Chapter 13: Schizophrenia and Other Psychotic Disorders Flashcards
What is schizophrenia?
Characterized by an array of diverse symptoms, including extreme oddities in perception, thinking, action, sense of self, and manner of relating to others. However, the hallmark of schizophrenia is a significant loss of contact with reality, referred to as psychosis.
T or F: The risk of developing schizophrenia over the course of one’s lifetime is a little under 1 percent.
True. Around 0.7 percent to be exact.
*Approximately 1 out of every 140 people alive today who survive until at least age 55 will develop the disorder.
T or F: People whose fathers were older (50 years or more) at the time of their birth have an elevated risk of developing schizophrenia when they grow up.
True.
T or F: Having a parent who works as a dry cleaner is a risk factor for schizophrenia.
True.
When do the vast majority of schizophrenia cases begin?
The vast majority of cases of schizophrenia begin in late adolescence and early adulthood (18-30), but this differs between men and women.
*In men, there is a peak in new cases of schizophrenia between ages 20 and 24. The incidence of schizophrenia in women peaks during the same age period, but the peak is less marked than it is for men. After about age 35, the number of men developing schizophrenia falls markedly, whereas the number of women developing schizophrenia does not.
There is a second rise in new cases that begins around age 40, as well as a third spike in onset that occurs when women are in their early sixties.
Do men or women tend to have more severe cases of schizophrenia?
Males tend to have a more severe form of schizophrenia
*May also explain why schizophrenia is more common in males than it is in females (for every three men who develop the disorder, only two women do so [1.4:1])
What might explain the better clinical outcome of
women with schizophrenia?
Female sex hormones play some protective role (I.e., when estrogen levels are low or are falling, psychotic symptoms in women with schizophrenia often get worse, signalling that estrogen may be a protective factor).
What is a delusion (schizophrenia)?
A delusion is essentially an erroneous belief that is fixed
and firmly held despite clear contradictory evidence.
T or F; Not all people who have delusions suffer from schizophrenia.
True. However, delusions are common in schizophrenia, occurring in more than 90 percent of patients at some time during their illness
In schizophrenia, certain types of delusions or false beliefs are quite characteristic. What are they?
- Beliefs that one’s thoughts, feelings, or actions are being controlled by external agents (made feelings or impulses)
- That one’s private thoughts are being broadcast indiscriminately to others (thought broadcasting)
- That thoughts are being inserted into one’s brain by some external agency (thought insertion), or that some external agency has robbed one of one’s thoughts (thought withdrawal).
- Delusions of reference, where some neutral environmental event (such as a television program or a song on the radio) is believed to have special and personal meaning intended only for the person.
- Other strange propositions, including delusions of bodily changes (e.g., bowels do not work) or removal of organs, are also not uncommon.
What is a hallucination (schizophrenia)?
A hallucination is a sensory experience that seems real to the person having it, but occurs in the absence of any external perceptual stimulus.
T or F: Hallucinations can occur in any sensory modality (auditory, visual, olfactory, tactile, or gustatory).
True. However, auditory hallucinations (e.g., hearing voices) are by far the most common.
*75 percent of patients with schizophrenia
T or F: Patients can become emotionally involved in their hallucinations, often incorporating them into their delusions.
True. In some cases, patients may even act on their hallucinations and do what the voices tell them to do.
Are patients who are hallucinating really hearing
voices?
Neuroimaging studies that compare hallucinating patients with non-hallucinating patients suggest that patients with speech hallucinations have a reduction in brain (gray matter) volume in the left hemisphere auditory and speech perception areas. Reduced brain volume in these areas could lead to a failure to correctly identify internally generated speech, erroneously tagging it as coming from an external source.
What is disorganized speech?
Disorganized speech, on the other hand, is the external manifestation of a disorder in thought form. Basically, an affected person fails to make sense, despite seeming to using language in a conventional way and following the semantic and syntactic rules governing verbal communication.
T or F: Goal-directed activity is almost universally disrupted in schizophrenia.
True. Many researchers attribute these disruptions of “executive” behaviour to impairment in the functioning of the prefrontal region of the cerebral cortex.
What is catatonia?
There are two general symptom patterns of schizophrenia. What are they?
Referred to as positive-and negative-syndrome schizophrenia.
Positive symptoms are those that reflect an excess or distortion in a normal repertoire of behaviour and experience, such as delusions and hallucinations. Disorganized thinking (as revealed by disorganized speech) is also thought of in this way.
Negative symptoms, by contrast, reflect an absence or deficit of behaviours that are normally present.
Regarding the negative symptom pattern of schizophrenia, it is thought that the negative symptoms fall into two broad domains. What are they?
One domain involves reduced expressive behaviour—either in voice, facial expression, gestures or speech. This may show itself in the form of blunted affect or flat affect or in alogia, which means very little speech.
The other domain concerns reductions in motivation or in the experience of pleasure. The inability to initiate or persist in goal-directed activity is called avolition. Diminished ability to experience pleasure is called anhedonia.
What does the presence of persistent negative symptoms in schizophrenia demonstrate for future outcomes?
The presence of negative symptoms in the clinical picture is not a good sign for the patient’s future outcome. Even though patients with negative symptoms may seem emotionally unexpressive, how they appear and how they are feeling are two different things.
T or F: Most patients with schizophrenia have positive symptom and negative symptom patterns?
True.
T or F: There is a great deal of heterogeneity in the presentation of schizophrenia.
True. Patients with this disorder often look quite different clinically.
T or F: The subtypes of schizophrenia (paranoid, disorganized, catatonic) are no longer used in DSM-5.
True. Research using the sub-typing approach did not yield major insights into the etiology or treatment of the disorder.
What is schizoaffective disorder?
Conceptually something of a hybrid, in that it is used to describe people who have features of schizophrenia and severe mood disorder.
The reliability of schizoaffective disorder has tended to be quite poor, and clinicians often do not agree about who meets the criteria for the diagnosis. What has the DSM-5 done to improve reliability?
DSM-5 specifies that mood symptoms have to meet criteria for a full major mood episode and also have to be present for more than 50 percent of the total duration of the illness.
T or F: Long-term outcomes (10yrs) are better for those with schizoaffective disorder than those with schizophrenia.
True.
What is schizophreniform disorder?
Category reserved for schizophrenia-like psychoses that last at least a month but do not last for 6 months and so do not warrant a diagnosis of schizophrenia
What is delusional disorder?
Like those with schizophrenia, these individuals old beliefs that are considered false and absurd by those around them. Unlike individuals with schizophrenia, however, people given the diagnosis of delusional disorder may otherwise behave quite normally.
What is erotomania?
A subtype of delusional disorder. The theme of the delusion involves great love for a person, usually of higher status.
What is brief psychotic disorder?
Involves the sudden onset of psychotic symptoms or disorganized speech or catatonic behaviour. The episode usually lasts only a matter of days (too short to warrant a diagnosis of schizophreniform disorder)
T or F: Brief psychotic disorder is often triggered by stress.
True.
T or F: Brief psychotic disorder often lasts a few days so a diagnosis of schizophreniform cannot be diagnosed.
True. These individuals will return to normal functioning and may never have another episode again.
T or F: As with the mood disorders, schizophrenia concordance rates for identical twins are routinely and consistently found to be significantly higher than those for fraternal twins or ordinary siblings.
True. The concordance rate is 28 percent.
*If schizophrenia were exclusively a genetic disorder,
the concordance rate for identical twins would, of course, be 100 percent.
T or F: Because MZ twins have identical genes, children of a “well” twin will have an elevated risk of schizophrenia even if their parent did not suffer from the disorder.
True. A predisposition to schizophrenia may remain “unexpressed” unless “released” by unknown environmental factors.