Chapter 12 - Schizophrenia and Other Psychotic Disorders

Question 1

schizophrenia

Answer 1

A chronic psychotic disorder characterized by disturbed behaviour, thinking, emotions, and perceptions.

Question 2

prodromal phase

Answer 2

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

Question 3

residual phase

Answer 3

In schizophrenia, the phase that follows an acute phase, characterized by a return to the level of functioning of the prodromal phase.

Question 4

positive symptoms

Answer 4

Flagrant symptoms of schizophrenia, such as hallucinations, delusions, bizarre behaviour, and thought disorder.

Positive symptoms involve a break with reality, as represented by appearance of hallucinations and delusional thinking.

Question 5

negative symptoms

Answer 5

Behavioural deficiencies associated with schizophrenia, such as social skills deficits, social withdrawal, flattened affect, poverty of speech and thought, psychomotor retardation, and failure to experience pleasure.

Negative symptoms involve loss or reduction of normal functions, including a lack of emotions or emotional expression (maintaining a blank expression), loss of motivation, loss of pleasure in normally pleasant activities, social withdrawal, and impovershed speech (“poverty of speech”).

Question 6

Clinical Features of Schizophrenia:

Disturbed Thought Processes

Answer 6

Delusions (fixed false ideas) and thought disorder (disorganized thinking and incoherent speech).

Question 7

Clinical Features of Schizophrenia:

Attentional Deficiencies

Answer 7

Difficulty attending to relevent stimuli and screening out irrelevant stimuli.

Question 8

Clinical Features of Schizophrenia:

Perceptual Disturbances

Answer 8

Hallucinations (sensory perceptions in the absence of external stimulation).

Question 9

Clinical Features of Schizophrenia:

Emotional Disturbances

Answer 9

Fat (blunted) or inappropriate emotions.

Question 10

Clinical Features of Schizophrenia:

Other Types of Impairments

Answer 10

Confusion about personal identity, lack of volition, excitable behaviour or states of stupor, odd gestures or bizarre facial expressions, and impaired ability to relate to others.

Question 11

Major Subtypes of Schizophrenia:

Disorganized Type

Answer 11

Confused and bizarre behaviour, incoherent speech, vivid hallucinations, flat or inappropriate affect, and disorganized delusions.

Question 12

Major Subtypes of Schizophrenia:

Catatonic Type

Answer 12

Gross disturbances in motor activity in which behaviour may slow to a stupor but abruptly shift to a highly agitated state.

Question 13

Major Subtypes of Schizophrenia:

Paranoid Type

Answer 13

Delusions (typically themes of grandeur, persecution, or jealousy) and frequent auditory hallucinations.

Question 14

Major Diagnostic Features of Schizophrenia:

A: Two or more of the following must be present for a significant portion of time over a1-month period:

Answer 14

1. Delusions
2. Hallucinations
3. Speech that is either incoherent or characterized by marked loosening of associations
4. Disorganized or catatonic behaviour
5. Negative features (e.g., flattened affect)

Question 15

Major Diagnostic Features of Schizophrenia:

B: Functioning in such areas as social relations, work, or self-care during the course of the disorder is markedly below the level achieved prior to the onset of the disorder. And…

Answer 15

If the onset develops during childhood or adolescence, there is a failure to achieve the expected level of social development.

Question 16

Major Diagnostic Features of Schizophrenia:

C: Signs of the disorder have occurred continuously for a period of at least 6 months. This 6-month period must include an active phase lasting at least a month in which psychotic symptoms which are characteristic of schizophrenia occur. What are these symptoms?

Answer 16

1. Delusions
2. Hallucinations
3. Speech that is either incoherent or characterized by marked loosening of associations
4. Disorganized or catatonic behaviour
5. Negative features (e.g., flattened affect)

Question 17

Major Diagnostic Features of Schizophrenia:

D: What is the final major diagnostic feature?

Answer 17

The disorder cannot be attributed to the effects of a substance (e.g., substance abuse or prescribed medication) or to a general medical condition.

Question 18

Aberrent Content of Thought

Common types of Delusions

Answer 18

• Delusions of persecution (e.g., “The CIA is out to get me.”)
• Delusions of reference (“People on the bus are talking about me,” or “People on TV are making fun of me,” or “The neighbors hear everything I say. They’ve put bugs in the walls of my house.”)
• Delusions of being controlled (believing one’s thoughts, feelings, impulses, or actions are controlled by external forces, such as agents of the devil)
• Delusions of grandeur (believing oneself to be Jesus or believing one is on a special mission, or having grand but illogical plans for saving the world)

Question 19

thought disorder

Answer 19

A disturbance in thinking characterized by the breakdown of logical associations between thoughts.

Question 20

Attentional Deficiencies:

Eye Movement Dysfunction

Answer 20

About 1 in 3 patients with chronic schizophrenia have some form of eye movement dysfunction. Patients with these dysfunctions (also called eye tracking dysfunctions) show unusual eye movements when tracking a moving target across their field of vision.

Question 21

Attentional Deficiencies:

Abnormal Event-Related Potentials (ERPs)

Answer 21

Schizophrenia patients tend to suffer from sensory overload, which is thought to be due to a greater difficulty in filtering out extraneous stimuli.

Question 22

hallucinations

Answer 22

Perceptions occuring in the absence of external stimuli that become confused with reality.

Question 23

True or False:

Visual hallucinations are the most common type of hallucination in people with schizophrenia.

Answer 23

FALSE:

Auditory, not visual, hallucinations are the most common types of hallucinations among people with schizophrenia.

Question 24

Subtypes of Schizophrenia:

Disorganized Type

(definition)

Answer 24

The subtype of schizophrenia characterized by disorganize behaviour, bizarre delusions, and vivid hallucinations.

Question 25

Subtypes of Schizophrenia:

Disorganized Type

(description)

Answer 25

The disorganized type of schizophrenia is associated with features such as confused behaviour; incoherent speech; silly, irrelevelent laughter; vivid and frequent hallucinations; flattened or inappropriate affect; and disorganized delusions that often involve sexual or religious themes. Social impairment is common. People with disorganized schizophrenia display silliness and giddiness of mood, giggling and talking nonsensically They often neglect their appearance and hygiene and lose control of their bladders and bowels.

Question 26

Subtypes of Schizophrenia:

Catatonic Type

(definition)

Answer 26

The subtype of schizophrenia characterized by gross disturbances in motor activity, such as catatonic stupor.

Question 27

Subtypes of Schizophrenia:

Catatonic Type

(description)

Answer 27

The catatonic type of schizophrenia is characterized by markedly impaired motor behaviour and a slowing of activity to the point of stupor, but may abruptly switch into an agitated phase. People with catatonic schizophrenia may show unusual mannerisms or grimacing, or maintain bizarre, apparently strenuous postures for hours, although their limbs become stiff or swollen. A striking, but less common feature, is waxy flexibility, which involves adopting a fixed posture into which they have been positioned by others.

(Catatonia is not unique to schizophrenia. It can occur in other disorders, including brain disorders, drug intoxication, and metabolic disorders. In fact is more often found in people with mood disorders than in those with schizophrenia).

Question 28

Subtypes of Schizophrenia:

Paranoid Type

(definition)

Answer 28

The subtype of schizophrenia characterized by hallucinations and systemized delusions, commonly involving themes of persecution, grandeur, or jealousy.

Question 29

Subtypes of Schizophrenia:

Paranoid Type

(description)

Answer 29

The paranoid type of schizophrenia is characterized by preoccupations with one or more delusions or with the presence of frequent auditory hallucinations. The behaviour and speech of someone with paranoid schizophrenia do not show the marked disorganization typical of the disorganized type, nor is there a prominent display of flattened or inappropriate affect, or catatonic behaviour. The delusions often involve themes of grandeur, persecution, or jealousy. The patient may believe, for example, that is or her spouse or lover is unfaithful, despite a lack of evidence. Patients may become highly agitated, confused, and fearful.

Question 30

dopamine hypothesis

Answer 30

The prediction that schizophrenia involves overactivity of dopamine transmission in the brain.

Question 31

phenotypes

Answer 31

Outward expression of traits, such as eye color or observed behaviour.

Question 32

endophenotypes

Answer 32

Measurable processes or mechanisms not apparent to the naked eye that explain how an organism’s genetic code influences its observable characteristics or phenotypes.

Question 33

tardive dyskinesia (TD)

Answer 33

A disorder characterized by involuntary movements of the face, mouth, neck, trunk, or extremeties, caused by long-term use of antipsychotic medication.

Question 34

brief psychotic disorder

Answer 34

A psychotic disorder lasting from a day to a month that often follows exposure to a major stressor. (Psychotic features differentiate it from an adjustment disorder).

Characterized by at least one of the following features: delusions, hallucinations, disorganized speech, or disorganized or catatonic behaviour.

Eventually there is a full return to the individual’s prior level of functioning.

Question 35

schizophreniform disorder

Answer 35

A psychotic disorder lasting less than 6 months in duration, with features that resemble schizophrenia.

Although some cases have good outcomes, in others, the disorder persists beyond 6 months and may be reclassified as schizophrenia or perhaps another form of psychotic disorder, such as schizoaffective disorder.

Question 36

schizoaffective disorder

Answer 36

A type of psychotic disorder in which individuals experience both severe mood disturbance and features associated with schizophrenia.

Question 37

delusional disorder

Answer 37

A type of psychosis characterized by persistent delusions, often of a paranoid nature, that do not have the bizarre quality of the type found in paranoid schizophrenia.

Question 38

Delusional Disorders:

Erotomanic Type

Answer 38

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

Question 39

Delusional Disorders:

Grandiose Type

Answer 39

Inflated beliefs about your worth, importance, power, knowledge, or identitiy, or bliefs that you hold a special relationship to a deity or a famous person. Cult leaders who believe they have special mystical powers or enlightenment may have delusional disorders of this type.

Question 40

Delusional Disorders:

Jealous Type

Answer 40

Delusions of jealousy in which the person may become convinced, without due cause, that his or her lover is unfaithful. The delusional person may misinterpret certain ‘clues’ as signs of unfaithfulness, such as spots on the bedsheets.

Question 41

Delusional Disorders:

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 maligned and mistreated. People with such delusions may repeatedly institute court actions, or even commit acts of violence against those who they perceived are responsible for their mistreatment.

Question 42

Delusional Disorders:

Somatic Type

Answer 42

Delusions involving physical defects, disease, or disorder. People with these delusions may believe that foul odors are eminating from their bodies, or that internal parasites are eating away at them, or that certain parts of their body are unusually disfigured or ugly or not functioning properly despite evidence to the contrary.

Question 43

Delusional Disorders:

Mixed Type

Answer 43

Delusions typify more than one of the other types; no single theme predominates.

Question 44

What is schizophrenia and how prevalent is it?

Answer 44

Schizophrenia is a chronic psychotic disorder characterized by acute episodes involving a break with reality, as manifested by features such as delusions, hallucinations, illogical thinking, incoherent speech, and bizarre behaviour. Residual deficits in cognitive, emotional, and social areas of functioning persist between acute episodes. Schizophrenia is believed to affect about 1% of the adult population.

Question 45

What are the major phases of schizophrenia?

Answer 45

Schizophrenia usually develops in late adolescence or early adulthood. Its onset may be abrupt or gradual. Gradual onset involves a prodromal phase, a period of gradual deterioration that precedes the onset of acute symptoms. Acute episodes, which may occur periodically throughout life, are typified by clear psychotic symptoms, such as hallucinations and delusions. Between acute episodes, the disorder is characterized by a residual phase in which the person’s level of functioning is similar to that which was present during the prodromal phase.

Question 46

What are the most prominent features of schizophrenia?

Answer 46

Among the more prominent features of schizophrenia are disorders in the content of thought (delusions) and the form of thought (thought disorder), as well as the presence of often severe perceptual distortions (hallucinations) and emotional disturbances (flattened or inappropriate affect). There are also dysfunctions in brain processes regulating attention to stimuli from the external world.

Question 47

What are the specific subtypes of schizophrenia?

Answer 47

The disorganized type is associated with grossly disorganized behaviour and thought processes. The catatonic type is associated with grossly impaired motor behaviours, such as maintenance of fixed postures and muteness for long periods. The paranoid type is characterized by paranoid delusions and frequent auditory hallucinations. The undifferentiated type is a catchall category applying to cases in which schizophrenic episodes don’t clearly fit the other types. The residual type applies to individuals who do not have prominent psychotic behaviours at the time of evaluation.

May be Type I (mostly positive symptomology, etc.) and Type II (mostly negative symptomology, etc.), also.