The main goal of this class are to gain an introductory exposure to the nature of the psychiatric disorder known as schizophrenia as revealed by the scientific method. We will discuss a broad range of findings from the scientific investigation of biological and psychological factors related to schizophrenia and its treatment. More specifically we will learn about: (1) key symptomatic features through discussion and enactments of interviews with actors portraying many of the cardinal features of the illness, (2) what brain imaging studies (MRI and fMRI) and neurochemistry have taught us about the neuroscience of the disorder, (3) scientific psychological data and theories concerning cognition, emotion and behavior in schizophrenia, and (4) current, evidence-based somatic and psychosocial approaches to treatment. A brief historical overview of the recent emergence of the psychiatric category of schizophrenia will be presented as well.
Psychology of Schizophrenia: Introduction and History
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來自 Wesleyan University 的課程
Schizophrenia
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從本節課中
Psychological Science
In the fourth module we discuss common cognitive deficits, disruptions in social cognition and cognitive models of the disorder.
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Matt KurtzProfessor
Psychology and Neuroscience and Behavior
I'm going to be talking to you today about the psychology of the disorder
and specifically about different aspects of cognitive functioning,
social cognitive functioning, emotional functioning,
dysfunctional beliefs, and some models of cognitive processing,
in people with schizophrenia.
To start, in our discussion of the cognitive elements of schizophrenia,
it's important to think a little bit about the history of
our understanding of the cognitive deficits in people with schizophrenia.
We talked before in the history segment,
about one of the first psychiatrists who really
defined the disorder schizophrenia for the first time, that was Emil Kraepelin.
Kraepelin,
in his initial discussions of schizophrenia and his initial descriptions of it,
noted that people with schizophrenia often had difficulties focusing their attention,
and they also had difficulties in remembering things,
and these were major aspects of Kraepelin's model of schizophrenia.
Kraepelin was very attuned to these cognitive difficulties,
and I should also say that when I say cognitive,
I'm talking about disruptions in the ability to pay attention,
to remember things, to maybe manipulate information in my mind,
so that sort of, take for example,
string of numbers, put them backwards in my mind.
Those types of sort of concentration tasks are
what I mean when I talk about cognitive skills.
Kraepelin, in this initial model was very
influenced by psychologist by the name of Wilhelm Wundt,
who is considered to be the first experimental psychologist.
He started the first experimental psychology lab in 1879 in Leipzig, Germany.
Kraepelin worked in Wundt's lab, and as a result,
became very familiar with
experimental psychological techniques that were being used at that time.
He became very interested in psychological assessment,
the use of tests, standardized tests,
to assess sort of psychological constructs or skills.
And he took this training that he got from Wundt into his own research career
as he pursued in Munich for many years after.
So, Kraepelin, in his initial description of schizophrenia,
which he of course called dementia praecox,
talked about these deficits in attention and
memory and problem solving, deficits in cognition.
Bleuler in term, who first gave us the actual name of schizophrenia,
described one of the key aspects of schizophrenia as being related to ambivalence.
It's one of what has been called Bleuler's Four A's.
And the idea of ambivalence is that people with
schizophrenia have severe disruptions in their motivation,
their ability to carry out activities.
So from Kraepelin, we get this idea of people with
schizophrenia having deficits in attention,
memory problem solving, and from Bleuler,
we get this idea of severe motivational deficits in many people with the disorder.
Making it very hard for them to follow through on activities,
to be motivated, to accomplish goals.
So, given this history,
it's been pretty clear that over the last 20 to 30 years,
we've had a real explosion of research in cognition and affect in schizophrenia.
What's interesting about these findings is in many ways they're
presaged by some of Bleuler's own descriptions of the disorder.
So, I'm going to read for you now a quote from Bleuler that actually
presages many of the ideas that I'll be talking about in the lecture today.
So, this is a direct quote from a Bleuler's book,
Dementia Praecox, and it goes as follows: "Therefore,
if one wants to speak of intellectual dementia in our patients,
one must express oneself approximately as follows: the
schizophrenic is not generally
demented but he is demented with regard to certain periods,
to certain constellations, and to certain complexes.
In mild cases, the defective functions are the exception.
In most severe cases,
those who sit around in our mental institutions taking no part in anything,
the defective functions are the rule...
The mildest case can commit as great a piece of folly as the most severe,
but he commits it far more rarely."
So, in this quote, there are really three crucial ideas that are
encapsulated about cognitive difficulties in people with schizophrenia.
Number one, the deficits are widespread,
there are deficits in a variety of different areas.
Number two, there is great heterogeneity with some people
with schizophrenia having severe deficits in cognition,
other people with schizophrenia having
very mild deficits or no deficits at all in cognition.
And number three, the idea that deficits and
cognition have a close relationship to functional outcome.
Bleuler's saying that those with
the most severe deficits are the ones that we find in our mental institutions.
So, in that one quote,
Bleuler gets across three of
the real crucial ideas concerning cognition and schizophrenia.
