Schizophrenia Spectrum Disorders and Personality Disorders (OER)

Unit 3 Lecture Notes–Schizophrenia Spectrum Disorders and Personality Disorders (OER)

Reading #1 and #2

Schizophrenia Spectrum Disorders

Sometimes these disorders are called Psychotic Disorders-A loss of contact with reality.

The most common psychotic disorder is Schizophrenia.

The most prominent symptoms are hallucinations (false sensory experiences) and delusions (false beliefs).

Hallucinations can impact any one of our five senses. The most common, however, are auditory hallucinations, in which an individual hears voices. The voices are not their own and they usually tell the person terrible things such as: “You are ugly” or “You are no good.” These voices create intense fear for the person with this affliction.

As noted, any of the 5 senses can be impacted. For instance, some individuals experience taste or gustatory hallucinations (e.g., “I can taste the poison you put in my milk.”), while others might experience a tactile or touch hallucination (e.g., “I feel bugs living in my abdomen.”). There are also smell (olfactory) hallucinations, and visual hallucinations.

Delusions-There are different types.

a) Delusion of Grandeur (Grandiose Delusion)-In this type of delusion an individual believes something great about oneself (e.g., “I am Elvis”).

b) Paranoid Delusion-In this type of delusion the person fears that others are out to harm him/her in some way (e.g., “The government is watching us through our T.V.’s”).

c) Idea of Reference (referential delusion)-This involves the belief that something (e.g., billboard, tv ad) refers to the person in question (e.g. A person with schizophrenia might state: “The weather map on TV contains a coded message for me from the government.”)

d) Thought Insertion-This involves the belief that someone or something is placing thoughts into one’s own mind (e.g., “The neighbor’s cat sends me important data.”).

e) Thought Broadcasting-This involves the belief that one’s thoughts can be heard by others (e.g., “Please stop listening to my thoughts.”).

Other symptoms might include:

a) Disorganized Speech-This is speech that may make no sense. For instance, a person will respond to a question with an answer that is not related to the question.

b) Disorganized Behavior-This may involve odd dress and mannerisms. An example would be the hair twirling that you see in the video below.

c) Alogia-This is reduced speech

d) Neologisms-Making up and using “new” words.

e) Clang Associations-Rhyming words (e.g., I am a man named Stan and I ran).

Here is the link to two excellent videos highlighting the core features of schizophrenia.

The first video highlights the case of Gerry. You should notice paranoid delusions, disorganized thinking, and a hair twirling mannerism. The second video highlights the case of Heather. Disorganized thinking is prominent in this clip.

https://www.youtube.com/watch?v=aMQ8DZS0fqE
https://www.youtube.com/watch?v=kvdw4b7tC-8&feature=related

The symptoms of this disorder can be categorized as being positive or negative. There is nothing good about positive symptoms. The term refers to adding something to one’s life experience that was not there previously (e.g., delusion, fear). Negative symptoms refer to things that have been taken away from the person who has this illness (e.g., social skills, motivation).

Now, schizophrenia has been referred to as a disorder of young adulthood, as it usually develops between the ages of 18-25. It occurs in 3 stages;

1) Prodromal Stage-This is the first stage that involves odd behaviors that may be overlooked by parents as just being a teen (e.g., A teen sits in his room staring at the wall in the dark). Although overlooked at the time, a parent could look back at such behavior and realize that it may have been the beginning of this disorder.

2) Active Stage-This involves the full-blown symptoms of the illness. Here is where we see both the positive and negative symptoms of schizophrenia.

3) Residual-This involves the absence of the major symptoms but can be described as a return to prodromal like symptoms. Notice—this stage does not indicate cure! Only about ¼ of those with this illness attain a full recovery!

Other Psychotic Disorders

Delusional Disorder-This disorder involves the presence of a delusion. Other psychotic symptoms are not present. Those with this disorder may be able to function in day to day activities. Here is the link to a great resource describing this disorder and its specific types. https://my.clevelandclinic.org/health/diseases/9599-delusional-disorder

Schizophreniform Disorder-This disorder involves psychotic symptoms that last at least 1 month but no longer than 6 months.

Brief Psychotic Disorder-This involves symptoms (e.g., delusions, hallucinations) that last at least a day but no longer than a month. This disorder may develop in response to a significant stressor in one’s life.

Etiology of Schizophrenia

Schizophrenia is influenced by genes. If one member of a pair of identical twins has this illness his/her co-twin has about a 47% chance of developing this disorder as well. There are other potential etiological factors as well (e.g., cannabis use).

Dopamine-Hypothesis-This involves the idea that too much dopamine is being produced in specific areas of the brain which leads to the development of this disorder.

Make sure that you read/study the sections in your readings on etiology. Also, make sure to watch the following video. Pay particular attention to the part on mothers who develop the flu during pregnancy. Note: You will see Heather again in this video.

https://www.youtube.com/watch?v=QiBdBhRhAWI&list=PLQg5bcAT048BSLjW467hOkurswTbXNHMe

Treatment for Schizophrenia

The treatment for this illness involves the administration of antipsychotic drugs (e.g., Thorazine). Anti as a prefix means against—so against psychosis. Side effects are a concern with different drug treatments. One specific issue is tardive dyskinesia. This involves the development of involuntary muscle movements (e.g. hand movements) in the afflicted individual. If the drug treatment is not discontinued these movements can become permanent.

Reading #3 and #4

Personality Disorders

Personality Disorders-These disorders (there are 10 of them) involve maladaptive personality styles. Some are regarded as being “ego syntonic”, meaning that the symptoms are in “sync” with the persons ego (self). Wow! What this really means is that the individual is not distressed by their symptoms. Some of the personality disorders cause distress for the individual. They are referred to as being ego-dystonic (out of sync with the self and thus upsetting).

All 10 are fascinating. They are categorized into clusters A, B, or C (Please see Page 1 of Reading #4 for the details on each). Each is also discussed below.

1) Antisocial PD-This is a “criminal personality.”” Those with this PD lie, steal, cheat, kill, extort, etc. They are charming, warm, and manipulative and do not express remorse for their actions. Yikes!

2) Schizoid PD-These individuals are “loners” having no interest in social relationships with others, including family. They prefer to be alone, are emotionally cold, and typically select solitary employment (e.g., night watchman at a factory).

3) Narcissistic PD-These folks have an exaggerated sense of self-importance They believe that they are better than others and think that others should admire and praise them. They lack empathy, brag, and will “fish for compliments.” (e.g., They might state: “I look awful today” just so that someone will say “O no—you look fine.”)

4) Paranoid PD-Those with this disorder mistrust people. They are suspicious of others and will not share much personal information (e.g., with work colleagues).

5) Borderline PD-Those with this diagnosis have an unclear sense of who they are, feel empty, and are prone to bouts of anger. They can love an individual one day and hate them the next. Self-mutilation and fleeting psychotic states are also sometimes seen in those with this diagnosis.

6) Schizotypal PD-Those with this disorder exhibit odd behaviors and mannerisms. They may be disheveled and unkempt (e.g., body odor). They may believe in spirits or magic.

7) Obsessive-Compulsive PD-Those with this PD manifest a rigid personality structure. They like order and routine. They seek perfection. They may actually cancel vacations for fear that their work won’t be done correctly while they are away.

8) Histrionic PD-Individuals with this diagnosis seek to be the center of attention. They are often loud, overly dramatic and showy.

9) Dependent-These individuals need constant advice and reassurance on how to live their life. They “depend” on others to help them make even the most basic decisions (e.g., what to wear).

10) Avoidant PD-These individuals desire social interaction but fear negative evaluation from others. For instance, they may sign up for college classes but never show fearing that they will be rejected by their peers. They wish to interact, but their fear of negative evaluation prevents it.

Personality Disorders are difficult to treat, as traits become quite stable over time. Some individuals with personality disorders do not feel as if they are in any need of psychological intervention. Consider those with Narcissistic PD. They believe that they are fine and would not understand why anyone would suggest that they need help.

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