Chapter 14 - Psychosis

Question 1

Who were early figures in diagnosing schizophrenia, and what were their contributions?

Answer 1

-Emil Kraepelin (1899): Combined symptoms like catatonia, hebephrenia, and paranoia under the term dementia praecox, distinguishing it from manic depression.
-Eugen Bleuler (1908): Coined the term schizophrenia (“split mind”) and introduced the concept of associative splitting, describing a breakdown in associative threads.

Question 2

What are two key clusters of symptoms in schizophrenia?

Answer 2

-Hallucinations: Seeing or hearing things that others do not.
Delusions: Unrealistic, bizarre beliefs not shared by others in the same culture.

Question 3

Why is it challenging to identify symptoms of schizophrenia?

Answer 3

-The symptoms vary greatly, and not all individuals diagnosed share the same behaviors or symptoms.

Question 4

What characterizes psychosis in schizophrenia?

Answer 4

-Psychosis involves delusions and hallucinations, causing a loss of contact with reality and affecting daily functioning.

Question 5

What is included in the schizophrenia spectrum of disorders?

Answer 5

• Schizophrenia spectrum includes schizophreniform disorder, schizoaffective disorder, delusional disorder, and brief psychotic disorder.

Question 6

How does the DSM-5-TR assess schizophrenia symptoms?

Answer 6

-Symptoms are assessed on a 0–4 scale, with 0 indicating no symptoms, and include positive, negative, and disorganized symptoms.

Question 7

What are positive symptoms of schizophrenia?

Answer 7

-Positive symptoms include disturbing experiences like delusions and hallucinations.

Question 8

What types of delusions are common in schizophrenia?

Answer 8

-Delusion of grandeur: Believing one has exceptional abilities or fame.
Delusion of persecution: Believing others are plotting harm.
Cotard’s syndrome: Belief that one is dead or non-existent.
Capgras syndrome: Belief that loved ones have been replaced by impostors.

Question 9

What are hallucinations in schizophrenia?

Answer 9

-Hallucinations are sensory experiences without external input, with auditory hallucinations being the most common, often associated with abnormal activation of the left auditory cortex.

Question 10

What are negative symptoms of schizophrenia?

Answer 10

-Negative symptoms reflect a lack or insufficiency of normal behavior, such as:

Avolition: Inability to initiate or persist in activities
Alogia: Limited speech, brief replies
Anhedonia: Lack of pleasure
Asociality: Lack of interest in social interaction
Affective flattening: Limited emotional expression`

Question 11

What are disorganized symptoms of schizophrenia?

Answer 11

-Disorganized symptoms include erratic behaviors like:

Disorganized speech: Communication problems
Inappropriate affect: Laughing or crying at inappropriate times
Catatonic immobility: Remaining in a position someone else places them in

Question 12

What other disorders are related to psychosis in the DSM-5-TR?

Answer 12

-Schizophreniform disorder
Schizoaffective disorder
Delusional disorder (various subtypes)
Brief psychotic disorder
Attenuated psychosis syndrome
Schizotypal personality disorder

Question 13

What is the prevalence of schizophrenia in the general population?

Answer 13

-Schizophrenia affects 0.2% to 1.5% of the general population.

Question 14

What are some characteristics of schizophrenia’s impact on life expectancy?

Answer 14

-People with schizophrenia typically have a lower life expectancy and may be at risk of suicide.

Question 15

When can the symptoms of schizophrenia begin?

Answer 15

• Symptoms can begin early, with a prodromal stage where unusual behaviors occur before serious symptoms develop.

Question 16

How long can it take for someone at high risk of schizophrenia to show symptoms?

Answer 16

• It can take 2–10 years for symptoms to develop in individuals at high risk.

Question 17

Is relapse possible even after early treatment for schizophrenia?

Answer 17

-Yes, relapse is possible even after early treatment.

Question 18

Is schizophrenia universal across cultures?

Answer 18

-Yes, schizophrenia occurs in all races and cultures, though treatment outcomes vary across different cultural settings.

Question 19

How do cultural factors impact schizophrenia treatment?

Answer 19

-Treatment outcomes are often better in poorer countries, though there are also issues with misdiagnoses due to stereotypes and bias.

Question 20

How do family studies relate to schizophrenia?

Answer 20

-Children of parents with schizophrenia are more likely to develop the disorder, indicating a genetic predisposition.

Question 21

What did the Genain quadruplet study show about schizophrenia?

Answer 21

-The Genain quadruplets, who shared the same genes and environment, all developed schizophrenia, but their onset, symptoms, and course varied.

Question 22

How do twin studies inform our understanding of schizophrenia?

Answer 22

-Identical twins (100% shared genes) have a higher concordance rate for schizophrenia than fraternal twins (50% shared genes), indicating a genetic component.

Question 23

What do adoption studies reveal about schizophrenia?

Answer 23

-Adoption studies show that a good environment can reduce the risk of schizophrenia, even in genetically predisposed individuals.

Question 24

How do gene-environment interactions play a role in schizophrenia?

Answer 24

-Genetic vulnerability interacts with specific environmental factors, particularly during critical developmental stages, leading to the development of schizophrenia.

Question 25

What are linkage and association studies in the context of schizophrenia?

Answer 25

-These studies suggest that multiple common genes contribute to schizophrenia risk, each having a small effect that can be detected by genome-wide association studies.

Question 26

What is a potential genetic marker for schizophrenia?

Answer 26

-An eye-tracking deficit may be a marker for schizophrenia.

Question 27

How do multiple genes contribute to schizophrenia?

Answer 27

-Schizophrenia involves multiple genes located at different sites throughout chromosomes, referred to as quantitative trait loci, which may account for varying severity levels.

Question 28

How does dopamine relate to schizophrenia?

Answer 28

-Dopamine plays a key role in schizophrenia, with neuroleptics (dopamine antagonists) being effective in treatment, but also producing negative side effects. Dopamine agonists like L-dopa and amphetamines can worsen symptoms.

Question 29

What brain structural changes are associated with schizophrenia?

Answer 29

-People with schizophrenia often have abnormally large lateral and third ventricles, and hypofrontality (less active frontal lobe), which is associated with negative symptoms.

Question 30

How do viral infections contribute to schizophrenia?

Answer 30

-Prenatal exposure to viruses like influenza or parasites like Toxoplasma gondii may increase the risk of schizophrenia, along with other prenatal brain damage indicators such as finger ridge patterns.

Question 31

What role does stress play in the development of schizophrenia?

Answer 31

-Stress, examined through sociogenic and social selection hypotheses, can influence the development and progression of schizophrenia. People with schizophrenia may also drift into lower social classes due to their condition.

Question 32

How can family dynamics affect schizophrenia?

Answer 32

-Family factors such as “schizophrenogenic” mothers, double bind communication, and high levels of expressed emotion (EE) can contribute to the onset and relapse of schizophrenia.

Question 33

What is expressed emotion (EE) and how does it impact schizophrenia?

Answer 33

• EE refers to high levels of criticism, disapproval, and animosity in family interactions, and is a predictor of relapse in schizophrenia across cultures.

Question 34

What are neuroleptics, and how do they work in treating schizophrenia?

Answer 34

-Neuroleptics are dopamine antagonists that help people think more clearly and reduce or eliminate delusions and hallucinations.

Question 35

What percentage of people respond to neuroleptics?

Answer 35

-Neuroleptics are effective for 60%–70% of people who try them.

Question 36

ow do newer antipsychotics compare to traditional neuroleptics?

Answer 36

-Newer antipsychotics have fewer side effects, reduce both positive and negative symptoms, and improve cognitive functioning.

Question 37

What is transcranial magnetic stimulation (TMS), and how is it used in schizophrenia treatment?

Answer 37

-TMS is used to treat auditory hallucinations, though the effect is brief.

Question 38

Is the psychoanalytic approach effective for schizophrenia?

Answer 38

-No, the psychoanalytic approach is not beneficial and may even be harmful.

Question 39

What is behavioural family therapy, and how does it help schizophrenia patients?

Answer 39

-Behavioural family therapy involves working with families to improve interactions and includes ongoing support to maintain benefits.

Question 40

What is a token economy, and how is it used in schizophrenia treatment?

Answer 40

-A token economy rewards patients for achieving independence in daily skills, promoting better functioning.

Question 41

What role does CBT play in treating schizophrenia?

Answer 41

• CBT is used to address symptoms of delusions and depression.

Question 42

What is the importance of early intervention in schizophrenia treatment?

Answer 42

-Early intervention can help manage symptoms before they worsen, improving long-term outcomes

Question 43

How do schizophrenia treatments vary across cultures?

Answer 43

-Treatments include herbal medicines, acupuncture, oral treatments, imprisonment, and ancestor worship, depending on cultural practices.

Question 44

How can schizophrenia be prevented in at-risk individuals?

Answer 44

-Prevention involves identifying and treating children at risk, addressing instability in the early family environment, and treating individuals in the prodromal stages of the disorder.