Chapter 12: Schizophrenia

Question 1

Psychosis

Answer 1

Loss of Contact with Reality

Question 2

Delusions

Answer 2

fixed beliefs that are not swayed by evidence even contributory evidence.

Delusions of grandeur– belief they have exceptional abilities, wealth, or fame; belief they are God or other religious saviors

Delusions of control– belief that others control their thoughts/feelings/actions

Delusions of thought broadcasting– belief that one’s thoughts are transparent and everyone knows what they are thinking

Delusions of persecution– a belief they are going to be harmed, harassed, plotted or discriminated against by either an individual or an institution; it is the most common delusion (Arango & Carpenter, 2010)

Delusions of reference– belief that specific gestures, comments, or even larger environmental cues are directed directly to them

Delusions of thought withdrawal– belief that one’s thoughts have been removed by another source

Question 3

Hallucinations

Answer 3

Sensory experience without the presence of external stimulus. Can occur in any of the five senses

Question 4

Disorganized Thinking and Speech

Answer 4

Very common in Schizophrenia-like illnesses. Thoughts and speech can be circumstantial or tangential. For example, patients may give unnecessary details in response to a question before they finally produce the desired response. While the question is eventually answered in circumstantial speech patterns, in tangential speech patterns the patient never reaches the point. The speech is also incoherent and easily derailed

Question 5

Disorganized/abnormal behavior:

Answer 5

Odd behavior that can be childlike silliness to unpredictable violence. It can also be Catatonic or completely unreactive to reality. Catatonic behaviors can be negative (resistant to instruction), mute or in a stupor, rigid, posturing in weird positions or experience catatonic excitement such as hyperactivity or deliriousness

Question 6

Negative Symptoms of schizophrenia

Answer 6

Often present before positive symptoms and remain after positive symptoms occur. They are harder to diagnose and treat than positive symptoms
They include

Diminished emotional expression – Reduction in emotional expression; reduced display of emotional expression

Alogia – Poverty of speech or speech content

Anhedonia – Inability to experience pleasure

Asociality – Lack of interest in social relationships

Avolition – Lack of motivation for goal-directed behavior

Question 7

Describe how schizophrenia presents.

Answer 7

Presents with two of the following symptoms: psychosis, delusions, hallucinations, disorganized thinking and speech, abnormal behavior, and negative symptoms. The symptoms must be present over a one month period and must persist up to a 6 month period. It is not uncommon to have prodromal (full appearance of condition) symptoms and residual symptoms that follow it.

Question 8

Describe how schizophreniform disorder presents.

Answer 8

Sort of an intermediate with schizophrenic disorders. Mainly in the time for the persistence of symptoms. It’s not usually longer than 6 months. Although 2/3rds of schizophreniform disorders last longer than 6 months and turn into schizophrenia.
Final bit, any mood disorders like depression or mania must be present for a short time otherwise a schizoaffective disorder might be appropriate.

Question 9

Describe how schizoaffective disorder presents.

Answer 9

It is psychotic symptoms present with some mood disorder like symptoms. Patients must have a persistent mood component with psychotic symptoms and must continue for 2 weeks otherwise will be considered a mood disorder

Question 10

Describe how delusional disorder presents.

Answer 10

One delusion that is present for at least a month and does not have other schizophrenic symptoms and only brief mood disorders. The following can be mixed or unspecified. There are five subtypes of delusional disorder. There are:

Erotomaniac delusion: Someone being in love with them who isn’t. Such as parasocial celebrity fixations

Grandiose Delusions: Such as having made a discovery, having a talent or insight or believing they have the word of God.

Jealous Delusion: That their partner is unfaithful

Persecutory Delusion: such as they are being conspired against

Somatic Delusions: Delusions about bodily sensations.

Question 11

What are the four positive symptoms identified in a schizophrenia diagnosis? Define and identify their difference.

Answer 11

Psychosis (break from reality) , delusions (fixed beliefs without evidence), hallucinations (sensory experiences that are not real), disorganized thinking and speech (non-coherent or sensical speech), abnormal behavior (odd behavior)

Question 12

What is meant by negative symptoms? What are the negative symptoms observed in schizophrenia-related disorders?

Answer 12

Negative Symptoms: (Decreased ability to initiate speech, express emotion or feel pleasure)

Often present before positive symptoms and remain after positive symptoms occur. They are harder to diagnose and treat than positive symptoms

Diminished emotional expression – Reduction in emotional expression; reduced display of emotional expression

Alogia – Poverty of speech or speech content

Anhedonia – Inability to experience pleasure

Asociality – Lack of interest in social relationships

Avolition – Lack of motivation for goal-directed behavior

Question 13

Describe the epidemiology of schizophrenia spectrum disorders.

Answer 13

Schizophrenia 0.3-0.7%
All others 0.2-0.3%

Question 14

Discuss the different prevalence rates across the schizophrenia related disorders. Are there differences among the disorders? Between genders?

Answer 14

Men typically are present with negative symptoms and women are present with more affect laden symptoms

genders are equal in numbers for schizophrenia, schizoaffective and delusional disorder and schizophreniform tends to be higher in females

Schizophrenia is 0.3-0.7% of the population, all other disorders appear to be within 0.2-0.3%

Question 15

Are there differences in prevalence rates depending on symptom presentations? If so, what?

Answer 15

Men typically present earlier and have more negative symptoms. Negative symptoms typically present bore positive symptoms

Question 16

Describe the comorbidity of schizophrenia spectrum disorders.

Answer 16

High comorbidities with substance abuse disorder. Marijuana use may cause schizophrenia. Additionally its comorbid with anxiety, OCD and panic disorder. Also there is a lot of suicide and suicide attempts as 5-6% of schizophrenics do commit suicide and 20% attempt it

Question 17

Describe the biological causes of schizophrenia spectrum disorders.

Answer 17

Twin studies support that schizophrenia is genetic with a 48% concordance rate.

Schizophrenics have significant ventricle enlargement, reduction in brain volume in the medial temporal lobe (amygdala, hippocampus and the neocortical surface) are all in the temporal lobe.

While there is a genetic predisposition, it is a lock and key mechanism with environmental stressors which cause the stress cascade. The HPA axis is partly responsible for this. Particularly the release of glucocorticoids.

Stress and symptoms relapse is strong.

It is believed that abnormal brains structures and glucocorticoids cause schizophrenia

Question 18

Describe the psychological causes of schizophrenia spectrum disorders.

Answer 18

Premorbid cognitive impairment coupled with an aversive experience lead to dysfunctional beliefs and maladaptive behaviors.

Diathesis Stress model: Neurocognitive Impairment>Aversive Life Events> Dysfunctional Attitudes>Cognitive Distortions>Hyperactivation of the HPA>Schizophrenia

Question 19

Describe the sociocultural causes of schizophrenia spectrum disorders.

Answer 19

Schizophrenics who return to highly expressed emotions and critical homes are much more likely of relapse than those with reduced expressed emotions. Familial stress is a high predictor of schizophrenia and relapse

Question 20

What evidence is there to support a biological model with respect to explaining the development and maintenance of the schizophrenia spectrum and other psychotic disorders?

Answer 20

The lock and key metaphor. While there are brain structural and genetic components that give someone the predisposition for schizophrenia, it is environmental stimuli that unlock it

Question 21

Describe psychological treatment options for schizophrenia spectrum and other psychotic disorders.

Answer 21

Antipsychotic medications such as Thorazine and Chlorpromazine although they produce significant side effects such as muscle tremors and involuntary movements. Tor reduce these symptoms, it is encouraged to give only the bare minimum does to reduce schizophrenic symptoms

Second generation antipsychotics such as Chorazil, Risperdal and Abilify reduce side effects and effect both dopamine and serotonin

Question 22

What is the Psychological approach to schizophrenia

Answer 22

CBT Does not address symptom reduction. But improves understanding of their symptoms and focuses on maladaptive response to the psychotic symptoms. CBT tends to be effective in conjunction with meds

Question 23

Describe family interventions for schizophrenia spectrum and other psychotic disorders.

Answer 23

Family wide psychoeducation in conjunction with low emotion problem solving tends to be effective. Usually uses Family based CBT to aide with the affliction

Increasing social skills help mitigate the isolating factors associated with the illness

Inpatient hospitalizations of community therapies are usually done on an outpatient basis however there may be short term hospitalizations to help reduce psychotic symptoms

Question 24

Define tardive dyskinesia.

Answer 24

involuntary movements isolated to the tongue, mouth, and face