Abnormal Psychology Test 3 (Ch 14-15)

Token Economy Program

A behavioral program in which a person's desirable behaviors are reinforced systematically throughout the day by the awarding of tokens that can be exchanged for goods or privileges. In token economies, patients are rewarded when they behave acceptably and are not rewarded when they behave unacceptably.

Case Manager

A community therapist who offers a full range of services for people with schizophrenia or other severe disorders, including therapy, advice, education, guidance, and protection of patients' rights

Milieu Therapy

A humanistic approach to institutional treatment based in the premise that institutions can help patients recover by creating a climate that promotes self-respect, responsible behavior, and meaningful activity. It is that institutions cannot be of help to patients unless they can somehow create a social climate, or milieu, that promotes productive activity, self respect, and individual responsibility

Agranulocytosis

A life-threatening drop in white blood cells. This condition is sometimes produced by the atypical antipsychotic drug clozapine.

Family Therapy

A patient's therapy may be strongly influenced by the behavior and reactions of his or her relatives at home. Provides family with guidance, training, practical advice, psychoeducation about the disorder, and emotional support and empathy. The families of people with schizophrenia and other severe mental disorders may also turn to faily support groups and family psychoeducational programs for encouragement and advice.

Aftercare

A program of posthospitalization care and treatment in the community.

Day Center

A program that offers hospital-like treatment in the community.

Scizophrenia

A psychotic disorder in which personal, social and occupational functioning deteriorate as a result of unusual perceptions, odd thoughts, disturbed emotions, and motor abnormalities.

Halfway House

A residence for people with schizophrenia or other severe problems, often staffed by paraprofessionals. Also known as a group home or crisis house.

Psychosis

A state in which a person loses contact with reality in key ways

Sheltered Workshop

A supervised workplace for people who are not yet ready for competitive jobs.

Community Mental Health Center

A treatment facility that provides medication, psychotherapy, and emergency care for psychological problems and coordinates treatment in the community.

Schizophrenogenic Mother

A type of mother- supposedly cold, domineering, and uninterested in the needs of her children- who was once thought to cause schizophrenia in her child.

Course of Schizophrenia

Although its course varies widely from case to case, many sufferers seem to go through three phases- prodromal, active and residual. During the prodromal phase, symptoms are not yet obvious, but the person is beginning to deteriorate. He or she may withdraw socially, speak in vague or odd ways, develop strange ideas, or express little emotion. During the active phase, symptoms become apparent. Sometimes this phase is triggered by stress or trauma in the person's life. Many people eventually enter a residual phase in which they return to a prodromal-like level of functioning. Each of these phases may last for months or years. A fuller recovery from schizophrenia is more likely in people who functioned quite well before the disorder (had good premorbid functioning)

Behavioral View

Behaviorists usually cite operant conditioning and principles of reinforcement as the cause of schizophrenia. As they attend more and more to irrelevant cues, their responses become increasingly bizarre. Because the bizarre responses are rewarded with attention or other types of reinforcement, they are likely to repeated again and again.

Psychotherapy

By helping people to relieve thought and perceptual disturbances, antipsychotic drugs allow people to learn about their disorder and participate actively in therapy, think more about themselves and their relationships, make changes in their behavior, and cope with stressors in their lives. The most helpful forms include cognitive-behavioral therapy and two sociocultural interventions- family therapy and social therapy. Often the various approaches are combined.

Formed Thought Disorders

Can cause the sufferer great confusion and make communication extremely difficult. Often such thought disorders take the form of positive symptoms, as in loose associations, neologisms, persevation, and clang. People who have loose associations, aka derailment, the most common formal thought disorder, rapidly shift from one topic to another, believing that their incoherent statements make sense. Some people use neologisms, made up words that have meaning only to the person using them. Some also use clang, or rhyme to think or express themselves.

Community Approach

Community mental health act was passed which stipulated that patients with psychological disorders were to receive a range of mental health services- outpatient therapy, inpatient therapy, emergency care, preventive care, and aftercare- in their communities rather than being transported to institutions far from home.

Cognitive View

Congruent with biological view, however, when people attempt to understand their unusual experiences, more features of their disorder emerge.

Neuroleptic Drugs

Conventional antipsychotic drugs, so called because they often produce undesired effects similar to the symptoms of neurological disorders

Antipsychotic Drugs

Drugs that help correct grossly confused or distorted thinking

Tardive Dyskinesia

Extrapyramidal effects involving involuntary movements that some patients have after they have taken conventional antipsychotic drugs for an extended time.

Psychological Views: Psychodynamic Explanation

Freud believed that schizophrenia develops from two psychological processes: regression nto a pre-ego stage and efforts to re-establish ego control. Some people also regress to the earliest point in their development, to the pre-ego state of primary narcissism, in which they recognize and meet only their own needs.

Delusions

Ideas that they believe wholeheartedly but have no basis in fact. They may consider the ideas enlightening or may feel confused by them. Delusions of persecution are the most common. People with such delusions believe that they are being plotted of discriminated against, spied on, slandered, threatened, attacked, etc. People may also have delusions of reference: they attach specific and personal meaning to the actions of others or to various objects or events. People with delusions of grandeur believe themselves to be great inventors, religious savors, or other specially empowered persons. People with delusions of control believe their feelings, thoughts, and actions are being controlled by other people.

Social Labeling

Many believe that the features of schizophrenia are influenced by the diagnosis itself.

Psychomotor Symptoms

Many move relatively slowly and a number make awkward movements or repeated grimaces and odd gestures that seem to have a private purpose- perhaps ritualistic or magical. May take certain extreme forms, such as catatonia. People in a catatonic stupor stop responding to their environment, remaining motionless and silent for long stretches of time.

Inappropriate Affect

Many people with schizophrenia display inappropriate affect, emotions that are unsuited to the situation. They may smile when making a somber statement or upon being told terrible news, or they may become upset in situations that should make them happy.

Loss of Volition

Many people with schizophrenia experience avoilition, or apathy, feeling drained of energy and of interest in normal goals and unable to start or follow through on a course of action. This problem is particularly common in people who have had schizophrenia for many years, as if they have been worn down by it. Similarly, people with schizophrenia may feel ambivalence, or conflicting feelings, about most things.

Restricted Affect

Many people with schizophrenia have a blunted affect- they show less anger, sadness, joy, and other feelings than most people. And some show no emotion at all, called flat affect. In some cases, they may have anhedonia, a general lack of pleasure or enjoyment.

Diagnosing Schizophrenia

Many researchers believe that in order to help predict the course of schizophrenia, there should be a distinction between so-called type I and type II. People with type I are thought to be dominated by positive symptoms, such as delusions, hallucinations, and certain formal thought disorders. Those with type II have more negative symptoms, such as restricted affect, poverty of speech, and loss of volition. The positive symptoms of type I may be linked more closely to biochemical abnormalities in the brain, while the negative symptoms of type II may be tied largely to structural abnormalities in the brain.

Schizoaffective Disorder Key Features

Marked Symptoms of both schizophrenia and a major depressive episode or a manic episode (6 Months or More)

Social Withdrawal

May withdraw from their social environment and attend only to their own ideas and fantasies. Can distance them further from reality.

Sociocultural: Multicultural Factors

More prevalent in African Americans and more likely to have hallucinations, paranoia, and suspiciousness.

Family Dysfunctioning

One of the best known family theories of schizophrenia is the double-bind hypothesis. It says that some parents repeatedly communicate pairs of mutually contradictory messages that place children in so-called double bind situations: the children cannot avoid displeasing their parents because nothing they do is right. Double bind messages typically consist of a verbal communication (the primary communication) and an accompanying- and contradictory- nonverbal communication (the metacommunication). Family theorists have long recognized that some families are high in expressed emotion- that is, members frequently express criticism, disapproval, and hostility toward each other and intrude on one another's privacy. People who are trying to recover from schizophrenia are almost four times more likely to relapse if they live with such a family than if they live with one low in expressed emotion.

Positive Symptoms

Pathological excesses or bizarre additions to a person's behavior. Delusions, disorganized thinking, and speech, heightened perceptions and hallucinations, and inappropriate affect are the ones found most often in schizophrenia.

Perception and Attention Problems with Schizophrenia

People with schizophrenia have demonstrated deficiencies in smooth pursuit rapid eye movement, weaknesses that may be related to attention problems. Another kind of perceptual problem consists of hallucinations, perceptions that a person has in the absence of external stimuli. People who have auditory hallucinations, by far the most common, hear sounds and voices that seem to come from outside their heads.

Poverty of Speech

People with schizophrenia often have alogia, or poverty of speech, a reduction in speech or speech content. Some people with this negative kind of formal thought disorder think and say very little. Other says quite a but but still manage to convey little meaning.

Delusional Disorder Key Features

Persistent delusions that are not bizarre and not due to schizophrenia; persecutory, jealous, grandiose, and somatic delusions are common (1 Month or More)

Cognitive-Behavioral Therapy

Provide clients with education and evidence about the biological causes of hallucinations; they help clients learn more about the "comings and goings" of their own hallucinations and delusions. The clients learn, for example, to identify which kinds of events and situations trigger the voices in their heads; the therapists challenge their clients' inaccurate ideas about the power of their hallucinations, such as the idea that the voices are all-powerful and uncontrollable and must be obeyed. The therapists also have the clients conduct behavioral experiments to put such notions to the test; The therapists teach clients to reattribute and more accurately interpret their hallucinations. Clients may, for example, adopt and apply alternative explanations; and the therapists teach clients techniques for coping with their unpleasant sensations (hallucinations). The clients may learn ways to reduce the physical arousal that accompanies hallucinations-using special breathing and relaxation techniques.

Biological Factors of Schizophrenia: Genetic Factors

Researchers believe that some people inherit a biological disposition to schizophrenia and develop the later disorder when they face extreme stress. The genetic view has been supported by studies of relatives of people with schizophrenia, twins with schizophrenia, people with schizophrenia who are adopted, and genetic linkage and molecular biology. Identical twins have a higher concordance rate than fraternal twins. The biological relatives of adoptees with schizophrenia are more likely than their adoptive relatives to develop to schizophrenia. Schizophrenia most likely a polygenic disorder, caused by a combination of gene defects.

Biological Factors of Schizophrenia: Biochemical Abnormalities

Researchers have developed a dopamine hypothesis (the theory that schizophrenia results from excessive activity of the neurotransmitter dopamine). There was an accidental discovery of antipsychotic drugs, medications that help remove the symptoms of schizophrenia. The first group, the phenothiazines, were first made to combat allergies. Atypical antipsychotic drugs, also known as second-generation antiphychotic drugs, are a relatively new group of antipsychotic drugs whose biological action is different from that of the traditional antipsychotic drugs. With abnoral brain structures, using brain scans, they have found that many people with schizophrenia have enlarged ventricles- the brain cavities that contain cerebrospinal fluid.Some investigators also suggest that the brain abnormalities come from viruses before birth

Social Therapy

Social therapy, or personal therapy, does indeed help keep people out of the hospital.

Negative Symptoms

THose that seem to be pathological deficiencies, characteristics that are lacking in a person. Poverty of speech, blunted and flat affect, loss of volition, and social withdrawal are commonly found in schizophrenia.

Deinstitutionalization

The discharge of large numbers of patients from long-term institutional care so that they might be treated in community programs.

Symptoms of Schizophenia

The symptoms can be grouped into three categories: positive symptoms (excesses of thought, emotion, and behavior) negative symptoms (deficits of thought, emotion, and behavior), and psychomotor symptoms (unusual movements or gestures). Some people are more dominated by positive symptoms and others by negative, although most tend to have both kinds of symptoms to some degree.

Sociocultural Views

Theorists, recognizing that people with mental disorders are subject to a wide range of social and cultural forces, believe that multicultural factors, social labeling, and family dysfunctioning all contribute to schizophrenia.

Extrapyramidal Effects

Unwanted movements, such as severe shaking, bizarre-looking grimaces, twisting of the body, and extreme restlessness, sometimes produced by conventional antipsychotic drugs. They appear to be caused by the drugs' impact on the extrapyramidal areas of the brain, areas that help control motor activity. These undesired effects include Parkinsonian and related symptoms, neuroleptic malignant symptoms, and tardive dyskinesia.

Schizophreniform Disorder Key Features

Various psychotic symptoms, such as delusions, hallucinations, disorganized speech, restricted or inappropriate affect, and catatonia (For 1-6 Months)

Brief Psychotic Disorder Key Features

Various psychotic symptoms, such as delusions, hallucinations, disorganized speech, restricted or inappropriate affect, and catatonia (For Less than One Month)

Schizophrenia Key Features

Various psychotic symptoms, such as delusions, hallucinations, disorganized speech, restricted or inappropriate affect, and catatonia. (For 6 Months or More)

R.D. Laing's View

combined sociocultural principles with existential philosophy, arguing that schizophrenia is actually a constructive process in which people try to cure themselves of the confusion and unhappiness caused by their social environment.