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. uch symptoms may include delusions, unli!ely and nearly impossible ideas
the individual believes to be true, hallucinations, unreal perceptual e"periences,
disorganized thought and speech, and catatonia, an e"treme lac! of responsiveness to the
outside world. #egative symptoms, or Type II symptoms, are characterized by an
absence of behaviors. ome negative symptoms may include affective flattening, a severe
reduction or complete absence of emotional responses to the environment, alogia, a
reduction in spea!ing, and avolition, the inability to persist at common, goal$oriented
activities. %epression, an"iety, substance abuse, inappropriate affect, anhedonia, and
impaired social s!ills are disorganized symptoms of schizophrenia. In a video during a
class, a &'$year$old male schizophrenic patient displayed positive symptoms of
schizophrenia. ( mathematician, the patient suffered from some disorganized thought and
speech and described having auditory hallucinations. This patient had type I
schizophrenia with mostly positive symptoms. )nli!e a patient with Type II
schizophrenia, who would have mostly negative symptoms, this patient did not have
affective flattening, avolition or alogia. *pages +,-$+--.
/. 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 re0ecting 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$bind theory suggests that
parents of schizophrenic patients force their children into a double bind by constantly
communicating conflicting messages to them. These mi"ed behaviors prevent children
from trusting their own feelings or perceptions, leading them to develop distorted
perceptions of reality and later schizophrenia. 1hile scientific research does not support
this theory, it does suggest that odd communication patterns between parents and children
can lead to stress that can later develop into schizophrenia. The e"pressed emotion theory
hypothesizes that families high in e"pressed emotion can lead to the development of
schizophrenia in biologically vulnerable individuals. cientific evidence does support this
theory, with research suggesting that patients in high e"pressed$emotion families relapsed
sooner than the patients in low e"pressed$emotion families. 2%iscuss family3
+. 4enetics is believed to be one biological factor related to the development of
schizophrenia. Twin studies of schizophrenia suggest the that concordance rate for
monozygotic twins is &56 but only 1&6 for dizygotic twins. ome twin studies have
even found concordance rates as high as ,76. In an adoption study on schizophrenia in
1855, 9eonard :eston found that 1,6 of adopted children whose birth mother had
schizophrenia later developed the illness. This figure was similar to the 1+6 of children
who grew up with a schizophrenic mother. These studies suggest that genetics, while not
the only determinate factor of schizophrenia, does play a role in its development. Prenatal
viral e"posure is also believed to be a biological factor. ;pidemiological studies show
high rates of schizophrenia among individuals whose mothers were e"posed to the
influenza virus while pregnant. These rates were especially high among individuals
whose mothers were infected during their second trimester, a crucial development period
for the central nervous system. 2Importance of family factors, write during test3
&. Individuals with paranoid schizophrenia have prominent delusions and hallucinations
that involve themes of persecution and grandiosity. <ost do not e"hibit disorganized
speech or behavior and may even be lucid and articulate. The combination of persecutory
and grandiose delusions can lead to violent and sometimes suicidal behavior. Paranoid
schizophrenics tend to be diagnosed later in life and have better prognoses than other
schizophrenics. %isorganized schizophrenics do not have well$formed delusions or
hallucinations but suffer from severely disorganized thoughts and behaviors. They may
spea! 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. (
rare type of the disease, catatonic schizophrenia is not well researched. =atatonic
schizophrenics display behaviors and ways of spea!ing that suggest almost complete
unresponsiveness to their environment. They may senseless repeat words *echolalia. or
repeat imitations of another>s movements *echopra"ia. and suffer from catatonic stupors
or e"citement. 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 4od wished to !ill her but did not have disorganized speech
or behavior. 29oose (ssociations3 The video of the interview with arah Palin
demonstrated disorganized thought in Palin>s responses to the interviewer>s ?uestions.
#ot only did her reply not include an answer to the ?uestion but it changed topics several
times and did not ma!e sense.
7. Individuals with delusional disorders have non$bizarre delusions of at least one
month>s duration and function at a relatively high level. Those with paranoid
schizophrenia suffer from delusions and hallucinations with themes of persecution and
grandiosity. The two are different in their symptoms. %elusional disorders are more
focused on delusions rather than other elements of schizophrenia li!e hallucinations,
disorganized thought, speech, and behavior and negative symptoms. ymptoms of
delusional disorders must persist for at least one month for a diagnosis but symptoms of
paranoid schizophrenia must persist for at least si" months. 1hile both disorders involve
paranoid delusions, paranoid schizophrenics tend to suffer from more grandiose paranoid
delusions and have lower levels of functioning. %elusional disorder is different from
paranoid personality disorder in that individuals with paranoid personality disorder suffer
from intense feelings of mistrust rather than delusions of paranoia. They interpret
ordinary situations and events in a paranoid manner but do not e"perience paranoid
delusions.
,. @orderline symptomsA out of control emotions that cannot be soothed, hypersensitivity
to abandonment, tendency to cling to tightly to other people, history of hurting oneself,
unstable self$concept, unstable relationships, an"iety, depression
(ntisocial symptomsA impairment in ability to form positive relationships, tendency to
engage in behaviors that violate basic social normsBvalues, deceit, repetitive lying,
tendency to commit violent crimes with little remorse, poor impulse control
:istrionic symptomsA rapidly shifting emotions, unstable relationships, desire to be center
of attention, highly dramatic behavior and speech, overtly seductive, overly dependent
#arcissitic symptomsA highly dramatic, grandiose behaviors, see! admiration, shallow in
emotional e"pressions C relationships with others, see dependency on others as wea!,
preoccupied with feelings of self$importance, ma!e unreasonable demands in
relationships
(voidant symptomsA e"tremely an"ious about criticism from others, avoid interactions
with others, restrained C nervous during interactions with others, hypersensitive to being
evaluated, depression, loneliness, feelings of unworthiness
%ependent symptomsA an"iety about interpersonal interactions, an"iety 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 re0ection and abandonement
Dbsessive symptomsA perfectionism, dogmatic, ruminative, emotionally bloc!ed, in
control of emothions, lac! spontaneity, wor!aholics, little desire for leisure activities
<s. :ollywood is either borderline or narcissistic
-.
8. 1omenA depression, 4(%, somatosization disorder, dissociative identity disorder,
borderline personality disorder, dependent personality disorder, dementia, anore"ia
<enA antisocial personality disorder, schizophrenia, paranoid personality disorder,
schizoid personality disorder, schizotypal personality disorder, narcissitic personality
disorder
Temporal differencesA schizophrenia, dementia
11. @ipolar disorderA characterized by mania and depression, bipolar 1 and /,
schizophreniaA risperidone *atypical antipsychotic., affects serotonin receptors and is a
wea! bloc!er of dopamine receptors. %opamine e"cess in the mesolimbic pathway may
contribute to schizophrenia
/1. ymptomsA auditory hallucinations, depersonalization, an"iety, depression, substance
abuse, feelings of loneliness and inade?uacy, inability to maintain personal relationships
(ccording to the %<, 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 an"iety that she has e"perienced since
childhood. he demonstrates several symptoms of depression including sadness,
depressed mood, some anhedonia, in regards to social relationships and se", 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 e"treme physical
violence and suicide and her family history of schizophrenia. In the vignette, the patient>s
depersonalization seems to be her most worrisome symptom and the accompanying
an"iety with these episodes are what cause her to welcome hospitalization and treatment.
he describes having fre?uent episodes in which she feels detached from her own body
and in a trance. he describes herself as E0ust an empty shell that is transparent to
everyone.F It>s not schizophrenia because she has few negative and positive symptoms.
he mentions e"periencing auditory and visual hallucinations only recently and ?uite
rarely and has not e"perienced any delusions. he also appears coherent and responsive
with no signs of disorganized thought and speech, disorganized or catatonic behavior.
(dditionally, she displays no signs of affective flattening, alogia, avolition, inappropriate
affect, or avolition. :er inability to maintain long$term relationships and friendships may
suggest schizoid personality disorder. :owever, this diagnosis is unli!ely because she
does date regularly and has made attempts at forming stable friendships with roommates.
(n individual with schizoid personality disorder may have virtually no human contact
and may ma!e no effort to socialize with others.
//. (fter considering her symptoms, I believe that <s. 4 is suffering from schizotypal
personality disorder and depersonalization disorder. he displays distinguishing
characteristics of the disorder from all four categoriesA paranoia, ideas of reference, odd
beliefs or magical thin!ing and illusions. he is often paranoid that others tal! about her
after she leaves her apartment, causing her an"iety and forcing her to run errands and
leave her home only very late at night. he also believes that random events relate to her.
he thin!s that ordinary statements made by others around her are secret messages
relayed to her by the Girgin <ary, warning her of an impending visit. This belief of an
upcoming visit from the Girgin <ary is an e"ample of her odd beliefs and magical
thin!ing. :er idea that secret messages are hidden all around her demonstrates the
illusions she e"periences. (ccording to the vignette, she is Econstantly on the loo!out for
messages or clues that she believes will reveal to her when and where the visitation with
occur.F he is also suffering from depersonalization disorder because she describes
having almost Econstant feelings of depersonalization and derealization.F 1hile
schizotypal personality disorder is related to schizophrenia, <s. 4. does not fit that
diagnosis because she demonstrates levels of high$functioning and is aware of her odd
believes and ac!nowledges she may be mista!en in having them. he also has no
catatonic symptoms nor does she e"perience hallucinations or delusions. 1hile she does
display some symptoms of antisocial personality disorder, she is not dominated by her
avoidance of social interaction. (lso, she does not appear deceitful and has no inclination
towards violence.