chapter 11

Question 1

what is schizophrenia

Answer 1

A chronic, debilitating psychological disorder impacting every part of a person’s life, characterized by a break in reality that typically takes place in the form of:

• hallucinations
• delusions
• pattern of aberrant behavior

Develops during late adolescence or early adulthood
- Suddenly, within a few weeks or months

positive symptoms
negative symptoms

Question 2

hallucinations

Answer 2

Perceptions attributed to external stimuli confused with reality

Sensory distortions such as “hearing voices” or “seeing things”

Question 3

delusions

Answer 3

Firmly held inaccurate beliefs despite reality

Fixed, false beliefs

Question 4

phases of schizophrenia

Answer 4

prodromal phase
acute episode
residual phase

Question 5

prodromal phase

Answer 5

The period of deterioration preceding the onset of acute symptoms

In schizophrenia, the period of decline in functioning that precedes the first acute psychotic episode

Characterized by subtle symptoms involving unusual thoughts or abnormal perceptions (but not outright delusions or hallucinations), as well as waning interest in social activities

Question 6

acute episode

Answer 6

The emergence of clear psychotic features

lapses in job performance or schoolwork, speech becomes vague, hoards food, collects garbage, talking to oneself on the street → increasingly bizarre behavior

Question 7

residual phase

Answer 7

Level of functioning that was typical of the prodromal phase

Follows acute episodes

In which their behavior returns to the level of the prodromal phase

Flagrant psychotic behaviors are absent, but the person is still impaired

Difficult functioning

Question 8

positive symptoms

Answer 8

Flagrant symptoms such as hallucinations, delusions, bizarre behavior, thought disorder

Question 9

negative symptoms

Answer 9

Behavioral symptoms as social skills deficit and withdrawal, flattened affect, poverty of speech/thought, failure to experience pleasure, psychomotor retardation

Question 10

criteria for schizophrenia

Answer 10

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 avolition)

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 disturbance persist for at least 6 months. This 6 month period must include at least 1 month of symptoms (or less ifi successfully treated) that meet Criterion A (ie., 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, 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)

Question 11

Disturbed thought and speech

Answer 11

Aberrant content of thought: delusions of thought

delusions of persecution or paranoia

delusions of reference

delusions of being controlled

delusions of grandeur

thought broadcasting

thought insertion

thought withdrawal

Question 12

Delusions of persecution or paranoia

Answer 12

“The CIA is out to get me”

Question 13

Delusions of reference

Answer 13

“People on the bus are talking about me”
“People on TV are making fun of me”

Question 14

Delusions of being controlled

Answer 14

Believing that one’s thoughts, feelings, impulses, or actions are controlled by external forces such as agents of the devil

Question 15

Delusions of grandeur

Answer 15

Believing oneself is to be Jesus

Question 16

Thought broadcasting

Answer 16

“As I think, my thoughts leave my head on a type of mental ticker tape. Everyone around has only to pass the tape through their mind and they know my thoughts”

Question 17

Thought insertion

Answer 17

“The garden looks nice and the grass looks cool, but the thoughts of [a man’s name] come into my mind. There are no other thoughts there, only his… He treats my mind like a screen and flashes his thoughts on it like you flash a picture”

Question 18

Thought withdrawal

Answer 18

“I am thinking about my mother, and suddenly my thoughts are sucked out of my mind by a phrenological vacuum extractor, and there is nothing in my mind; it is empty”

Question 19

thought disorder

Answer 19

A disturbance in thinking characterized by a breakdown in thoughts
Breakdown in:
- Organization
- Processing
- Control
Of thoughts

Question 20

Attentional deficiencies

Answer 20

Eye movement dysfunction
and
Abnormal event related potentials

Question 21

Eye movement dysfunction

Answer 21

Difficulty tracking a slow moving target across their field of vision

Eyes fall back and catch up in a jerky movement

Question 22

Abnormal event related potentials

Answer 22

Abnormal brain wave patterns in response to external stimuli

Sensory ‘gating’ that suppresses does not supress does not disregard relevant stimuli

Difficulty filtering out irrelevant stimuli

Sensory overload and jumbling of sensations

Question 23

Emotional disturbances

Answer 23

More negative and fewer positive emotions than healthy individuals

Flat affect

Less facial expressions

Question 24

Perceptual disturbances

Answer 24

Hallucinations
- Sensory experiences in the absence of external stimulation in relation to the five senses
- Auditory are the most common (70%)

Attributed to:
- Disturbances in brain chemistry (high dopamine?)
- Inner speech/misattributed self talk attributed to external sounds
- Abnormal structure and connections in neurons

Question 25

Catatonia

Answer 25

Three or more of the following symptoms: - Stupor (no psychomotor activity; not actively relating to environment) - Catalepsy (passive induction of a posture held against gravity) - Waxy flexibility (slight, even resistance to positioning by examiner) - Mutism (no, or very little, verbal response) - Negativism (opposition or no response to instructions or external stimuli) - Posturing (spontaneous and active maintenance of a posture against gravity) - Mannerism (odd, circumstantial caricature of normal actions) - Stereotypy (repetitive, abnormally frequent, non-goal-directed movements) - Agitation, not influenced by external stimuli - Grimacing - Echolalia (mimicking another’s speech) - Echopraxia (mimicking another’s movements)

Question 26

Brief Psychotic Disorder

Answer 26

Applies to a psychotic disorder that last from a day to a month and is characterized by at least one of the following features: delusions, hallucinations, disorganized speech, or grossly disorganized or catatonic behavior

Question 27

Brief Psychotic Disorder criteria

Answer 27

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 4. Grossly disorganized or catatonic behavior 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 or another medical condition

Question 28

specify with brief psychotic disorder

Answer 28

With a marked stressor(s) (brief reactive psychosis): If symptoms occur in response to events that, singly or together, would be markedly stressful to almost anyone in similar circumstances in the individual’s culture Without marked stressor(s): If symptoms do not occur in response to events that, singly or together, would be markedly stressful to almost anyone in similar circumstances in the individual’s culture With peripartum onset: If onset is during pregnancy or within 4 weeks With catatonia

Question 29

Schizophreniform Disorder

Answer 29

Consists of abnormal behaviors identical to those in schizophrenia that have persisted for at least one month but fewer than six months

Question 30

Schizophreniform Disorder criteria

Answer 30

A. Two or (more) of the following, each present for a significant portion of time during a 1 month period (or less is successfully treated). At least one of these must be (1), (2), or (3): 1. Delusions 2. Hallucinations 3. Disorganized speech 4. Negative symptoms 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 or another medical condition

Question 31

Schizophreniform Disorder specify with

Answer 31

With good prognostic features: The specificer requires the presence of at least two of the following features: - Onset of prominent psychotic symptoms within 4 weeks of the first noticeable change in usual behavior or functioning; confusion or perplexity; good premorbid social and occupational functioning; and absence of blunted or flat affect Without good prognostic features: This specified is applied if two or more of the above features have not been present With catatonia

Question 32

Schizoaffective Disorder

Answer 32

Sometimes referred to as a “mixed bag” of symptoms because it includes psychotic behaviors associated with schizophrenia occuring at the same time as a major mood disorder At some point in the course of the disorder, delusions or hallucinations occur for a period of at least two weeks without the presence of a major mood disorder

Question 33

Schizoaffective Disorder criteria

Answer 33

A. An uninterrupted period of illness during which there is a major mood episode (major depressive or manic) concurrent with Criterion A of schizophrenia 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 portion of the illness D. The disturbance is not attributable to the effects of a substance or another medical condition

Question 34

Schizoaffective Disorder specify

Answer 34

Bipolar type: This subtype applies if a manic episode is part of the presentation. Major depressive episodes may also occur Depressive type: This subtype applies if only major depressive episodes are part of the presentation

Question 35

Delusional Disorder

Answer 35

Applies to people who hold persistent, clearly delusional beliefs, often involving paranoid themes Rare: 20/10,000 people during their lifetimes Beliefs may be bizarre or may fall within a range of seeming plausibility, such as unfounded beliefs

Question 36

Delusional Disorder criteria

Answer 36

A. The presence of one (or more) delusions with a duration of 1 month or longer B. Criterion A for schizophrenia has never been met C. Apart from the impact of the delusion(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 delusional 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

Question 37

Delusional Disorder TYPES (list)

Answer 37

erotomanic type grandiose type jealous type persecutory type somatic type mixed type unspecified type with bizarre content

Question 38

Erotomanic Type

Answer 38

Delusional beliefs that someone else, usually a person of a higher social status such as a movie start of a political figure, is in love with you; also called erotomania

Question 39

Grandiose Type

Answer 39

Inflated beliefs about one’s own worth, importance, power, knowledge, identity, or beliefs that one has a special relationship to a deity or to a famous person. Cult leaders who believe they have special mystical powers of enlightenment may have delusional disorders of this type.

Question 40

Jealous Type

Answer 40

Delusions of jealousy in which the person may become convinced, without due cause, of the infidelity or his or her partner. The delusional person may misinterpret certain clues as a signs of unfaithfulness, such as spots on the bed sheets

Question 41

Persecutory Type

Answer 41

The most common type of delusional disorder, persecutory delusions involve themes of being conspired against, followed, cheated, spied on, poisoned or drugged, or otherwise malsigned or mistreated. People with these delusions may repeatedly bring legal actions against those whom they perceive to be responsible for their mistreatment or may even commit acts of violence against them.

Question 42

Somatic Type

Answer 42

Delusions involving the person’s physical or medical condition. People with these delusions may believe that foul odors are emanating from their bodies or that internal parasites are eating away at them.

Question 43

Mixed Type

Answer 43

Delusions typify more than one or the other types with no single predominant theme

Question 44

Unspecified Type

Answer 44

This subtype applies when the dominant delusional belief cannot be clearly determined or is not described in the specific types

Question 45

With bizarre content

Answer 45

Delusions are deemed bizarre if they are clearly implausible, not understandable, and not derived from ordinary life experiences

Question 46

perspectives (list)

Answer 46

psychodynamic learning social-cognitive biological

Question 47

psychodynamic perspective

Answer 47

**Regression** to a psychological state corresponding to early infancy in which the prodding of the id produces bizarre, socially deviant behavior and gives rise to hallucinations and delusions

Question 48

learning

Answer 48

People with schizophrenia **learn to exhibit** certain bizarre behaviors when they are more likely to be reinforced than behaviors that would be considered normal

Question 49

Social-Cognitive theorists

Answer 49

**Modeling and selective reinforcement** of bizarre behavior may explain some schizophrenic behaviors in the hospital setting

Question 50

Biological

Answer 50

Proven genetic component → theory is combination of genes Biochemical: - Dopamine hypothesis - Viral infections + Vitamin D deficiency Brain abnormalities: - Studies show structural abnormalities - Loss or thinning of gray matter - Especially in prefrontal cortex - regulating attention, organizing thoughts and behavior, prioritizing information, formulation goals - Damage or developmental failure during prenatal development or early

Question 51

Dopamine hypothesis

Answer 51

overactivity of dopamine in the brain is involved in schizophrenia

Question 52

Viral infections + Vitamin D deficiency

Answer 52

Viral (flu, rubella, etc) as predisposition Lack of vitamin D in seasons with less sun as predisposition

Question 53

Family factors

Answer 53

- communication deviance - Evidence shows that parents with high levels of communication deviance stand a higher than average risk of having offspring with schizophrenia spectrum disorders - expressed emotion - Living with high EE relative appears to impose greater stress on people who are challenged by mental disorders

Question 54

communication deviance

Answer 54

a pattern of unclear, vague, disruptive, or fragmented communication that is often found among parents and family members of people with schizophrenia

Question 55

expressed emotion

Answer 55

a pattern of responding to the family member with schizophrenia in hostile, critical, and unsupportive ways

Question 56

treatment (list)

Answer 56

biomedical learning based approach psychosocial rehabilitation approach family intervention programs

Question 57

biomedical

Answer 57

Remember the 50s! Antipsychotics Eases intensive, flagrant behavior patterns like delusions and hallucinations Antipsychotics tardive dyskinesia 1st vs 2nd gen

Question 58

1st gen antipsychotics

Answer 58

thorazine, trifluoperazine, fluphenazine, haloperidol Prescribed less; second round; more intense; more side effects Tardive dyskinesia

Question 59

tardive dyskinesia

Answer 59

Involuntary movements of the face, mouth, trunk, or extremities caused by long term use Major risk of long term use of neuroleptics

Question 60

2nd gen psychotics

Answer 60

clozapine, risperidone, olanzapine Family involvement plays a role! Greater accompaniment of families may require less medication

Question 61

Learning based approaches

Answer 61

Token economy systems Social skills training - Increases adaptive behavior

Question 62

Psychosocial rehabilitation approaches

Answer 62

Help people adapt more successfully to occupational and social roles in the community

Question 63

Family intervention programs

Answer 63

Helps families cope with the burden of care, communicate more clearly, and learn more helpful ways of relating to the patient