Chapter 13 Schizophrenia Spectrum and Other Psychotic Disorders

Question 1

Schizophrenia

Answer 1

1. The startling disorder characterized by a broad spectrum of emotional dysfunctions including delusions, hallucinations, disorganized speech and behavior, and inappropriate emotions.
2. Disorder characterized by a broad spectrum of cognitive and emotional dysfunctions including hallucination, delusions, disorganized speech and behaviour and inappropriate emotions
   - one of the most severe mental illnesses
   - effects men more *more women then men later on in life
   - no one essential symptom (ex arthur who it came and went)

Question 2

Clinical description of Schizophrenia

Answer 2

• negative symptoms come first
• onset of positive symptoms “psychotic break”
• negative symptoms are hard to treat
• Positive symptoms dramatic but respond to medication

Question 3

Course of Schizophrenia

Answer 3

• prodromal phase starts in high school
• 1st active phase in late teens, early 20’s
• residual phase ongoing following treatment for positive symptoms
• additional active phase from time to time if stressor
• recovery is not as good with each successive active phase
• 22% of individuals have one episode and return to premorbid functioning

Question 4

Prevalence of Schizophrenia

Answer 4

1% of general population, equally common in both men and women, later onset in women, more commonly diagnosed in ethnic minorities

Question 5

Schizophrenia: Genetic influences

Answer 5

Liklihood someone will develop schizophrenia if they are related to someone who has it tracks very well with genes that are shared

• 48% ID twins
• 46% if both parents have schizophrenia
• 17% dizygotic twin has schizophrenia
• 15% if one parent
• <5% if other relative

Question 6

Catatonia

Answer 6

1. alternating immobility and excited agitaiton

Question 7

Hebephrenia

Answer 7

silly and immature emotionality

Question 8

Paranoia

Answer 8

delusions of grandeur or persecution.

Question 9

Psychotic behavior

Answer 9

1. Unusual behaviors, usually involving delusions (irrational beliefs) and/or hallucinations.

Question 10

Positive symptoms

Answer 10

1. Delusions- delusion of grandeur (exaggerated importance), delusions of persecution- “out to get me”,
2. Hallucinations- auditory most common (more activity in the Brocas area of the brain), visual, oolfactory, gustatory (taste), and tactile (touch)
3. Symptoms that are added to a person’s experience.These are delusions and hallucinations.
4. Overt symptoms.

Question 11

Delusion

Answer 11

1. delusion of grandeur (exaggerated importance), delusions of persecution- “out to get me”,
2. Disorder of thought content.
3. A belief that would be seen by most others as a misrepresentation of reality
   - thinking that someone else is putting thoughts into your head
   - delusions of grandeur (thinking your someone your not ex. that you can cure all hunger in the world)
   - delusions of persecution common (believing others are out to get you)
   - Cotards syndrom - person believes part of their body has changed
   - Capgras syndrom - believes someone has been replaced by a double

Question 12

Delusion of grandeur

Answer 12

A mistaken belief that the person is famous or powerful

Question 13

Delusions of persecution

Answer 13

People are out to get them.

Question 14

Hallucination

Answer 14

1. sensory experience without external stimuli
   - hearing, seeing, smelling, tasting, or feeling something that isn t actually present
2. Experiencing sensory events without the presence of stimuli. Most common is auditory.
3. The experience of sensory events without any input from the surrounding environment
   - Auditory most common, but can be from any sense like vision (like video)
   - Say they feel bugs on them
4. A psychotic symptom of perceptual disturbance in which something is seen, heard, or otherwise sensed although it is not actually present.

Question 15

Negative symptoms

Answer 15

1. Avolition, Alogia, Anhedonia, and Flat Affect (absence of affect)
2. Symptoms that are absent from their experience.
3. Behavioural deficits
4. Tend to endure beyond acute episodes
5. These are behaviors/thoughts/things that are subtracted from a “normal” experience and render it abnormal
6. they include emotional and social withdrawal, apathy and poverty of speech or thought
7. Less outgoing symptoms such as the absence or insufficiency of normal behaviors.

Question 16

Avolition

Answer 16

1. inability to initiate and persist, lack of motivation
2. Lack of energy and absence of interest in or an inability to persist in what are usually routine activities
   - usually personal hygiene
   - highly associated with poor outcomes compared to other symptoms

Question 17

Alogia

Answer 17

1. absence of speech
2. Relative absence of speech, delayed comments or slow responses to questions
3. a deficiency in the amount or content of speech.

Question 18

Anhedonia

Answer 18

1. absence of pleasure
2. Lack of pleasure experienced
3. Loss of interest in or a reported lessening of the experience of pleasure. Included in eating, social interactions and sexual relations. Delay in seeking treatment for schizophrenia
4. Inability to experience pleasure.

Question 19

Affective Flattening/ Flat affect

Answer 19

1. No outward expression of emotion. About 2/3 experience this. Respond inside rather then outside, like wearing a mask.
2. An apparently emotionless demeanor (including toneless speech and vacant gaze) when a reaction would be expected.

Question 20

Disorganized speech

Answer 20

1. (tangentiality or loose association/ derailment
   Inappropriate Affect- crying when something is happy, laughing uncontrollably
   Disorganized behavior- agitation and gesturing that its extreme and nonsensical, catatonic immobility and waxy flexibility
2. Jumping from topic to topic, speaking illogically.
3. • Disorganized speech, motor behaviour, and emotional reactions
     - Inappropriate affect and disorganized behaviour
4. Style of talking characterized by incoherence and lack of typical logic patterns, jump from topic to topic
   - “associative splitting” or “cognitive slippage”

Question 21

Disorganized symptom

Answer 21

1. Disorganized speech (tangentiality or loose association/ derailment
   Inappropriate Affect- crying when something is happy, laughing uncontrollably
   Disorganized behavior- agitation and gesturing that its extreme and nonsensical, catatonic immobility and waxy flexibility
2. Variety of erratic behaviors that affect speech, motor behavior, and emotional reactions.

Question 22

Disorganized Type

Answer 22

disrupted speech and behavior

• disjointed hallucinations and delusions
• flat or inappropriate affect

Question 23

Disorganized behaviour

Answer 23

Disorganized Behaviour: Bizarre behaviours. Includes catatonic immobility, waxy flexibility (tendency to keep limbs in position a person puts them in ie. therapist) and hoarding

Question 24

Inappropriate affect

Answer 24

1. crying when something is happy, laughing uncontrollably
2. laughing at a funeral. Bizarre behaviors.
3. Emotional responses are out of context (laughs at family pet dying, mad at winning the lottery)
4. An emotional display that is inappropriate for the situation.

Question 25

Catatonic immobility

Answer 25

Disturbance of motor behavior in which the person remains motionless, sometimes in an awkward posture, for extended periods

Question 26

Waxy flexibility

Answer 26

Rigidity, agitation, odd mannerisms

Question 27

Schizophreniform disorder

Answer 27

1. presentation of Schizophrenia, but lasts shorter than a 6 month period 2. Experienced for a few months, then they can resume their normal lives. Sometimes as a result of treatment but also reasons are unknown

Question 28

Schizoaffective disorder

Answer 28

1. Presentation of both Schizophrenia and Mood disorder symptoms 2. Schizophrenia and characteristics of mood disorder. Likely to not get better on their own and instead experience major life difficulties. Delusions and hallucinations must happen for atlas 2 weeks in the absence of mood symptoms

Question 29

Premorbid

Answer 29

Before the psychotic episode

Question 30

Delusional disorder

Answer 30

1. Persistent beliefs that are not in line with reality, but don ot meet criteria for schizophrenia - Erotomania, grandiose, jealous, persecutory, and somatic - imagined events could happen, but are not 2. Beliefs that aren't generally held by other members of society. May become isolated as suspicious of others, but tend not to have flat affect, anhedonia, or other negative symptoms - delusional substypes are: erotomanic, grandiose, jealous, persecutory and somatic

Question 31

Erotomanic type

Answer 31

irrational belief that one is loved by another person, usually of higher status

Question 32

Grandiose type

Answer 32

Believing in one's inflated worth, power, knowledge, identity, or special relationship to a deity or famous person.

Question 33

Jealous type

Answer 33

Sexual partner is unfaithful

Question 34

Persecutory type

Answer 34

Believing oneself (or someone close) is being malevolently treated in some way

Question 35

Somatic delusions

Answer 35

The person feels afflicted by a physical defect or general medical condition

Question 36

Shared psychotic disorder (folie a deux)

Answer 36

1. Develop delusions similar to that of a person who they share a close relationship with 2. Condition in which people develop a delusion simply as a result of close relationships with a delusional individual

Question 37

Substance-induced psychotic disorder

Answer 37

Psychosis caused by the ingestion of medications, psychoactive drugs, or toxins.

Question 38

Psychotic disorder associated with another medical condition

Answer 38

Psychological dysfunction associated with distress or impairment in functioning that is not a typical or culturally expected response, which associated with another medical condition

Question 39

Brief psychotic disorder

Answer 39

1. Delusions, hallucinations, or disorganized speech/ behavior lasting less than 1 month 2. Lasts for only a few days and characterized by the presence of more positive symptoms such as delusions, hallucinations, or disorganized speech or behaviour lasting one month or less

Question 40

Attenuated psychosis syndrome

Answer 40

1. Requires further study. Patients are aware of their troubling and bizarre nature of these symptoms

Question 41

prodromal phase

Answer 41

beginning of symptoms, often negative symptoms and some bizarre beliefs or actions

Question 42

Active phase

Answer 42

positive symptoms are prominent and some negative symptoms

Question 43

Residual Phase

Answer 43

negative symptoms remain after active phase has ended

Question 44

Endophenotyping

Answer 44

Find the gene or genes that cause these difficulties

Question 45

Smooth-pursuit eye movement

Answer 45

Eye-tracking

Question 46

Hypofrontality

Answer 46

People with schizophrenia display a range of deficits in the prefrontal section of the brain, and this area may be less active in people with schizophrenia

Question 47

Double blind communication

Answer 47

1. communication style of conflicting messages to children (no longer supported)

Question 48

Expressed emotion (EE)

Answer 48

1. Three aspects: -Criticism -hostility -Emotional Overinvolvement (individuals that return to families that are EE are more likely to relapse) 2. Patients who had limited contact with their relatives did better than the patients who spent longer periods with their families.

Question 49

Jane has spent the last half hour staring in the mirror. As you approach her she turns away and giggles. When you ask what she's laughing at, she answers, but you're having difficulty understanding what she says.

Answer 49

Disorganized

Question 50

Drew has experienced hallucinations and bizarre delusions for the last 4 months

Answer 50

Schizophreniform disorder

Question 51

Greg's cognitive skills and affect are relatively intact. He, however often has delusions and hallucinations that convince him enemies are out to persecute him

Answer 51

Delusional Disorder

Question 52

Alice usually holds an unusual posture and is sometimes seen grimacing

Answer 52

Catatonic

Question 53

Cameron has started to hear voices and this is very disturbing to him. He told his parents and recognizes that he needs to see a mental health professional

Answer 53

Attenuated psychosis syndrome

Question 54

Lately, Dom has become more isolated because he believes his coworkers and conspiring to get him fired. He becomes agitated whenever he sees a group of employees talking and laughing because he believes that they are plotting against him.

Answer 54

C - Delusional disorder

Question 55

Natalie reveals to her therapist that she hears numerous voices talking to hr and giving her orders. Her doctor has just sent her to his therapist for what he believes to be a major depressive episode. She had begun to sleep all the time and contemplated suicide often

Answer 55

B - Schizoaffective disorder

Question 56

If Shawns schizophrenia symtoms disappeared after about four months and he returned to his normal life what diagnosis might be receive

Answer 56

A - Schizophreniform Disorder

Question 57

Elias believes the government is out to get him. He thinks agents follow him daily, monitor his calls, and read his mail. His roommate Cedric tried to convince him otherwise. After a year of this, however, Cedric began to believe the government was correct and the government was out to get him too

Answer 57

D - Shared Psychotic Disorder

Question 58

The greatest risk of having schizophrenia is in those who have a (n) _________ or __________ with schizophrenia. Any relative with schizophrenia will make your chances of developing the disorder _______ than those of the general population

Answer 58

identical twin, fraternal twin, higher

Question 59

Raised in a home other than that of their biological parents, adopted children of parents with schizophrenia have a __________ chance of having the disorder themselves. Children of people with schizophrenia adopted into families without schizophrenia have a __________-than-average chance of having schizophrenia

Answer 59

higher, higher

Question 60

The likelihood of a child's having schizophrenia is influence by the ___________ of the parent's disorder. One may inherit a predisposition for __________________ schizophrenia that is the same or different form that of the parent.

Answer 60

severity, general

Question 61

Setting up an elaborate ___________ in which patients are fined for disruptive or inappropriate behavior and rewarded for appropriate behavior is beneficial in hospitals

Answer 61

token economy

Question 62

In _____________ clinicians attempt to reteach such behaviors as basic conversation, assertiveness, and relationship building to people with schizophrenia

Answer 62

social skills training

Question 63

Aside from social skills training, two psychosocial treatments for schizophrenia, _________ (teaching family members to be supportive) and _________ (teaching meaningful jobs, may be helpful

Answer 63

family intervention, vocational rehabilitation

Question 64

Recent studies sometimes indicate that the relationship of the neurotransmitters ______ and ___________ may explain some positive symptoms of schizophrenia

Answer 64

dopamine, serotonin

Question 65

Because antipsychotic medications may cause serious side effects, some patients stop taking them. One serious side effect is called ___________, which may include parkinsonian symptoms.

Answer 65

extrapyramidal symptoms

Question 66

Difficult cases of schizophrenia seem to improve with a serotonin and dopamine antagonist called __________

Answer 66

Olanzapine