Symptoms of Schizophrenia

Positive (present) symptoms reflect presence, or addition of symptoms not seen in normal people -

voices

delusions

Negative (absent) symptoms reflect absence of things normally seen in normal people -

"flat" affect

social avoidance

Types of Schizophrenia:

disorganized -

disturbed thinking

hallucinations

disorganized speech

bizarre behavior

catatonic schizophrenia -

withdraws from world

may sit immobile for long time

speaks very little

paranoid schiz -

hallucinations and delusions that are marked by paranoia

persecution beliefs

can be dangerous

undifferentiated -

symptoms don't allow clear diagnosis in other categories.

residual schiz -

category for people who had major episode, but now show no or minor symptoms.

Rosenhan's "Sane in Insane Places" investigation:

Went to hospitals, said they heard voices, then once checked in, reported no more symptoms

Eventually released from hospitals - 7 to 52 days later, most with diagnosis of "schizophrenia in remission"

Raises issue of labeling

Anxiety Disorders

(Axis I disorders)

Estimated 15% of population in US experience at some point.

Phobias - persistent, irrational, disruptive fears

More common in women than men

Sometimes linked with initial traumatic experience with trigger

systematic desensitization - common treatment for phobias

Obsessive compulsive disorder: disorder marked by persistent, uncontrollable intrusions of unwanted thoughts (obsessions) and urges to engage in senseless rituals (compulsions)

Post Traumatic Stress Disorder (PTSD) - anxiety or dissociative disorder?

WWI soldiers

first appeared in DSM-III

Intrusive symptoms:

- flashbacks

- nightmares

- intrusive thoughts

Avoidance & numbing symptoms:

- detachment from experience, from other people

- loss of memory for parts of the traumatic memory

- efforts to avoid thinking about or being reminded of event

Arousal symptoms:

- extreme alertness

- exaggerated startle reaction

- difficulty sleeping or concentrating, because of hypervigilance

Diagnostic criteria also requires

1. exposure to possible death or serious injury (trauma) AND

2. response to this exposure that involved fear, helplessness or horror

DSM-IIIR (1987) - trauma had to be: "Outside range of normal human experience"

IN DSM-IV (1994) - "outside of normal range" criteria dropped

Is PTSD really an anxiety disorder or a dissociative disorder?

Complex PTSD (Judith Herman) - in response to ongoing trauma or in context of prolonged relationship

Dissociation - at root, "unlinking"

disruption in integration of identity, consciousness, memory or perception.

Mild example: highway hypnosis

More extreme symptoms:

1. Depersonalization experience - sensation that life is happening to someone else, floating outside body

2. Derealization - sensation that what is happening is not real.

3. Lose of memory for entire events or periods of your life

Dissociation as twisted form of coping?

Betrayal Trauma Theory (Jennifer Freyd)

Paradox: children who are abused by their parents also have to rely on those parents.

Recovered memory vs. False memory debate

Dissociative Identity Disorder (Multiple Personality Disorder) -

2 or more distinct identities that recurrently take control of the body

Mood Disorders:

Depression (unipolar)

Bipolar Disorder (Manic Depression)

Bipolar Disorder

Strong apparent genetic link (identical twin - 72% chance)

Roughly equal in men and women

Depressed "pole" looks like major depression

Up pole called mania --

feeling self importance

expansive plans

high self-esteem

have difficulty concentrating

sleep little

act euphoric

highly active

Kay Redfield Jamison - An Unquiet Mind

Depression - Prevalence Estimates:

Nearly 1 in 5 Americans will experience at some point in their lives

1 in 20 Americans are severely depressed at any time.

Sex difference in prevalence

Why? (we don't really know)

Biological theories

Cultural theories

women ruminate; men distract?

Comorbidity - co-occurrence of more than one disorder

Major depression has to persist beyond a few days; not given as diagnosis for someone who has just experienced death of love one.

Feeling down has to extend beyond what is considered "normal" and interfere with ability to function.

Symptoms of Depression:

discouraged, sad, lacking hope, irritable

lethargic (lack of energy, motivation, feel tired)

loss of enthusiasm

low self-esteem

sleep changes (sleeping more or can't sleep)

appetite changes (eating more or less)

loss of interest in sex

Course of depression

Majority of cases of depression will dissipate in 5-10 months, even without treatment.

40% of people experiencing depression will recover, but will experience depression again.

10% of people experiencing depression stay accutely depressed.

(Remaining 50% of people experiencing depression will not have it again)

Many questions about why depression is cyclical: Is there biological vulnerability that led them to get depressed to begin with, and makes them depressed again?

Or, does having depression itself make you more likely to get depressed?

Multiple triggers/vulnerability factors for similar outcome:

- Early childhood loss, esp. death of a parent

- Depressive thinking style

Negative thoughts about self, the world and one's future

Depressive attributional thinking (internal, stable and global for negative outcomes)

- Depressive spiral - initial depressing event prevents person from getting positive reinforcement.

Seasonal Affective Disorder (SAD) - related to short days

light helps set ciradian rhythms, affect hormone melatonin

treated with special therapeutic lights

Post-partum Depression - 2/3 of women experience "baby blues" (first few days or weeks)

True postpartum depression, 10-20%, and interferes more

- associated with very high expectations

- other changes in life at same time

- lacking support network