7 Schizophrenia Spectrum and Other Psychotic Disorders

Question 1

_____, the startling disorder characterized by a broad spectrum of cognitive and emotional dysfunctions including delusions and hallucinations, disorganized speech and behavior, and inappropriate emotions.

Answer 1

Schizophrenia

Question 2

Benedict _____, used the French term démence (loss of mind) précoce (early, premature), because the onset of the disorder is often during adolescence.

Answer 2

Morel

Question 3

He combined several symptoms of insanity that had usually been viewed as reflecting separate and distinct disorders: catatonia (alternating immobility and excited agitation), hebephrenia (silly and immature emotionality), and paranoia (delusions of grandeur or persecution).

Answer 3

Emil Kraepelin

Question 4

Kraepelin thought these symptoms (3) shared similar underlying features and included them under the Latin term dementia _____. Although the clinical manifestation might differ from person to person, Kraepelin believed an early onset at the heart of each disorder develops into “mental weakness”

Answer 4

praecox

Question 5

A second major figure in the history of schizophrenia was Kraepelin’s contemporary, Eugen _____, a Swiss psychiatrist who introduced the term schizophrenia.

Answer 5

Bleuler

Question 6

A. 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):

1. Delusions.
2. Hallucinations.
3. Disorganized speech (e.g., frequent derailment or incoherence).
4. Grossly disorganized or catatonic behavior.
5. Negative symptoms (i.e., diminished emotional expression or abolition).

B. 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, or 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).

C. 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 Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

D. 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.

E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

F. 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 the other required symptoms of schizophrenia, are also present for at least 1 month (or less if successfully treated).

Specify if:
The following course specifiers are only to be used after a 1-year duration of the disorder and if they are not in contradiction to the diagnostic course criteria.

First episode, currently in acute episode: First manifestation of the disorder meeting the defining diagnostic symptom and time criteria. An acute episode is a time period in which the symptom criteria are fulfilled.
First episode, currently in partial remission: Partial remission is a period of time
during which an improvement after a previous episode is maintained and in which the defining criteria of the disorder are only partially fulfilled.
First episode, currently in full remission: Full remission is a period of time after a previous episode during which no disorder-specific symptoms are present.
Multiple episodes, currently in acute episode: Multiple episodes may be determined after a minimum of two episodes (i.e., after a first episode, a remission and a minimum of one relapse).
Multiple episodes, currently in partial remission
Multiple episodes, currently in full remission
Continuous: Symptoms fulfilling the diagnostic symptom criteria of the disorder are remaining for the majority of the illness course, with subthreshold symptom periods being very brief relative to the overall course.
Unspecified:

Specify if:
With catatonia

Answer 6

Schizophrenia

Question 7

_____ spectrum disorder constitutes the group of diagnoses we cover in this chapter, as recognized by those in the field of _____. In fact, Eugen Bleuler, who coined the term _____, identified the different variants that were all included within this spectrum.

Answer 7

Schizophrenia

Question 8

A belief that would be seen by most members of a society as a misrepresentation of reality is called a disorder of thought content, or a delusion.

Because of its importance in schizophrenia, _____ has been called “the basic characteristic of madness”.

Answer 8

delusion

Question 9

Arthur’s belief that he could end starvation for all the world’s children is also a delusion of _____.

Answer 9

grandeur

Question 10

A common delusion in people with schizophrenia is that others are “out to get them.”

Answer 10

Delusion of Persecution

Question 10

A common delusion in people with schizophrenia is that others are “out to get them.”

Answer 10

Delusion of Persecution

Question 11

Other more unusual delusions include Capgras syndrome, in which the person believes someone he or she knows has been replaced by a double.

Answer 11

Capgras Syndrome

Question 12

_____ syndrome, in which the person believes he is dead.

Answer 12

Cotard’s

Question 13

A person develops “stories” around some issue—for example, a famous person is in love with her.

Answer 13

Erotomania

Question 14

Hallucinations can involve any of the senses, although hearing things that aren’t there, or _____ hallucination, is the most common form experienced by people with schizophrenia.

Answer 14

auditory

Question 15

_____ or “thinking about thinking.” In other words, metacognition is a phrase to describe examining your own thoughts.

Answer 15

Metacognition

Question 16

The researchers used the brain-imaging technique while the men were experiencing hallucinations and while they were not, and they found that the part of the brain most active during hallucinations was _____ area.

Answer 16

Broca’s

Question 17

Research suggests that emotional _____ is deficient in persons with auditory verbal hallucinations, contributing to the confusion both with others as well as when interpreting “inner voices”.

_____ is that aspect of our spoken language that communicates meaning and emotion through our pitch, amplitude, pauses, etc

Answer 17

Prosody

Question 18

_____ is the inability to initiate and persist in activities.

Answer 18

avolition

Question 19

A person with _____ may respond to questions with brief replies that have little content and may appear uninterested in the conversation.

Sometimes _____ takes the form of delayed comments or slow responses to questions.

Answer 19

alogia

Question 20

_____ is the presumed lack of pleasure experienced by some people with schizophrenia.

Answer 20

Anhedonia

Question 21

The authors concluded that the _____ in schizophrenia may represent difficulty expressing emotion, not a lack of feeling.

They may stare at you vacantly, speak in a flat and toneless manner, and seem unaffected by things going on around them.

Answer 21

flat affect

Question 22

Perhaps the least studied and therefore the least understood symptoms of schizophrenia are referred to as the “_____ symptoms.”

These include a variety of erratic behaviors that affect speech, motor behavior, and emotional reactions.

Answer 22

disorganized

Question 23

David didn’t really answer the question he was asked. This type of response is called _____—that is, going off on a tangent instead of answering a specific question.

Answer 23

tangentiality

Question 24

David also abruptly changed the topic of conversation to unrelated areas, a behavior that has variously been called loose association or _____.

Answer 24

derailment

Question 25

_____ is one of the most curious symptoms in some individuals with schizophrenia; it involves motor dysfunctions that range from wild

Answer 25

Catatonia

Question 26

A. The clinical picture is dominated by three (or more) of the following symptoms:

1. Stupor (i.e., no psychomotor activity; not actively relating to environment).
2. Catalepsy (i.e., passive induction of a posture held against gravity).
3. Waxy flexibility (i.e., slight, even resistance to positioning by examiner).
4. Mutism (i.e., no, or very little, verbal response [exclude if known aphasia]).
5. Negativism (i.e., opposition or no response to instructions or external stimuli).
6. Posturing (i.e., spontaneous and active maintenance of a posture against gravity).
7. Mannerism (i.e., odd, circumstantial caricature of normal actions).
8. Stereotypy (i.e., repetitive, abnormally frequent, non-goal-directed movements).
9. Agitation, not influenced by external stimuli.
10. Grimacing.
11. Echolalia (i.e., mimicking another’s speech).
12. Echopraxia (i.e., mimicking another’s movements).

Answer 26

Catatonia Associated With Another Mental Disorder (Catatonia Specifier)

Question 27

A. 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):

1. Delusions.
2. Hallucinations.
3. Disorganized speech (e.g., frequent derailment or incoherence).
4. Grossly disorganized or catatonic behavior.
5. Negative symptoms (i.e., diminished emotional expression or abolition).

B. An episode of the disorder lasts at least 1 month but less than 6 months. When the diagnosis must be made without waiting for recovery, it should be qualified as “provisional.”

C. 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.

D. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

Answer 27

Schizophreniform Disorder

Question 28

A. An uninterrupted period of illness during which there is a major mood episode (major depressive or manic) concurrent with Criterion A of schizophrenia.
Note: The major depressive episode must include Criterion A1 : Depressed mood.

B. Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode (depressive or manic) during the lifetime duration of the illness.

C. Symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the active and residual portions of the illness.

D. The disturbance is not attributable to the effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

Specify whether:

295. 70 (F25.0) Bipolar type: This subtype applies if a manic episode is part of the presentation. Major depressive episodes may also occur.
296. 70 (F25.1) Depressive type: This subtype applies if only major depressive episodes are part of the presentation.

Specify if:
With catatonia (refer to the criteria for catatonia associated with another mental disorder, pp. 119-120, for definition).

Answer 28

Schizoaffective Disorder

Question 29

A. The presence of one (or more) _____ with a duration of 1 month or longer

B. Criterion A for schizophrenia has never been met
Note: Hallucinations, if present, are not prominent and are related to the _____ theme (e.g., the sensation of being infested with insects associated with _____ of infestation).

C. Apart from the impact of the _____(s) or its ramifications, functioning is not markedly impaired, and behavior is not obviously bizarre or odd.

D. If manic or major depressive episodes have occurred, these have been brief relative to the duration of the _____ periods

E. The disturbance is not attributable to the physiological effects of a substance or another medical condition and is not better explained by another mental disorder, such as body dysmorphic disorder or obsessive-compulsive disorder

Specify whether:
Erotomanie type: This subtype applies when the central theme of the _____ is that another person is in love with the individual.
Grandiose type: This subtype applies when the central theme of the _____ is the conviction of having some great (but unrecognized) talent or insight or having made some important discovery.
Jeaious type: This subtype applies when the central theme of the individual’s _____ is that his or her spouse or lover is unfaithful.
Persecutory type: This subtype applies when the central theme of the _____ involves the individual’s belief that he or she is being conspired against, cheated, spied on, followed, poisoned or drugged, maliciously maligned, harassed, or obstructed in the pursuit of long-term goals.
Somatic type: This subtype applies when the central theme of the _____ involves bodily functions or sensations.
Mixed type: This subtype applies when no one _____ theme predominates.
Unspecified type: This subtype applies when the dominant _____ belief cannot be clearly determined or is not described in the specific types (e.g., referential _____ without a prominent persecutory or grandiose component)

Specify if:
With bizarre content: _____ are deemed bizarre if they are clearly implausible, not understandable, and not derived from ordinary life experiences (e.g., an individual’s belief that a stranger has removed his or her internal organs and replaced them with someone else’s organs without leaving any wounds or scars).

Answer 29

Delusional Disorder

Question 30

Previous versions of the DSM included a separate delusional disorder—_____ disorder (folie à deux), the condition in which an individual develops delusions simply as a result of a close relationship with a delusional individual.

Answer 30

shared psychotic

Question 31

A. Presence of one or both of the following symptoms:

1. Delusions.
2. Hallucinations.

B. There is evidence from the history, physical examination, or laboratory findings of both (1)and (2):

1. The symptoms in Criterion A developed during or soon after substance intoxication or withdrawal or after exposure to a medication.
2. The involved substance/medication is capable of producing the symptoms in Criterion A.

C. The disturbance is not better explained by a psychotic disorder that is not substance/ medication-induced. Such evidence of an independent psychotic disorder could include the following:
The symptoms preceded the onset of the substance/medication use; the symptoms persist for a substantial period of time (e.g., about 1 month) after the cessation of acute withdrawal or severe intoxication: or there is other evidence of an independent non-substance/medication-induced psychotic disorder (e.g., a history of recurrent non-substance/medication-related episodes).

D. The disturbance does not occur exclusively during the course of a delirium.

E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Answer 31

Substance/Medication-Induced Psychotic Disorder

Question 32

A. Prominent hallucinations or delusions.
B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition.
C. The disturbance is not better explained by another mental disorder.
D. The disturbance does not occur exclusively during the course of a delirium.
E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

Specify whether:
Code based on predominant symptom:
293.81 (F06.2) With delusions: If delusions are the predominant symptom.
293.82 (F06.0) With hallucinations: If hallucinations are the predominant symptom.

Answer 32

Psychotic Disorder Due to Another Medical Condition

Question 33

A. Presence of one (or more) of the following symptoms. At least one of these must be (1), (2), or (3):
1. Delusions.
2. Hallucinations.
3. Disorganized speech (e.g., frequent derailment or incoherence).
4. Grossly disorganized or catatonic behavior.
Note: Do not include a symptom if it is a culturally sanctioned response

B. Duration of an episode of the disturbance is at least 1 day but less than 1 month, with eventual full return to premorbid level of functioning

C. The disturbance is not better explained by major depressive or bipolar disorder with psychotic features or another psychotic disorder such as schizophrenia or catatonia, and is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

Answer 33

Brief Psychotic Disorder

Question 34

DSM-5 is proposing a potentially new psychotic disorder for further study _____.

These people may have some of the symptoms of schizophrenia but are aware of the troubling and bizarre nature of these symptoms.

Answer 34

Attenuated Psychosis Syndrome

Question 35

One genetic explanation for these differences may be the presence of _____ mutations in the sisters. These are genetic mutations that can occur as a result of a mutation in a germ cell (egg or sperm) of one of the parents or, perhaps in the case of these sisters, in the fertilized egg after conception.

Answer 35

de novo

Question 36

Remember, in complex disorders such as this, researchers are not looking for a “schizophrenia gene” or genes. Instead, researchers try to find basic processes that contribute to the behaviors or symptoms of the disorder and then find the gene or genes that cause these difficulties—a strategy called _____.

Answer 36

endophenotyping

Question 37

Some research suggests that people who use marijuana in high doses have an increased likelihood of developing schizophrenia and that people with schizophrenia are more likely to have a _____ use disorder than individuals without schizophrenia.

Answer 37

cannabis

Question 38

In addition, the term _____ communication was used to portray a communication style that produced conflicting messages, which, in turn, caused schizophrenia to develop.

Here, the parent presumably communicates messages that have two conflicting meanings; for example, a mother responds coolly to her child’s embrace but says, “Don’t you love me anymore?” when the child withdraws.

Answer 38

double bind

Question 39

Called _____ (meaning “taking hold of the nerves”), these medications provided the first real hope that help was available for people with schizophrenia.

Answer 39

neuroleptics

Question 40

These symptoms include the motor difficulties similar to those experienced by people with Parkinson’s disease, sometimes called parkinsonian symptoms.

_____is one of the most common; it includes an expressionless face, slow motor activity, and monotonous speech.

Answer 40

Akinesia

Question 41

Another extrapyramidal symptom is tardive _____, which involves involuntary movements of the tongue, face, mouth, or jaw and can include protrusions of the tongue, puffing of the cheeks, puckering of the mouth, and chewing movements.

Answer 41

dyskinesia

Question 42

An interesting treatment for the hallucinations experienced by many people with schizophrenia involves exposing the individual to magnetic fields. Called _____ magnetic stimulation, this technique uses wire coils to repeatedly generate magnetic fields—up to 50 times per second—that pass through the skull to the brain

Answer 42

transcranial