Somatoform and schizophrenic DisordersTSMU Department of psychology4th year, 1st semester, 2nd group Done by :Mustafa Khalil Ibrahim Rafal Abdulrahman Jawad Almamoori

Somatoform disorders A disorder in which people have physical illnesses

or complaints that cannot be fully explained by actual medical conditions

Dissociative disorders A personality disorder marked by a disturbance in

the integration of identity, memory, or consciousness.

Historically, both somatoform and dissociative disorders used to be categorized as hysterical neurosis in psychoanalytic theory neurotic disorders result

from underlying unconscious conflicts, anxiety that resulted from those conflicts and ego defense mechanisms

Basic Definitions

Soma – Meaning Body Preoccupation with health and/or body

appearance and functioning No identifiable medical condition causing the

physical complaints Types of Somatoform Disorders:

Hypochondriasis Somatization disorder Conversion disorder

Somatoform Disorders

Hypochondriasis A disorder in which individuals are preoccupied with having

or getting physical ailments despite reassurances that they are healthy

severe anxiety focused on the possibility of having a serious disease

shares age of onset, personality characteristics of running in families with panic disorder

illness phobia vs. hypochondriasis 60% of patients with illness phobia develop hypochondriasis 1% to 14% of medical patients treatment usually involves cognitive-behavioral therapy and

general stress management treatment (gain retained after 1 year follow-up)

Somatoform Disorders

Somatization disorder A disorder characterized by unexplained physical

complaints in several categories over many years. Briquet’s syndrome (100 years ago) patients have a history of many physical complaints that

can not be explained by a medical condition, the complaints are not intentionally produced

20% of patients in primary care setting develops during adolescence (majority women) may be connected to Antisocial personality disorder difficult to treat (reassurance, stress reduction, more

adoptive methods of interacting with family are encouraged)

Somatoform Disorder

Conversion Disorder A disorder in which psychological conflict or stress brings about

loss of motor or sensory function. Physical malfunctioning without any physical or organic

pathology Malfunctioning often involves sensory-motor areas Persons show la belle indifference Retain most normal functions, but without awareness of this

ability Statistics▪ Rare condition, with a chronic intermittent course▪ Seen primarily in females, with onset usually in adolescence▪ Not uncommon in some cultural and/or religious groups

Somatoform Disorder

Conversion disorder (cont.) Freudian psychodynamic view is still popular (anxiety converted into

physical symptoms) Emphasis on the role of trauma (stress), conversion, and

primary/secondary gain Detachment from the trauma and negative reinforcement seem

critical Different from factitious disorder (intentional) Treatment▪ Similar to somatization disorder▪ Core strategy is attending to the trauma▪ Remove sources of secondary gain▪ Reduce supportive consequences of talk about physical symptoms

Somatoform Disorder

Derealization Loss of sense of the reality of the external

world Depersonalization

Loss of sense of your own reality types of Dissociative Disorders:

Dissociative amnesia Dissociative fugue Dissociative identity disorder (DID).

Dissociative Disorders

Dissociative Amnesia Inability to recall personal information,

usually of a stressful or traumatic nature Generalized vs. selective amnesia

Dissociative Fugue Sudden, unexpected travel away from

home, along with an inability to recall one’s past (new identity)

Occur in adulthood and usually end abruptly

Dissociative Disorders

Dissociative Identity Disorder Formerly multiple personality disorder Many personalities (alters) or fragments of

personalities coexist within one body The personalities or fragments are dissociated Switch (transition form one personality to

another, includes physical changes) Can be simulated by malingers are usually

eager to demonstrate their symptoms whereas individuals with DID attempt to hide symptoms

Very high comorbidity Prevalence about 3%

Dissociative Disorders

Dissociative Identity Disorder Auditory hallucinations (coming from

inside their heads) 97% severe child abuse Onset – approximately 9 years Suggestible people may use dissociation

as defense against severe trauma Real and false memories Temporal lobe pathology (out of body

experiences)

Dissociative Disorders

Treatment Dissociative amnesia and fugue▪ Get better on their own▪ Coping mechanisms to prevent future

episodes DID▪ Reintegration of identities▪ Neutralization of cues▪ Confrontation of early trauma▪ hypnosis

Dissociative Disorders

SCHIZOPHRENIC DISORDERS

100,000 young people will have a first episode of schizophrenia.

5% of people with schizophrenia will die by suicide.

This Year Alone

"schizophrenia" "split mind" but it refers to a disruption of the usual balance of emotions and thinking.

Schizophrenia is chronic and a severe brain disorder in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior .

Schizophrenia

Epidemiology

Withdrawal from friends and family A drop in performance at school Trouble sleeping Irritability or depressed mood Lack of motivation

Symptoms in teenagers

Cognitive symptoms: For some patients, the cognitive symptoms of schizophrenia are subtle, but for others, they are more severe and patients may notice changes in their memory or other aspects of thinking. Symptoms include:

Poor “executive functioning” (the ability to understand information and use it to make decisions)

Trouble focusing or paying attention Problems with “working memory” (the ability to

use information immediately after learning it)

Major Types Of Schizophrenia

Major Types of Schizophrenia 1. Disorganized Type a person displays incoherent patterns of thinking

and grossly bizarre and disorganized behavior. Emotions are flattened or inappropriate to the

situation. Often, a person acts in a silly or childish manner,

such as giggling for no apparent reason. Language can become so incoherent, full of

unusual words and incomplete sentences, that communication with others breaks down.

If delusions or hallucinations occur, they are not organized around coherent theme.

Cont.

Disorganized thinking is inferred from disorganized speech. Effective communication can be impaired, and answers to questions may be partially or completely unrelated. Rarely, speech may include putting together meaningless words that can't be understood, sometimes known as word salad.

2. Catatonic Type The major feature of the catatonic type of schizophrenia

is a disruption in motor activity. Sometimes people with this disorder seem frozen in a

stupor. For long periods of time, the individual can remain motionless, often in a bizarre

position, showing little or no reaction to anything in the environment At other times,

these patients show excessive motor activity, apparently without purpose and not influenced by external stimuli.

The catatonic type is also characterized by extreme negativism, an apparently unmotivated resistance to all instructions.

3. Paranoid Type Individuals suffering from this form of schizophrenia experience complex and systematized delusions focused around specific themes:

Delusions of persecution. Individuals feel that they are being constantly spied on and plotted against and that they are in mortal danger.

Delusions of grandeur. Individuals believe that they are important or exalted beings—millionaires, great inventors, or religious figures such as Jesus Christ.

Delusions of persecution may accompany delusions of grandeur—an individual is a great person but is continually opposed by evil forces.

Delusional jealousy. Individuals become convinced— without due cause—that their mates are unfaithful.

They contrive data to fit the theory and “prove” the truth of the delusion. Individuals with paranoid schizophrenia rarely display obviously

disorganized behavior. Instead, their behavior is likely to be intense and quite formal.

4. Undifferentiated Type This is the grab-bag category of schizophrenia, describing a person who exhibits prominent delusions, hallucinations, incoherent speech, or grossly disorganized behavior that fits the criteria of more than one type or of no clear type. The hodgepodge of symptoms experienced by these individuals does not clearly differentiate among various schizophrenic reactions.

5. Residual Type Individuals diagnosed as residual type have usually suffered from a major past episode of schizophrenia but are currently free of major positive symptoms such as hallucinations or delusions. The ongoing presence of the disorder is signaled by minor positive symptoms or negative symptoms like flat emotion. A diagnosis of residual type may indicate that the person’s disease is entering remission, or becoming dormant.

Having a family history of schizophrenia. Exposure to viruses, toxins or

malnutrition while in the womb. Increased immune system activation,

such as from inflammation or autoimmune diseases.

Older age of the father. Taking mind-altering (psychoactive or

psychotropic) drugs during teen years and young adulthood

Risk Factors

Suicide. Any type of self-injury. Anxiety. Depression. Abuse of alcohol, drugs or prescription medications. Poverty. Homelessness. Family conflicts Inability to work or attend school. Social isolation. Health problems, including those associated with

antipsychotic medications, smoking and poor lifestyle choices.

Complications

Genetic Approaches .Environmental Stressors.Brain Function

Causes

Causes

Genetic Approaches Three independent lines of research

—family studies, twin studies, and adoption studies.

Persons related genetically to someone who has had schizophrenia are more likely to become affected than those who are not (Riley, 2011)

Environmental Stressors genetic factors place the individual at risk but

environmental stress factors must impinge for the potential risk to be manifested as a schizophrenic disorder.

Eg : live in urban . traumatic life events.

A hypothesis about the cause of certain disorders, such as schizophrenia, that suggests that genetic factors predispose an individual to a certain disorder but that environmental stress factors must impinge in order for the potential risk to manifest itself.

diathesis-stress hypothesis

Brain Function Another biological approach to the study of schizophrenia is to look for abnormalities in the brains of individuals

MRI has shown that the ventricles—the brain structures through which cerebrospinal fluid flows—are often enlarged in individuals with schizophrenia (Barkataki et al., 2006).

MRI studies also demonstrate that individuals with schizophrenia have measurably thinner regions in frontal and temporal lobes of cerebral cortex; the loss of neural tissue presumably relates to the disorder’s behavioral abnormalities (Bakken et al., 2011).

The study focused on changes in gray matter (largely the cell bodies and dendrites of nerve cells in the cortex) .

Diagnosis

Atypical antipsychotics Aripiprazole (Abilify) Asenapine (Saphris) Clozapine (Clozaril)

Psychosocial interventions 1- Social skills training. This focuses on improving communication and social interactions. 2- Family therapy. This provides support and education to families dealing with schizophrenia.

Treatments and drugs

Gerrig - Psychology and Life 20th Edition c2013 (book)

http://www.mayoclinic.org/diseases-conditions/schizophrenia/basics/treatment/con-20021077

http://emedicine.medscape.com/article/288259-overview#showall

http://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml

References

THANK YOU FOR ATTENTION

BY : MUSTAFA KHALIL IBRAHIM