PSYCHODYNAMICS of RESIDUAL SCHIZOPHRENIA

PREDISPOSING FACTORS

Psychological Factors

Psychodynamic theorists believe that schizophrenia involves regression to a pre-ego state of primary narcissism

and restitutive efforts to reestablish ego control. Behaviorists theorize that schizophrenic people fail to attend to relevant social cues and as a result develop

bizarre responses to the environment. The family explanation for schizophrenia holds that family

environment contains such confusing elements as a schizophrenic mother, double-bind communications,

marital schism and marital skew. R. D. Laing’s theory states that schizophrenia is actually a constructive process

by which people try to cure themselves of the confusion and unhappiness caused by their social and family

environment. Cognitive theorists contend that when schizophrenic people try to explain their biologically -

induced hallucinations or other strange sensations, they develop delusional thinking. Their logical processes lead

them to delusional conclusions. Most clinical theorists now agree that schizophrenia, in whatever form, can probably

be traced to a combination of factors such as these.

-Mr. Mucho Choco has claimed that he used to be cared for by his parents when he was still young. He grew up very

protected and cared for.

Socio-cultural and Environmental Factors

Some theorists proposed that poverty, society, and cultural disharmony could cause schizophrenia or

that people chose to become schizophrenic to cope with insanity of the modern world. Others proposed that schizophrenia was caused by living in the city

or living in isolation in the country. An enduring and consistent finding has been the strong association between schizophrenia and lower socio-economic

status. This unenviable status enhances their vulnerability by exposing them to constant

stressors.

-Mr. Mucho Choco he grew up in Tondo, Manila. He experienced being threatened by Boy “Lopez”

which influenced him to do vices such as smoking and influenced him to be the cause of trouble in

their place. He failed in studying Dentistry.

Biological Factors

Genetics: Based on the principle that some people inherit a biological predisposition to schizophrenia, is supported by studies of several kinds, including twin studies, adoption

studies, and chromosomal mapping studies. - According to our client, his older brother had schizophrenia.

Biological Views: This attempt to identify the biological abnormalities that are inherited or developed by persons with schizophrenia. The two most likely candidates are biochemical abnormalities and abnormal brain structures. The predominant biochemical explanation of

schizophrenia focuses on an unusually high level of activity in neurons that used the neurotransmitter dopamine. There is evidence that the brains of schizophrenic people contain an unusually large number of dopamine receptors. In addition, modern brain

imaging techniques have detected abnormal brain structures in schizophrenic people. The most typical abnormality is the presence of enlarged ventricles. -Unfortunately, the tests

needed are not done.

PRECIPATING FACTORS

Health Factors

-Information-processing overload: Too much information is sent at the same time to be filtered by the frontal lobe. In schizophrenia, the frontal

lobe loses its ability to slow down the transmission and reception of stimuli, causing an overload.

-Abnormal gating mechanism: This is manifested by the inability to selectively attend to stimuli.

-Undergoing the degeneration process; Diminished cognitive functioning; Diminished judgment ability

all caused by the pathologic course of

Psychological Factors

- Mr. Mucho Choco misses his family. He talks about his ‘Kuya Boy’.

-His best friend is ‘Darwin’.

- Mr. Mucho Choco experienced intimate relationship with ‘Jinky’, ‘Hazel’, and ‘Marichel’ but because of his illness he was left and longing for

love.

- He has expressed difficulty in speaking and interacting with others.

Environmental Factors

- Client is usually left alone in the house or is left with the helper.

- Some of his relatives avoid him because they fear that he might hurt them.

- He lives with his family, but when he failed in his study misunderstandings started between him and his father.

Health: Poor nutrition; Fatigue; Lack of exercise

Environment: Social isolation; Stigmatization; disruption in interpersonal relationships; lack of social support; inability to mingle with other people.

Attitudes: Low self-concept; lack of self-confidence; poor social skills; history of violent behavior; feeling overwhelmed by symptoms; difficulty in expressing emotions.

TRIGGERING FACTORS

Stressors: inadequate food; social isolation; poor support

system; lack of friends; inability to express emotions and control

anger.

Projection

-Unconscious blaming of unacceptable inclinations or thoughts on an external object. Projection relates to the development of paranoid delusions and auditory hallucinations.

Our client suffered from visual and auditory hallucinations prior to admision. verbalized, "May anghel at demonyo akong nakikita sabi nila punta ka

Denial

-Failure to acknowledge an unbearable condition; failure

to

- When asked about his problems he always answer,

"Ok raman to. Wala naman...Ayos lang."

Reaction Formation

-Development of conscious attitudes and behavior patterns that are opposite to what one really feels or

would like to do.

-Inappropriately smiles while talking about his problems.

Experiences and develops crisis

Tries to cope with crisis using habitual-problem solving response and adaptive coping mechanisms.

- Client verbalized, that he would concentrate on playing guitars and listening to music of ‘The Beatles’ and ‘Air Supply’ to keep his mind occupied. He used to go out on weekends and mingle with girls and smoke 1 dozen of cigarette a day. He never

mentioned friends. Smoking for our client was a way for him to relax.

Failure to be relieved from crisis causes increase in tension

Impaired ego integrity

DEFENSE MECHANISMS

Negative Symptoms

-Lapses of incoherence.

- Inappropriate affect: smiles while talking about his life.

- Poor rapport with others

- Short attention span, and brings up the same topic again and again

- Has trouble sequencing events prior to his illness, but can clearly remember events after that.

- Has difficulty in expressing his feelings and dealing with them appropriately, as claimed

Positive Symptoms

- Violent behavior: boxed his co-resident.

- Had visual and auditory hallucinations before admission

- Mannerism

Residual Schizophrenia

PSYCHOPATHOLOGY of RESIDUAL SCHIZOPHRENIA (Based on the Theory of

Erik Erikson)

NEUROSTR

Failed in his study

Misunderstanding with his father

Started vice such as Smoking

Intimate relationships with 3 women

Cause of trouble in Tondo with “Boy Lopez”

Confinement in mental institution

Separation from family

Low self-esteem

WEAK EGO

PSYCHOPATHOLOGY of RESIDUAL SCHIZOPHRENIA

BIOCHEMICAL AND NEUTROSTRUCTURAL THEORY

DEPRESSION

Problems in ADLsFeeling of Withdrawal Problems in Metabolic Activity

Decreased Amount of cerebral blood flow in the pre-frontal lobe of the cerebral cortex

Increased demand in cognitive functioning

Marked changes in the process of organizing, planning, learning from experience Cause of DeliquencyFailure to be relieved from crisis causes

increase in tension

Prolonged use of coping mechanisms

Impaired ego formation

Progressive deterioration of personality