Schizophrenia and Dissociative Disorders Notes

Schizophrenia – “split mind” Schizophrenia is the most debilitating of the psychological disorders and tends to strike in early adulthood. It is a thought disorder characterized by the following symptoms: Symptoms may be Positive or Negative: Positive symptoms are excesses in behavior (hallucinations, delusions, and disorganized speech and behavior). Negative symptoms are deficits in behavior (reduced emotional responsiveness, motivation, socialization, speech or movement). A. Cognitive Symptoms: 1. Hallucinations: perceptual experiences that do not have a basis in reality 2. Delusions: bizarre, false beliefs that have no basis in reality. Two types: delusions of grandeur and delusions of persecution. 3. Disturbed thought processes: Disorganized speech – neologisms (made up words) , clang association (linking words with similar sounds together/rhyming) , echolalia (repetition of words or phrases said by someone else) 4. Cognitive Flooding: Sensory overload B. Affective Symptoms: Flat affect or inappropriate C. Motor Symptoms: motor movements are random and purposeless 1. Syphilitic shuffle (Locomotor ataxia, a disorder of the spinal cord, often results in a characteristic shuffling gait.) 2. Repetitive movements ex. flapping 3. Catatonic State – fixed posture, mutism, imposed postures Diagnostic Criteria: At least two of the following must be present for one month: a. b. c. d. e. Delusions Hallucinations Disorganized speech Disorganized behavior Negative symptoms 3 Main Types of Schizophrenia 1. Disorganized Schizophrenia: Highest degree of psychological disorganization: regressive behaviors, lack of emotion, disorganized speech 2. Catatonic Schizophrenia – Characterized by psychomotor disturbance which is either stuperous or high degree of motor activity (flapping) : Waxy flexibility, reduced movement, rigid posture, sometimes too much movement 3. Paranoid Schizophrenia – Characterized by delusions of persecution or grandeur Physiological Abnormalities • • • • Enlarged ventricles Reduced size of hippocampus Increased size of basal ganglia: motor coordination, cognition, voluntary movement Abnormalities of the PFC The Dopamine Hypothesis: Schizophrenia is caused by an overactive dopamine system in the brain. Evidence FOR the Dopamine Theory of Schizophrenia: 1. Drugs that block dopamine (antagonists) reduce schizophrenic symptoms (disordered thoughts and behaviors). One side effect of antipsychotics is tardive dyskinesia: involuntary muscle contractions of the tongue, lips, trunk, and extremities. 2. Parkinson’s disease is characterized by symptoms like tardive dyskenisia and is treated with a drug called Ldopa, which increases dopamine levels. If given in excess, Ldopa causes schizophrenic-like distortions in thought. Ldopa is an agonist – it mimics dopamine. 3. High doses of amphetamines cause schizophrenic-like symptoms in a disorder called "substance induced psychotic disorder." Amphetamine psychosis is a model for schizophrenia because drugs that treat amphetamine psychosis also reduce schizophrenic symptoms. Amphetamines also make the symptoms of schizophrenia worse. 4. Children at risk for schizophrenia may have brain wave patterns similar to adults with schizophrenia. These abnormal brain wave patterns in children can be reduced by drugs that block dopamine receptors. Evidence AGAINST the Dopamine Theory of Schizophrenia: Amphetamines do more than increase dopamine levels. They also alter other neurotransmitter levels. 1. Drugs that block dopamine receptors act on receptors quickly. However, these drugs sometimes take many days to change the behavior of people with schizophrenia. 2. New drugs for schizophrenia, for example, clozapine, block receptors for both serotonin and dopamine. Treatment: Antipsychotics – developed in the 1950’s. Reduce symptoms of schizophrenia. Dissociative Disorders Dissociative disorders are so-called because they are marked by a dissociation from or interruption of a person's fundamental aspects of waking consciousness (such as one's personal identity, one's personal history, etc.). All of the dissociative disorders are thought to stem from trauma experienced by the individual with this disorder. The dissociative aspect is thought to be a coping mechanism -- the person literally dissociates himself from a situation or experience too traumatic to integrate with his conscious self. Dissociative amnesia: This disorder is characterized by a blocking out of critical personal information, usually of a traumatic or stressful nature. Dissociative amnesia, unlike other types of amnesia, does not result from other medical trauma (e.g. a blow to the head). Dissociative amnesia has several subtypes: Dissociative fugue is a rare disorder. An individual with dissociative fugue suddenly and unexpectedly takes physical leave of his or her surroundings and sets off on a journey of some kind. These journeys can last hours, or even several days or months. Individuals experiencing a dissociative fugue have traveled over thousands of miles. An individual in a fugue state is unaware of or confused about his identity, and in some cases will assume a new identity (although this is the exception). Dissociative identity disorder (DID), which has been known as multiple personality disorder, is the most famous of the dissociative disorders. An individual suffering from DID has more than one distinct identity or personality state that surfaces in the individual on a recurring basis. There are also significant gaps in the recall of every day events that are inconsistent with everyday forgetting. This disorder is also marked by differences in memory which vary with the individual's "alters," or other personalities. Treatment Since dissociative disorders seem to be triggered as a response to trauma or abuse, treatment for individuals with such a disorder may stress psychotherapy, although a combination of psychopharmacological and psychosocial treatments is often used. Many of the symptoms of dissociative disorders occur with other disorders, such as anxiety and depression, and can be controlled by the same drugs used to treat those disorders. A person in treatment for a dissociative disorder might benefit from antidepressants or anti-anxiety medication. Revised April 2016