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Read the case study then answer the 5 questions using the DSM 5 criteria for schizophrenia. this is from chapter 11 in the textbook Abnormal Psychology in a changing world tenth edition.
Sandra is a 26 year old female diagnosed with schizophrenia. Sandra’s mother, Mrs. G., denies any history of mental illness in the family, although she states that Sandra’s uncle was known as “eccentric” as he would place unusual mechanisms on the roof of his barn in order to bring in “electromagnetic energy” to help his cattle grow. Mrs. G. was a two- pack-a-day smoker when she was pregnant and suffered a severe bout of flu during her fifth month of gestation.
Sandra’s physical and cognitive development during childhood appears to have been within normal limits, although her social skills seem to have lagged behind those of her peers. She was considered quiet and painfully shy. Sandra’s parents fought constantly and even separated for a short while when Sandra was young. Mr. G., Sandra’s father, traveled constantly, and when he was home he was frequently critical of Sandra’s shyness. Mrs. G. has, in the past and currently, an intense, emotional and controlling relationship with Sandra.
Sandra’s intelligence level tests normal. She has no long-term friends and both Sandra and her mother say she has “never” had friends. Sandra tells you that the few times she brought home new acquaintances, her mother would “but in” and become intrusive and demanding. The friendship would usually end within a few weeks.
After graduating from high school, Sandra was accepted into a small, nearby community college. It was a few weeks after the beginning of her first semester that Sandra started “talking to herself”, and complained that the “angels” wouldn’t leave her alone. Her assigned roommate quickly asked to be moved to another room. Shortly after this, a dorm counselor found Sandra in her room sitting in a chair, staring at the floor and unresponsive. Although her limbs could be moved, they would “freeze” in place instead of falling when support was removed. Sandra seemed incapable of spontaneous movement and did not appear to hear or be able to respond to questions asked of her.
After a brief hospitalization that included administration of antipsychotics, Sandra’s symptoms seemed to resolve and she returned to college. However, after a few weeks she again had difficulty. At this point, Sandra’s mother removed her from school and took her home “to take care of her”. Sandra degenerated further. During this time, Sandra’s father died and the day after his funeral, the police found Sandra wading in a shallow pond in a park close to her home muttering to herself and occasionally screaming out in laughter for no apparent reason. Her speech was incoherent and rapid and she would not answer questions appropriately when questioned by the police.
After improvement during a second hospitalization, Sandra once again returned to her mother’s care. With the help of an employment counselor, Sandra was able to obtain a part-time job doing inventory in the early morning hours in a nearby store. Mrs. G. was very concerned that her daughter would not be able to keep her job if she remained on her antipsychotics or if she took time to see her outpatient psychologist, and so she stopped these treatments. Mrs. G. also frequently insists on walking Sandra to and from the store and often stays to “give her advice” while Sandra works.
Sandra’s behavior has once more deteriorated and she has been hospitalized for the third time. Currently, Sandra is mute and still for most of the day. She also burst into laughter or tears for no apparent reason and occasionally paces uncontrollably for several hours before becoming still once again.
- Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), OR (3).
- Disorganized speech (e.g.,) frequent derailment or incoherence).
- Grossly disorganized or catatonic behavior).
- Negative symptoms (i.e., diminished emotional expression or avolition).
- For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, on self-care, is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning).
- Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Creation A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).
- Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either 1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or 2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.
- The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
- If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to other required symptoms of schizophrenia, are also present for at least 1 month (or less is successfully treated).
- Identify the behaviors Sandra exhibits that match each criteria?
- Which of the symptoms you listed would be considered “positive symptoms”, which would be considered “negative symptoms” and which would be considered “cognitive symptoms”?
- Based on the symptoms Sandra exhibits, do you believe she meets the DSM-5 Criteria for Schizophrenia? Why or why not?
- Using the diathesis-stress stress theory of schizophrenia, list all the potential diathesis and stress/risk factors for schizophrenia identified in the case history for Sandra?
- Based on the case history and the information discussed in your text, explain the factors that could be causing Sandra’s frequent relapses?