfectionism

-either complete or nothing: might leave friends when they discover stuff that they don’t like about them

-->either the other is perfect, or he is nothing

1. neither desires, nor enjoy close relationships, including part of a close family
2. almost chooses solitary context of activity
3. little interest in sexual relation w/ others
4. pleasure in few if any activities
5. lacks friends outside 1^st degree relatives
6. appears indifferent to praise or criticism of others
7. shows coldness/detachment/flat affect

1. rich fantasy world, i.e. has emotional world, yet it doesn’t come out
1. high schizoid
2. low schizoid

àcan’t look at other people

àcan’t remember anyone of his school

àdidn’t start w/ any girl

àno meals together

àmeets his only friend once a week

àonly in college, he realized that he is missing something, but he couldn’t say what

àwhen he realized it, he got a job as a salesman in photo store

• no will for interpersonal relations
• cold
• relations are unsatisfactory/threatening
• only call for help in times of need

àmuch more in men than in women (X3)

àslightly higher in schizophrenic families

àtwin studies show

• lack of expression of affect/low social contact is somewhat genetic

1. psychoanalytical theory: bad relationship w/ mom: don’t know how to give and take love àemotional distortion àfear rejection
1. their emotion is threatening and thus they try to detach themselves from it

-fear of rejection: i.e. if mom is sick right after birth àlong separation from kid

àthey don’t really know what to do w/ their emotion àit is overwhelming àso others won’t eat them up!

àno ability to empathize!

November 25, 2002

Schizotypical

• similar to illusions
• thinks everyone can read their mind
• give amorphical things a shape
• give geometric shapes to people
• stares at poeple
• Tangential: thinks in logical twists associative: doesn’t know who he gets from one thing to the other
• Circumstantial: in schizophrenic thinks is association, yet come back to same point in the end
• Ideas of reference: paranoiding thinking that everything in surrounding is b/c of them!

àTV does not speak to himàthough he is aware of his magical thinking

• leads to schizophrenia
• seems to be genetic àmore common in schizophrenic families
• therefore, seen as a light schizophrenia
• the primary prob. is in the attention.
• Medication is the only know cure (similar to schizophrenia)
• Also antidepressants since they are
• see/analyze how rational he is
• prob.: he doesn’t trust anyone!!! So first, you have to get his trust

1. ideas of reference ànot delusions
2. magical thinking that infl. b/h, that is inconsistent w/ sub-cultural norms (i.e. telepathy/odd beliefs) [note = key: infl. b/h ànot just beliefs]
3. unusual perceptions, which includes bodily illusions
4. odd thinking and speech (tangential or stereotypical: i.e. always the same answer, regardless of answer)
5. suspiciousness/paranoid ideation
6. inappropriate or restricted affect
7. appearance or b/h that is odd/peculiar/eccentric
8. lack of close friends or confidents, except 1^st degree relatives
9. excessive social anxiety that does not diminish w/ exposure, that are related to paranoid fears and not low SE

Dramatic cluster

• Histerionic
• Borderline
• Narcissist
• Antisocial

• unclear borders of self: unclear where self ends and other person starts
• exaggeration of roles: i.e. female sexual provocation

DSM

1. uncomfortable in situations where ind. is not in center
2. seductive/sexual provocative interaction w/ others
3. displays shallow and quickly switching flat emotion
4. consistency uses physical appearance to get attention
5. style of speech that is extremely impressionistic yet no details
6. shows theatricality/dramatization of expression
7. is suggestible/easily infl. by others/circumstances
8. consider relation more intimate than they really are.

àoften threaten to commit suicide àout of attention – not b/c of wanting to really do it

• denial of emotions: b/c of
• oedipal complex: exaggerated sexuality
• oral fixation: being in center/childish/tovanut

àlots of anxiety, but they are not aware of what they really want = no clear identity = thus they are very suggestable/dependant

• identity
• flat affect
• denial

àattention: to give them reassurances, since they are not sure of who they really are

àa shallow kind of reaction formation

àyet don’t want sexual relationship (out of fear) àyet are provocative about it (irony!!!)

-dissociation of hysteric: out of this shame/fear of low self concept

• minimize things: don’t remember details
• pseodologia fantastica: could lie in order to get attention: lie about a rape

à Borderline: remorse after doing something bad women 3/1 to men

àproblem of identity

àDSM = only circumstantial

àtangential is a more pathological kind

• avoidant PD
• OC PD
• Dependent personality disorder

àunlike phobias, PDs are in axis 2 and not axis 1!

Avoidant personality disorder

• Closure/fear to have relations àunlike schizoid: wants to have relationship w/ surrounding but has difficulty doing so
• Low SE
• Limited world view
• anxiety

àthus will look for jobs w/ limited social interaction

àaxis 1 often shows depression/anxiety

àdiff. b/w DSM4 or DSM3 àvery diff. results in diff. measuring tools

DSM

1. social inhibition/inadequacies
2. oversensitive to negative evaluations

1. avoids work w/ social interaction b/c scared of criticism/rejection/disapproval
2. unwilling to get involved w/ people unless certain that he’ll be liked
3. shows restrain from intimate relations for fear of embarrassed/laughed at
4. preoccupied w/ being criticized/rejected in the present social situation
5. inhibited in new interpersonal inhibition b/c of feeling of inadequacy
6. views self as socially inapt/socially unappealing/inferior
7. unusually reluctant to take risk/new situations so they wont be embarrassed

àif over-inhibited, might b/c avoidant PD

[àover-unhibited = antisocial]

àb/c oversensitive threshold (threshold is too low) of autonomic nerve system

àantisocial = threshold is too high

àeven: don’t believe positive feedback!!!

1. in childhood: family therapy to show the whole family how ind.s feel when he is criticized (often at expense of others)
2. in adulthood: mixture of cognitive (show the wrong thinking) and behaviorist: slowly get him into social situations

Dependent personality disorder

àBrown-nosing: always sucking up to everyone

• can’t decide for themselves
• no risks: no initiation of activities
• only does things through a relationship

àmore people think that they dependent that the clinicians thinks

àmore women than men

DSM

1. extreme need to being taken care of, that leads to clinging b/h
2. fear of seperatio0n

1. has difficulty making daily decisions w/o lots of support from others
2. needs others in order to assume responsibility for most aspects of her own life
3. has difficulty expression disagreement w/ others for fear of loss of support of the other àdoes not incl. fear of revenge
4. Has difficulty initiating project /initiate activity b/c of sense of ability (vs. low motivation)
5. Excessive lengths in order to get support/nurture from others àeven volunteer to do unpleasant things
6. Feels uncomfortable/helpless when alone b/c sense of exaggerated fears that they can’t take care of themselves
7. Urgently seeks another relationship when other relationships end
8. Is unrealistically preoccupied w/ fears of being alone to take care of himself, even when it doesn’t really occurs

1. psychoanalytical: oral fixation: always need the nurture from the outside

àthe parent did not allow the kid to dev. beyond being dependent: reciprocal relationship. Parent is overprotective

àor kid doesn’t get enough nurture and always seek it

Obsessive-compulsive PD

• need for total control
• note smallest details
• hatmada

àperfectionist

ànukshim

àblocked emotions: can’t go w/ the flow

àvery little pleasure of interpersonal

àstingency

àcollect stuff

àtries to suck up to boss, yet are very down-looking at those lower than them

DSM

1. preoccupied w/ details/order/plans, so that main point of activity is lost
2. perfectionism disturbs task completion
3. friendships and pleasure are neglected b/c he is preoccupied w/ work
4. overconscientious about morality/ethic values
5. unable to discard old stuff, even w/ no sentimental values
6. reluctant to delicate tasks w/ other, unless they submit to his way of working
7. stringent w/ $$$ àto save up for future catastrophe
8. stubbornness/rigidity

• learn to follow the rules rigidly but they don’t learn to flow w/ life/intimacy
• parent is over controlling

1. find their automatic thought and see what they do b/c of those automatic thoughts
2. through a hierarchy of tasks do an increasingly harder thing: first leave a few things in the sinkàthen harder things (to let go of their perfectionism)

à Borderline: remorse after doing something bad women 3/1 to men

àproblem of identity

àusually triggered by specific events

• often triggered by child rape

-->forces try to control their mind!!!

• gross distortion of reality
• fragmentation of psych processes: emotion/thought/perception
• social withdrawal

1. delusions: unusual thoughts: i.e. being pursued
2. perceptions: hallucinations/voices -->usually speak to them or about them
3. disorganization of thought and speech: thoughts are broken up/tangential/cicrumstantial

1. violence is a not a necessity (some are violent, but not necessarily -->not by nature)
2. mixed up w/ multiple personality:(2 or more separate personalities) vs. schizophrenic who’s personality broke into components

• environments
• genetics
• stressors
• brain structure
• Brain structure: larger ventricals
• diff. b/w brain structure and brain function and b/w than and biochemical
• chronic = more brain structure problem
• Brain function: function prob: prefrontal dysfunction
• Biochemical: excessive dopamine

• scary to see a family member disintegrate in front of you
• can’t deal w/ himself
• medication changes his body: gains a lot of weight
• hallucinations = scary
• people feel shame: what did I do to get him like that?

Type 1-positive symptoms: what you have

• delusions -beliefs not based on reality, and impossible. (vs. self-deception: possible but not very probable): try to prove to everyone that their delusion is correct!
• Chasing delusions: someone is chasing me all the time
• Reference delusion: people believe that random things are attributed to them: the TV person is speaking only to him/earth quake is b/c of him/grandiose: I am so smart
• Control delusions: people from the outside control my thoughts
• Telepathic delusions: I send my thoughts to others (everyone can read my mind)
• Thought control: Not only do people control my thought but intentionally: My wife sends me that thought through the microwave
• Withdrawal of thought: people take my thoughts: my neighbor stole my thoughts!!!

• hallucinations
• disorganized speech/thoughts: ‘formal thought disorder’
• disorganized behavior i.e. catatonic

DSM

• delusions disorder: at least a month
• rotomanic:
• grandiose
• jealous
• chasing
• somatic (hypochondriac: less intensive), and were, everything is a general physical disaster: i.e. body parts switched: i.e snakes instead of stomach
• shame/sin delusions: he did something horrible, like responsible for the earthquake

àdelusions are culture bound!!!!!

• Japan: shame is a key delusions
• Germany: made a big sin

àsubstances/stress?

• hearing hallucinations is most common! (and more common w. women!) àhearing voices
• visual hallucinations: seeing things: usually goes w/ auditory hallucinations
• tactile hallucinations: ants walk on your skin
• somatic hallucinations: snakes eat your stomach

àproblem in flow of conversation

àmen: more speech problems. In women, speech is more bilateral, so there is a compromise

àalso in remission, harder for schizophrenics

àalso for their family members!!!

1. Shallow affect: blunted affect:
1. face totally shows no affect: flat. (schizodic person just withdraws): i.e. someone burns down his house: he sits and watches TV.
2. Monotonic speech

2. Allogic: only speak when spoken to
3. Avolition:low motivation to do things

• inappropriate affect: laugh at sad things/cry at sad things
• extreme mood switches:
• unhedonia: doesn’t enjoy things/hard to feel things, even though they want to (also seen in depression)

àtake away many of the positive symptoms, w/ no negative symptoms, he is more likely to get better

àgoes according to culture, external things: i.e. what kinds of labels my clothes have àregardless of my emotions:

• I go to theater and speak about my membership and not the plays!
• I play w/ my kids for them to get better, not for fun)

àbased on a culture which doesn’t allow for individuality

àdidn’t deal w/ anyone

1. 2 or more of the following: (present for sig. Period of time, for at least a month) (w/ medical intervention)
1. delusions
2. hallucinations
3. disorganized thought/incoherent speech
4. grossly disorganized/catatonic b/h
5. negative symptoms: flat affects/avolition/allogic

2. self-care/social skills/work functioning is below precious state for significant amount of time
3. duration: at least 6 months, must incl. 1 months of symptoms (incl. criterion A [#1]). Also includes periods of:
• prodromal: the gradual degeneration of organization at a much earlier stageàprocess
• residual: after active state, there is a return to prodromal state (after drugs)
• flat affect/lack of self care/odd thoughts

• reactive/acute onset: sudden, a reaction to something
• better prognosia: better chances at full remission
• process/chronic onset:

àoften seen a disorganization at a much earlier stage

àuntil the onset: active stage

• 10% always remain schizo
• 25% = full remission
• 65% - go between period active-residual

• 20-22% attempt suicide
• 10-15% succeed

Paranoid schizophrenics

• most common
• hallucinations/delusions of being chased
• grandiose
• often reactive: they have organized thought
• hard to convince him otherwise
• auditory/visual hallucinations
• some cognitive/skills are above other schizophrenics
• very skeptical about everyone
• loose judgment
• hard to treat: they think that they are being chased
• best prognosia, but could switch to another kind of schizophrenic
• accute

• hedophrenic: another name
• onsets earlier in life
• delusions/hallucinations w/o specific content
• very philosophic at youth
• goes to border of social
• odd behavior
• no organized b/h
• repeated actions (preservation)
• chronic

àsometimes they explain [afterwards] their actions: i.e. I was holding up the worldài.e. so a catastrophe won’t happen

• extreme movements
• extreme negativity
• echolalia

• not paranoid
• not hedophrenic (disorganized)

• if less than 6 month has past
• still a salad of things happed ànot clear yet what he has since his prob. is not fully dev.

Culture and schizophrenia

àin east, faster/better remission

àin developing countries, more care/extended family

àin east, faster/better remission

àin developing countries, more care/extended family

àless common genes = less common to get

• both parents are schizophrenic:
• 28-46%
• identical twins
• 28-46%
• dizygotic twins:
• 14%
• non-twin siblings:
• 9%
• 1 parent = schizophrenic:
• 13%
• nephew:
• 4%
• partner:
• 2%
• general population:
• 1%

àharder schizo is more genetic infl. than easy

à75-91%

àpossibly, schizo is a bunch of disease

Prenatal influence on schizo

àdiff. oxygen in brain.

[àuntil now, 12% of 1 parent]

Main idea: harder to leave your genes, despite no socialization to schizophrenia

Bio relatives of adopted kids: who’s mom = schizo

-10%

-remained w/ bio families àsome stayed in kibbutz/others went to city

àboth w/ bio families

results: no diff, yet more proximity = more prone to schizo

àgenetics also infl!!!

MRI/PET: Magnetic resonance imaging/position emission topography

àAtrophy of diff areas = diff. schizo.

negative symptoms

• Prefrontal area =less activity in schizo. àincl. Planning/org

Positive symptoms

• Temporal lobe = lack of proper memory/emotive integration
• Limbic system (amygdala/hippocampus)

Possible causers

• viral infections
• birth probs.
• malnutrition to brain

• parietal anoxia: lack of oxygen
• fever virus in mom, especially in 2^nd trimester

àanti-dopamine drugs – alleviate positive but not negative symptoms

àParkinson’s-like symptoms (disease w/ lack of dopamine)

• muscles probs.
• spontaneous muscle movements

àIt takes a few days after dopamine goes down until positive symptoms go down

àD4 receptors blockers [àkind of dopamine]

àespecially in D3/D4 receptors

àwhile in prefrontal = too little

àtherefore, Dopamine imbalance

serotonin = related to dopamine

• cognitive
• behaviorism
• psychodynamic

Psychodynamic

àregression: can’t differentiate reality and imagination

àregression to b/f relationship w/ mom

àthis approach is found to be untrue

->kid never learnt to focus on real/relevant part of life/reality

àin affects its path, but not onset

ài.e. the more supportive family = better remission

-double bind: double message: supportive, yet rejecting

i.e. if kid falls, she’ll pet him yet yell at him for falling

àyet, this is not causality

• lower socioeconomic
• stressful life

àh.m. person is able to get hob/schooling àif lower àlower socioeconomic

• less dirt!!!
• [less exposure to people = less diagnosis]

• stressor àoften but not always b/c of relapse!!!

àagoraphobia, incl. closed spaces of claustrophobia

àw/ agoraphoia = more women than men

àneed to deal w/ it early b/c it spreads to other things

àsometimes, anxiety attacks do not b/c real phobias

àsometimes, have to work on that as well

Automatic cognitive distortions: David Burns

1. all-or-nothing
2. generalization
3. mental filters: i.e. if I have things to do, then instead of looking at the good: what I have done, look at the negative: what I still have to do
4. discounting the positive
5. jumping to conclusions: i.e. call from boss = firing àeasy to get depressed
6. Magnification/Minimization
7. Emotional reasoning: I feel like I am an idiot
8. Should statement
9. Labeling: I label myself according to 1 thing that I did
10. Personalization/blame (of things that happen)

=X6 more!!!

• health
• divorce
• failure
• loss of people/grief
• trauma/abuse
• child-birth