POBLACIÓN POR RANGOS DE EDAD
PEA DEL SUBDISTRITO URBANO 7
C.- Nivel de satisfacción de las necesidades básicas
MULTIPLE-CHOICE 1. b (p. 241) 5 . a (p. 247) 9. c (p. 269) 2. c (p. 241-242) 6. d (p. 252) 10. d (p. 273) 3. c (p. 245-246) 7. b (p. 256) 4. a (p. 246) 8. c (p. 266) SHORT ANSVVER
1 . Change in sleep, eating, activity. Loss of interest, concentration, and energy. Social withdrawal. Negative feelings about self, thoughts of suicide. (p. 241)
Childhood over or undergratification leaves the person overly dependent. Thus, following a loss, they cannot be angry at the person for leaving them and turn the anger inward. (p. 246)
2.
3 . Emphasizes hopelessness. Individuals have low self-esteem and attribute negative experiences to factors which are internal, stable, global. Thus they feel hopeless. (p. 250- 25 1)
Manics reported good self-esteem but showed poor self-esteem on an indirect test (inferring esteem of the character in a short story). (p. 253)
(a) Study metabolic byproducts of neurotransmitters in the blood, urine, etc. (b) Study whether drugs that influence neurotransmitters also influence the disorders. (p. 254-255) The neuroendocrine system consists of brain areas (hypothalamus, etc.) that release hormones which influence depression-related behaviors such as appetite, sleep. Overactivity in these areas could be part of depression. (p. 256)
Help clients identify and change their beliefs using logical analysis, providing contrary examples or experiences, etc. (p. 257-258)
Advantage: they hasten recovery. Disadvantages: drug side-effects, relapse common if drug is discontinued. (p. 265)
Tests could not detect situational causes. Suicide is so very infrequent tests cannot predict accurately enough. (p. 257)
Schneidman emphasizes helping them to find and consider other alternatives (also to reduce suffering, reconsider suicide). (p. 275-276)
4. 5 . 6. 7 . 8. 9. 10 .
OVERVIEW
Chapters 10 and 11 discuss two disorders that have been the subject of extensive research. Similar physiological theories have developed implicating brain neurotransmitters in both disorders. Mood disorders (Chapter 10) have been the subject of extensive psychological and physiological research with effective treatments emerging from both areas. Schizophrenia (Chapter 11) has led to even more extensive study, at least in part because no overt cure exists. Of all the disorders covered in the text, schizophrenia comes closest to the common understanding of being “crazy.” Despite extensive study, it remains a major concern both socially and scientifically. Historically, psychopathologists have disagreed on how to define schizophrenia and even on whether the term refers to one or to several different problems. Despite recent advances, no cure for schizophrenia has emerged. Currently a combination of approaches emphasizing drugs can manage, but not cure, the problem. Schizophrenics are a major portion of mental hospital and health clinic patients.
After Chapter 11, the focus of the text shifts to disorders that often seem to be more social and behavioral in nature. These include substance abuse and dependence disorders (Chapter 12), personality disorders including antisocial personality disorder (Chapter 13), and sexual and gender identity disorders (Chapter 14).
CHAPTER SUMMARY
Schizophrenia is a complex disorder and difficult to define. The Clinical Symptoms of Schizophrenia include positive symptoms (or behavioral excesses such as confused thinking and speaking) and negative symptoms (or behavioral deficits including lack of energy, interest, and feelings).
The History of the Concept of Schizophrenia has included two traditions. Many American ideas about schizophrenia developed out of Bleuler’s broad, psychoanalytically based definition. Recent DSM editions have moved toward Kraepelin’s narrower, descriptive (rather than theoretical) approach, which has always been popular in Europe. Currently DSM-IV recognizes three subcategories of schizophrenia. Disorganized schizophrenics exhibit blatantly bizarre and silly behaviors. Catatonic schizophrenics show primarily motor symptoms including wild excitement and apathetic withdrawal to the point of immobility. Paranoid schizophrenics have well- organized delusions of persecution, grandiosity, and jealousy. Current research suggests the distinction between positive and negative symptoms represents another useful way to subcategorize schizophrenia.
Chapter
11
124 Chapter 1 1
Research on the Etiology of Schizophrenia has been extensive. Genetic, biochemical, and neurological data strongly suggest a biological diathesis to schizophrenia. Genetic data from family, twin, and more sophisticated adoptee studies all point to a genetic predisposition to schizophrenia. Biochemical research suggests excessive activity in nerve tracts of the brain that utilize the neurotransmitter dopamine for some schizophrenics. New neurological techniques suggest brain atrophy in schizophrenics with negative symptoms. Prenatal infections may be involved for these individuals.
Other research has looked at social class, family, and other variables. Since schizophrenia runs in families it is possible to select and follow children with a high risk of becoming schizophrenic. These studies suggest stressors that may potentiate the diatheses suggested by biological research. Many biological and psychological Therapies f o r Schizophrenia have been attempted. Antipsychotic drugs were a major advance. However schizophrenics need additional help to cope with social living. Traditional psychotherapeutic approaches have not been very effective with schizophrenics, but family and behavioral methods show promise. There remains a need to integrate skills and knowledge of various disciplines in order to help schizophrenics lead as normal a life as possible.
ESSENTIAL CONCEPTS
1 .
Most symptoms of schizophrenia can be grouped into positive symptoms (or behavioral excesses such as confused thinking and speaking) and negative symptoms (or behavioral deficits including lack of energy, interest, and feelings).Historic definitions of schizophrenia included Kraepelin's concept of dementia praecox and Bleuler's concept of loose associative threads. Currently DSM-IV has moved to Kraepelin's narrower definition.
DSM-IV defines three major subcategories of schizophrenia: disorganized, catatonic, and paranoid. These subcategories are limited. Research suggests the distinction between positive and negative symptoms may provide more useful distinctions.
Evidence from family, twin, and adoptee studies indicates a substantial genetic diathesis to schizophrenia, although this alone cannot fully explain the disorder's etiology.
Extensive research links dopamine activity in particular brain tracts to schizophrenia. The evidence suggests that both genetic and prenatal factors may lead to dopamine tract changes.
There is a link between low social status and schizophrenia. Sociogenic and social-selection explanations have been offered for this correlation.
Early theories that family issues cause schizophrenia have been discredited. However family patterns of communication and emotional expression may affect the post-hospital adjustment of schizophrenics.
Children of schizophrenic patients have been studied longitudinally in high-risk projects which shed light on the etiology of schizophrenia.
Currently no treatments of schizophrenia are totally effective. Neuroleptic medications are effective in controlling the positive symptoms of schizophrenia.
2. 3
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4. 5 . 6. 7 8. 9.Chapter 11 125
10. Family therapy and behavioral approaches show promise in improving the social adjustment of schizophrenics.
There remains a need to integrate skills of many disciplines to better help schizophrenics. 1 1 .
To My Students
Schizophrenia is a serious and complex problem. Traditional paradigms have generated a tremendous amount of research. Unfortunately no paradigm has proven highly useful and our understanding of this problem remains limited.
As a result this chapter spends little time describing paradigms and considerable time summarizing research. At times the discussion becomes unavoidably complex, especially when summarizing the genetic and physiological research. You may want to refer to the basic discussion of these topics in Chapter 2 of the text, especially pages 21 to 24.
The study questions indicate the core ideas to look for as you study. Take your time and ask your instructor if you have questions.
KEY TERMS
Schizophrenia (p. 283)
Positive symptoms (p. 283)
Disorganized speech [thought disorder] (p. 284)
Incoherence (p. 284)
Loose associations [derailment] (p. 284)
Delusions (p. 284)
Hallucinations (p. 285)
Negative symptoms (p. 286)
126 Chapter 1 1 Alogia (p. 286) Anhedonia (p. 286) Flat affect (p. 286) Asociality (p. 287) Catatonic immobility (p. 287) Waxy flexibility (p. 287) Inappropriate affect (p. 287) Dementia praecox (p. 288) Delusional disorder (p. 290) Disorganized schizophrenia (p. 290) Catatonic schizophrenia (p. 290) Paranoid schizophrenia (p. 290) Grandiose delusions (p. 290) Delusional jealousy (p. 290) Ideas of reference (p. 290) Undifferentiated schizophrenia (p. 290) Residual schizophrenia (p. 290) Labeling theory (p. 292)
Chapter 11 127
Dopamine theory (p. 295)
Sociogenic hypothesis (p. 301)
Social-selection theory (p. 30 1)
Schizophrenogenic mother (p. 30 1)
Expressed emotion [EE] (p. 302)
Prefrontal lobotomy (p. 304)
Antipsychotic drugs (p. 305)