PART 1
Discuss one cognitive or one pharmacological therapy you feel has significant potential in treating clients. Identify a disorder that it is used as a treatment. What new research supports this?
PART2
Review research literature on autism and provide information on it as both a neurological disorder and developmental disorder. Is there evidence for abnormal brain development? Based on this review, describe one theory as to the cause of autism.
PART3
Review this week’s course materials and learning activities, and reflect on your learning so far this week. Respond to one or more of the following prompts in one to two paragraphs:
- Provide citation and reference to the material(s) you discuss. Describe what you found interesting regarding this topic, and why.
- Describe how you will apply that learning in your daily life, including your work life.
- Describe what may be unclear to you, and what you would like to learn.
PART4- INDIVIDUAL PROGRAMMATIC ASSESSMENT DISORDER PAPER
Select a neurological, psychological, or neurodevelopmental disorder.
Write a 2,450- to 3,500-word paper comparing and contrasting three therapeutic interventions used to treat this disorder. Compare measures of effectiveness, such as validity, efficacy, symptom and behavior management, and recidivism. One therapy should be cognitive in nature, one should be pharmacological in nature, and the third should be an alternative therapeutic treatment.
Identify common symptoms associated with your disorder and rates of symptom reduction or management as reported with the three treatments. Based on your research, what would be your approach to treating the condition? Identify which treatments you would use. Explain why.
Analyze the neurophysiological underpinnings of diseases and disorders.
Examine contemporary attitudes toward the three treatments you selected.
Format your paper consistent with APA guidelines.
Include 7 to 10 peer-reviewed sources.
Submit your assignment.
Individual Programmatic Assessment: Disorde
Wk 5 Individual: Individual Programmatic Assessment: Disorder
chapter 16 Schizophrenia and the Affective Disorders
Outline
· ■ Schizophrenia
Description
Heritability
Pharmacology of Schizophrenia: The Dopamine Hypothesis
Schizophrenia as a Neurological Disorder
Section Summary
· ■ Major Affective Disorders
Description
Heritability
Season of Birth
Biological Treatments
The Monoamine Hypothesis
Role of the 5-HT Transporter
Role of the Frontal Cortex
Role of Neurogenesis
Role of Circadian Rhythms
Section Summary
Larry had become a permanent resident of the state hospital. His parents had originally hoped that treatment would help him enough that he could live in a halfway house with a small group of other young men, but his condition was so serious that he required constant supervision. Larry had severe schizophrenia. The medication he was taking helped, but he still exhibited severe psychotic symptoms. In addition, he had begun showing signs of a neurological disorder that seemed to be getting worse.
Larry had always been a difficult child, shy and socially awkward. He had no real friends. During adolescence he became even more withdrawn and insisted that his parents and older sister keep out of his room. He stopped taking meals with the family, and he even bought a small refrigerator of his own for his room so that he could keep his own food, which he said he preferred to that “pesticide-contaminated” food his parents ate. His grades in school, which were never outstanding, got progressively worse, and when he was seventeen years old, he dropped out of high school.
Larry’s parents recognized that something was seriously wrong with him. Their family physician suggested that Larry see a psychiatrist and gave them the name of a colleague that he respected, but Larry flatly refused to go. Within a year after he had quit high school, he became frankly psychotic. He heard voices talking to him, and sometimes his parents could hear him shouting for the voices to go away. He was convinced that his parents were trying to poison him, and he would eat only factory-sealed food that he had opened himself. Although he kept his body clean—sometimes he would stand in the shower for an hour “purifying” himself—his room became frightfully messy. He insisted on keeping old cans and food packages because, he said, he needed to compare them with items his parents brought from the store to be sure they were not counterfeit.
One day, while Larry was in the shower purifying himself, his mother cleaned his room. She filled several large plastic garbage bags with the cans and packages and put them out for the trash collector. As she reentered the house, she heard a howling noise from upstairs. Larry had emerged from the shower and discovered that his room had been cleaned. When he saw his mother coming up the stairs, he screamed at her, cursed her savagely, and rushed down the stairs toward her. He hit her so hard that she fell down the stairs, landing heavily on the floor below. He wheeled around, ran up the stairs, and went into his room, slamming the door behind him.
An hour later, Larry’s father discovered his wife unconscious at the foot of the stairs. She soon recovered from the mild concussion she had sustained, but Larry’s parents realized that it was time for him to be put in custody. Because he had attacked his mother, a judge ordered that he be temporarily detained and, as a result of a psychiatric evaluation, had him committed to the state hospital. The diagnosis was “schizophrenia, paranoid type.”
In the state hospital, Larry was given Thorazine (chlorpromazine), which helped considerably. For the first few weeks, he showed some symptoms that are commonly seen in Parkinson’s disease—tremors, rigidity, a shuffling gait, and lack of facial expression—but these symptoms cleared up spontaneously, as his physician had predicted. The voices still talked to him occasionally, but less often than before, and even then he could ignore them most of the time. His suspiciousness decreased, and he was willing to eat with the residents in the dining room. But he still obviously had paranoid delusions, and the psychiatric staff was unwilling to let him leave the hospital. For one thing, he refused to take his medication voluntarily. Once, after he had suffered a serious relapse, the staff discovered that he had only been pretending to swallow his pills and was later throwing them away. After that, they made sure that he swallowed them.
After several years, Larry began developing more serious neurological symptoms. He began pursing his lips and making puffing sounds; later, he started grimacing, sticking his tongue out, and turning his head sharply to the left. The symptoms became so severe that they interfered with his ability to eat. His physician prescribed an additional drug, which reduced the symptoms considerably but did not eliminate them. As he explained to Larry’s parents, “His neurological problems are caused by the medication that we are using to help with his psychiatric symptoms. These problems usually do not develop until a patient has taken the medication for many years, but Larry appears to be one of the unfortunate exceptions. If we take him off the medication, the neurological symptoms will get even worse. We could reduce the symptoms by giving him a higher dose of the medication, but then the problem would come back later, and it would be even worse. All we can do is try to treat the symptoms with another drug, as we have been doing. We really need a medication that helps treat schizophrenia without producing these tragic side effects.”
Most of the discussion in this book has concentrated on the physiology of normal, adaptive behavior. The last three chapters summarize research on the nature and physiology of syndromes characterized by maladaptive behavior: mental disorders and drug abuse. The symptoms of mental disorders include deficient or inappropriate social behaviors; illogical, incoherent, or obsessional thoughts; inappropriate emotional responses, including depression, mania, or anxiety; and delusions and hallucinations. Research in recent years indicates that many of these symptoms are caused by abnormalities in the brain, both structural and biochemical.
This chapter discusses two serious mental disorders: schizophrenia and the major affective disorders. Chapter 17 discusses anxiety disorders, autism, attention deficit disorder, and disorders caused by stress. Chapter 18 discusses drug abuse.
Schizophrenia
Description
Schizophrenia is a serious mental disorder that afflicts approximately 1 percent of the world’s population. Its monetary cost to society is enormous; in the United States this figure exceeds that of the cost of all cancers (Thaker and Carpenter, 2001 ). Descriptions of symptoms in ancient writings indicate that the disorder has been around for thousands of years (Jeste et al., 1985 ). The major symptoms of schizophrenia are universal, and clinicians have developed criteria for reliably diagnosing the disorder in people of a wide variety of cultures (Flaum and Andreasen, 1990 ). Schizophrenia is probably the most misused psychological term in existence. The word literally means “split mind,” but it does not imply a split or multiple personality. People often say that they “feel schizophrenic” about an issue when they really mean that they have mixed feelings about it. A person who sometimes wants to build a cabin in the wilderness and live off the land and at other times wants to take over the family insurance agency might be undecided, but he or she is not schizophrenic. The man who invented the term, Eugen Bleuler ( 1911/1950 ), intended it to refer to a break with reality caused by disorganization of the various functions of the mind, such that thoughts and feelings no longer worked together normally.
Schizophrenia is characterized by three categories of symptoms: positive, negative, and cognitive (Mueser and McGurk, 2004). Positive symptoms make themselves known by their presence. They include thought disorders, hallucinations, and delusions. A thought disorder —disorganized, irrational thinking—is probably the most important symptom of schizophrenia. Schizophrenics have great difficulty arranging their thoughts logically and sorting out plausible conclusions from absurd ones. In conversation they jump from one topic to another as new associations come up. Sometimes, they utter meaningless words or choose words for rhyme rather than for meaning. Delusions are beliefs that are obviously contrary to fact. Delusions of persecution are false beliefs that others are plotting and conspiring against oneself. Delusions of grandeur are false beliefs in one’s power and importance, such as a conviction that one has godlike powers or has special knowledge that no one else possesses. Delusions of control are related to delusions of persecution; the person believes (for example) that he or she is being controlled by others through such means as radar or a tiny radio receiver implanted in his or her brain.
schizophrenia A serious mental disorder characterized by disordered thoughts, delusions, hallucinations, and often bizarre behaviors.
positive symptom A symptom of schizophrenia evident by its presence: delusions, hallucinations, or thought disorders.
thought disorder Disorganized, irrational thinking.
delusion A belief that is clearly in contradiction to reality.
The third positive symptom of schizophrenia is hallucinations , perceptions of stimuli that are not actually present. The most common schizophrenic hallucinations are auditory, but they can also involve any of the other senses. The typical schizophrenic hallucination consists of voices talking to the person. Sometimes, the voices order the person to do something; sometimes, they scold the person for his or her unworthiness; sometimes, they just utter meaningless phrases. Olfactory hallucinations are also fairly common; often they contribute to the delusion that others are trying to kill the person with poison gas. (See Table 16.1 . )
hallucination Perception of a nonexistent object or event.
In contrast to the positive symptoms, the negative symptoms of schizophrenia are known by the absence or diminution of normal behaviors: flattened emotional response, poverty of speech, lack of initiative and persistence, anhedonia (inability to experience pleasure), and social withdrawal. The cognitive symptoms of schizophrenia are closely related to the negative symptoms and may be produced by abnormalities in overlapping brain regions. These symptoms include difficulty in sustaining attention, low psychomotor speed (the ability to rapidly and fluently perform movements of the fingers, hands, and legs), deficits in learning and memory, poor abstract thinking, and poor problem solving. Negative symptoms and cognitive symptoms are not specific to schizophrenia; they are seen in many neurological disorders that involve brain damage, especially to the frontal lobes. As we will see later in this chapter, positive symptoms appear to involve excessive activity in some neural circuits that include dopamine as a neurotransmitter, and negative symptoms and cognitive symptoms appear to be caused by developmental or degenerative processes that impair the normal functions of some regions of the brain. (Look again at Table 16.1 . )
