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CHAPTER 15 ■ Schizophrenia Spectrum and Other Psychotic Disorders
Disturbances in Perception ■■ Hallucinations, or false sensory perceptions not associated with real external stimuli, may involve any of the five senses. Types of hallucinations include the following: ■■ Auditory: Auditory hallucinations are false per- ceptions of sound. Most commonly they are of voices, but the individual may report clicks, rush- ing noises, music, and other noises. Command hallucinations are “voices” that issue commands to the individual. They are potentially danger- ous when the commands are directing violence toward self or others. Auditory hallucinations are the most common type in schizophrenia. ■■ Visual: These hallucinations are false visual perceptions that may consist of formed images, such as of people, or of unformed images, such as flashes of light. Visual hallucinations occur about 27% of the time in individuals with schizophrenia (and 15% of the time in affec- tive psychoses). They typically co-occur with auditory hallucinations and are associated with poorer outcomes (Waters et al., 2014). ■■ Tactile: Tactile hallucinations are false per- ceptions of the sense of touch, often of some- thing on or under the skin. One specific tactile hallucination is formication , the sensation that something is crawling on or under the skin. ■■ Gustatory: This type of hallucination is a false perception of taste. Most commonly, gustatory hallucinations are described as unpleasant tastes. ■■ Olfactory: Olfactory hallucinations are false perceptions of the sense of smell. ■■ Illusions are misperceptions or misinterpretations of real external stimuli. These may occur in the prodromal, active, and residual phases of schizo- phrenia and may co-occur with delusions. ■■ Echopraxia occurs when a client imitates move- ments made by others. The mechanisms under- lying echopraxia in schizophrenia are not well understood, but current evidence suggests that it may involve a disturbance in mirror neuron activ- ity in the presence of social cognition impairments and self-monitoring deficits culminating in imita- tive behavior (Urvakhsh et al., 2014). Negative Symptoms Negative symptoms refer to a group of symptoms that are deficits commonly noted in the clinical pic- ture of schizophrenia.
without cause, but the individual with the delusion searches for evidence to justify the belief. The sex- ual partner is confronted (and sometimes physi- cally attacked) regarding the imagined infidelity. The imagined “lover” of the sexual partner also may be the object of the attack. Attempts to restrict the autonomy of the sexual partner in an effort to stop the imagined infidelity are common. Disturbances in Thought Processes Manifested in Speech ■■ Loose associations are characterized by speech in which ideas shift from one unrelated subject to another. Typically, the individual with loose associ- ations is unaware that the topics are unconnected. When the condition is severe, speech may be inco- herent (e.g., “We wanted to take the bus, but the airport took all the traffic. The FBI is watching me. We have it all in our pockets”). ■■ Neologisms are newly invented words that are meaningless to others but have symbolic meaning to the individual (e.g., “She wanted to give me a ride in her new uniphorum ”). ■■ Clang associations are words governed by sounds, often taking the form of rhyming (e.g., “It is very cold. I am cold and bold. The gold has been sold”). ■■ Word salad is a group of words that are put together randomly, without any logical connection (e.g., “Most forward action grows life double plays circle uniform”). ■■ Circumstantiality occurs when the individual delays in reaching the point of a communication because of unnecessary and tedious details. The point or goal is usually met but only with numer- ous interruptions by the interviewer to keep the person on track of the topic being discussed. ■■ Tangentiality refers to a veering away from the topic of discussion and difficulty maintaining focus and attention. ■■ Perseveration occurs when the individual per- sistently repeats the same word or idea in response to different questions. It is a manifestation of a thought-processing disturbance in which the per- son gets stuck on a particular thought. ■■ Echolalia refers to repeating words or phrases spo- ken by another. In toddlers this is a normal phase in development, but in children with autism, echolalia may persist beyond the toddler years. In adulthood, echolalia is a significant neurolog- ical symptom of thought disturbance that occurs in schizophrenia, strokes, and other neurological disorders.
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