Final Questions

Final Questions

1. There are two types of fundamental symptoms of schizophrenia, positive and negative. Positive or Type I symptoms are characterized by unusual perceptions, thoughts, or behaviors. Such symptoms may include delusions, unlikely and nearly impossible ideas the individual believes to be true, hallucinations, unreal perceptual experiences, disorganized thought and speech, and catatonia, an extreme lack of responsiveness to the outside world. Negative symptoms, or Type II symptoms, are characterized by an absence of behaviors. Some negative symptoms may include affective flattening, a severe reduction or complete absence of emotional responses to the environment, alogia, a reduction in speaking, and avolition, the inability to persist at common, goal-oriented activities. Depression, anxiety, substance abuse, inappropriate affect, anhedonia, and impaired social skills are disorganized symptoms of schizophrenia. In a video during a class, a 40-year-old male schizophrenic patient displayed positive symptoms of schizophrenia. A mathematician, the patient suffered from some disorganized thought and speech and described having auditory hallucinations. This patient had type I schizophrenia with mostly positive symptoms. Unlike a patient with Type II schizophrenia, who would have mostly negative symptoms, this patient did not have affective flattening, avolition or alogia. (pages 378-388)

2. There are many theories regarding the role family environment plays in the development of schizophrenia in an individual. Psychodynamic theorists believe that schizophrenogenic mothers that are at the same time overprotective and rejecting of their children cause schizophrenia. They dominate their children, preventing them from developing a sense of self and causing them to feel worthless and unlovable. This theory had been disproved by scientific research because many mothers of individuals suffering from schizophrenia did not use this parenting style. The double-bind theory suggests that parents of schizophrenic patients force their children into a double bind by constantly communicating conflicting messages to them. These mixed behaviors prevent children from trusting their own feelings or perceptions, leading them to develop distorted perceptions of reality and later schizophrenia. While scientific research does not support this theory, it does suggest that odd communication patterns between parents and children can lead to stress that can later develop into schizophrenia. The expressed emotion theory hypothesizes that families high in expressed emotion can lead to the development of schizophrenia in biologically vulnerable individuals. Scientific evidence does support this theory, with research suggesting that patients in high expressed-emotion families relapsed sooner than the patients in low expressed-emotion families. {Discuss family}

3. Genetics is believed to be one biological factor related to the development of schizophrenia. Twin studies of schizophrenia suggest the that concordance rate for monozygotic twins is 46% but only 14% for dizygotic twins. Some twin studies have even found concordance rates as high as 75%. In an adoption study on schizophrenia in 1966, Leonard Heston found that 17% of adopted children whose birth mother had schizophrenia later developed the illness. This figure was similar to the 13% of children who grew up with a schizophrenic mother. These studies suggest that genetics, while not the only determinate factor of schizophrenia, does play a role in its development. Prenatal viral exposure is also believed to be a biological factor. Epidemiological studies show high rates of schizophrenia among individuals whose mothers were exposed to the influenza virus while pregnant. These rates were especially high among individuals whose mothers were infected during their second trimester, a crucial development period for the central nervous system. {Importance of family factors, write during test}

4. Individuals with paranoid schizophrenia have prominent delusions and hallucinations that involve themes of persecution and grandiosity. Most do not exhibit disorganized speech or behavior and may even be lucid and articulate. The combination of persecutory and grandiose delusions can lead to violent and sometimes suicidal behavior. Paranoid schizophrenics tend to be diagnosed later in life and have better prognoses than other schizophrenics. Disorganized schizophrenics do not have well-formed delusions or hallucinations but suffer from severely disorganized thoughts and behaviors. They may speak in word salads and appear disturbed. They also may not display emotional reactions or may have unusual and inappropriate emotional reactions to events. This type of schizophrenia tends to appear early and is often times unresponsive to treatments. A rare type of the disease, catatonic schizophrenia is not well researched. Catatonic schizophrenics display behaviors and ways of speaking that suggest almost complete unresponsiveness to their environment. They may senseless repeat words (echolalia) or repeat imitations of anothers movements (echopraxia) and suffer from catatonic stupors or excitement. In a video shown in class, a young woman suffering from paranoid schizophrenia suffered from delusions and hallucinations that led her to believe that being a lesbian was a sin and that God wished to kill her but did not have disorganized speech or behavior. {Loose Associations} The video of the interview with Sarah Palin demonstrated disorganized thought in Palins responses to the interviewers questions. Not only did her reply not include an answer to the question but it changed topics several times and did not make sense.

5. Individuals with delusional disorders have non-bizarre delusions of at least one months duration and function at a relatively high level. Those with paranoid schizophrenia suffer from delusions and hallucinations with themes of persecution and grandiosity. The two are different in their symptoms. Delusional disorders are more focused on delusions rather than other elements of schizophrenia like hallucinations, disorganized thought, speech, and behavior and negative symptoms. Symptoms of delusional disorders must persist for at least one month for a diagnosis but symptoms of paranoid schizophrenia must persist for at least six months. While both disorders involve paranoid delusions, paranoid schizophrenics tend to suffer from more grandiose paranoid delusions and have lower levels of functioning. Delusional disorder is different from paranoid personality disorder in that individuals with paranoid personality disorder suffer from intense feelings of mistrust rather than delusions of paranoia. They interpret ordinary situations and events in a paranoid manner but do not experience paranoid delusions.

7. Borderline symptoms: out of control emotions that cannot be soothed, hypersensitivity to abandonment, tendency to cling to tightly to other people, history of hurting oneself, unstable self-concept, unstable relationships, anxiety, depression

Antisocial symptoms: impairment in ability to form positive relationships, tendency to engage in behaviors that violate basic social norms/values, deceit, repetitive lying, tendency to commit violent crimes with little remorse, poor impulse control

Histrionic symptoms: rapidly shifting emotions, unstable relationships, desire to be center of attention, highly dramatic behavior and speech, overtly seductive, overly dependent

Narcissitic symptoms: highly dramatic, grandiose behaviors, seek admiration, shallow in emotional expressions & relationships with others, see dependency on others as weak, preoccupied with feelings of self-importance, make unreasonable demands in relationships

Avoidant symptoms: extremely anxious about criticism from others, avoid interactions with others, restrained & nervous during interactions with others, hypersensitive to being evaluated, depression, loneliness, feelings of unworthiness

Dependent symptoms: anxiety about interpersonal interactions, anxiety over need to be cared for by others, submit to unreasonable demands made by others, indecisiveness, can function only when in a relationship, fear of rejection and abandonement

Obsessive symptoms: perfectionism, dogmatic, ruminative, emotionally blocked, in control of emothions, lack spontaneity, workaholics, little desire for leisure activities

Ms. Hollywood is either borderline or narcissistic

8.

9. Women: depression, GAD, somatosization disorder, dissociative identity disorder, borderline personality disorder, dependent personality disorder, dementia, anorexia

Men: antisocial personality disorder, schizophrenia, paranoid personality disorder, schizoid personality disorder, schizotypal personality disorder, narcissitic personality disorder

Temporal differences: schizophrenia, dementia

11. Bipolar disorder: characterized by mania and depression, bipolar 1 and 2,

schizophrenia: risperidone (atypical antipsychotic), affects serotonin receptors and is a weak blocker of dopamine receptors. Dopamine excess in the mesolimbic pathway may contribute to schizophrenia

21. Symptoms: auditory hallucinations, depersonalization, anxiety, depression, substance abuse, feelings of loneliness and inadequacy, inability to maintain personal relationships

According to the DSM, I believe that this patient is suffering from depression with psychotic features and depersonalization disorder. I am diagnosing her with depression because of the episodes of depression and anxiety that she has experienced since childhood. She demonstrates several symptoms of depression including sadness, depressed mood, some anhedonia, in regards to social relationships and sex, sleep disturbances, feelings of worthlessness, poor self-esteem, and hallucinations with depressing themes. I believe that her depression has psychotic features because of her depression auditory and visual hallucinations featuring themes of extreme physical violence and suicide and her family history of schizophrenia. In the vignette, the patients depersonalization seems to be her most worrisome symptom and the accompanying anxiety with these episodes are what cause her to welcome hospitalization and treatment. She describes having frequent episodes in which she feels detached from her own body and in a trance. She describes herself as just an empty shell that is transparent to everyone. Its not schizophrenia because she has few negative and positive symptoms. She mentions experiencing auditory and visual hallucinations only recently and quite rarely and has not experienced any delusions. She also appears coherent and responsive with no signs of disorganized thought and speech, disorganized or catatonic behavior. Additionally, she displays no signs of affective flattening, alogia, avolition, inappropriate affect, or avolition. Her inability to maintain long-term relationships and friendships may suggest schizoid personality disorder. However, this diagnosis is unlikely because she does date regularly and has made attempts at forming stable friendships with roommates. An individual with schizoid personality disorder may have virtually no human contact and may make no effort to socialize with others.

22. After considering her symptoms, I believe that Ms. G is suffering from schizotypal personality disorder and depersonalization disorder. She displays distinguishing characteristics of the disorder from all four categories: paranoia, ideas of reference, odd beliefs or magical thinking and illusions. She is often paranoid that others talk about her after she leaves her apartment, causing her anxiety and forcing her to run errands and leave her home only very late at night. She also believes that random events relate to her. She thinks that ordinary statements made by others around her are secret messages relayed to her by the Virgin Mary, warning her of an impending visit. This belief of an upcoming visit from the Virgin Mary is an example of her odd beliefs and magical thinking. Her idea that secret messages are hidden all around her demonstrates the illusions she experiences. According to the vignette, she is constantly on the lookout for messages or clues that she believes will reveal to her when and where the visitation with occur. She is also suffering from depersonalization disorder because she describes having almost constant feelings of depersonalization and derealization. While schizotypal personality disorder is related to schizophrenia, Ms. G. does not fit that diagnosis because she demonstrates levels of high-functioning and is aware of her odd believes and acknowledges she may be mistaken in having them. She also has no catatonic symptoms nor does she experience hallucinations or delusions. While she does display some symptoms of antisocial personality disorder, she is not dominated by her avoidance of social interaction. Also, she does not appear deceitful and has no inclination towards violence.