Chapter 9 Flashcards
DSM-5 for schizophrenia
A. Two (or more) of the following, each present for a significant
portion of time during a 1-month period. At least one of these must
be (1), (2), or (3).
1. Delusions*
2. Hallucinations*
3. Disorganized speech* (e.g., frequent derailment or incoherence)
4. Grossly disorganized or catatonic behavior
5. Negative symptoms (i.e. diminished emotional expression or avolition)
B. For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning)
C. Continuous signs of the disturbance persist for at least
6 months. This 6-month period must include at least 1 month of symptoms
D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either 1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or 2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.
E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
F. If there is a history of autism spectrum disorder or a com- munication disorder of childhood onset, the additional diag- nosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1 month (or less if successfully treated)
Types of Delusions
Bizarre - Imagining impossible situations
Non-Bizarre - Imagining possible situations
Mood-congruent - occurs when in a manic or depressive state
Mood-incongruent - Happens without a particular mood’s influence
different types of delusions
persecutory - in which the individual believes they are being targeted, ridiculed, or deceived are the most common
somatic - bodily delusions
religious
grandiose - may entail a belief in having divine or special powers.
referential - people are giving you a message
Delusions
implausible beliefs that are resistant to change even in the face
of disconfirming or contradictory evidence.
Hallucinations
They are misinterpretations of sensory perceptions occurring while
the person is awake
Hearing voices is the most commonly occurring hallucination in
schizophrenia.
These voices are perceived as distinct from the patient’s thoughts
and may include instructions to carry out harmful acts.
auditory are the most common types of hallucinations
Disorganized speech
and thought disorder
Nonsensical speech often
signals the presence of
thought disorder.
Loosening of associations
Loosening of associations and of logical connections
between ideas occurs in
patients displaying thought
disorder and can manifest as
highly tangential responses
to questions or as quick
shifts from topic to topic.
Motor symptoms and grossly disorganized or catatonic behaviour
These behaviours refer to deficits in motor functioning, ranging from
agitation to immobility.
* Grossly disorganized behaviour
* Ex. Unpredictable movements/agitation, lack of self-care
* Catatonia: decrease in reactivity to environment
* Example of waxy flexibility: Devon often sits with one foot behind his head for
extended periods of time until a nurse moves it, and then does not move again
Negative and emotional symptoms
Avolition and diminished emotional expression are the negative
symptoms of schizophrenia.
* Avolition can manifest as apathy (ex. personal hygiene habits)
* Anhedonia, i.e. difficulty experiencing pleasure.
* Negative symptoms are associated with impairment in memory,
learning, attention and mental efficiency, as well as community
adjustment.
Positive symptoms
- exaggerated form of a typical experience
- hallucinations
- delusions
- disorganised speech
motor and grossly disorganised catatonic behaviour
negative and emotional symptoms
- sparse speech and language
- avolition (apathy, loss of motivation)
- adhedonia (inability to feel pleasure)
- diminished attention and concentration
DSM-5 schizaffective disorder
An uninterrupted duration of illness during which there is a major mood episode
(manic or depressive) in addition to criterion A for schizophrenia; the major
depressive episode must include depressed mood.
A. Two or more of the following presentations, each present for a significant amount
of time during a 1-month period. At least one of these must be from the first three
below.
* Delusions
* Hallucinations
* Disorganized speech (e.g., frequent derailment or incoherence)
* Grossly disorganized or catatonic behavior
* Negative symptoms (i.e., diminished emotional expression or avolition)
B. Hallucinations and delusions for two or more weeks in the absence of a major mood
episode (manic or depressive) during the entire lifetime duration of the illness.
C. Symptoms that meet the criteria for a major mood episode are present for the majority
of the total duration of the active as well as residual portions of the illness.
D. The disturbance is not the result of the effects of a substance (e.g., a drug of misuse or
a medication) or another underlying medical condition
bipolar and depressive type of schizoaffective disorder
Bipolar type: includes episodes of mania and sometimes major depression.
Depressive type: includes only major depressive episodes
Schizophrenia vs Schizoaffective
There has to be a definite period of at least two weeks in which there
are only psychotic symptoms (delusions and hallucinations) without
mood symptoms to diagnose schizoaffective disorder.
* However, a major mood episode (depression or mania) is present for the
majority of the total duration of the illness.
* Once the psychotic symptoms predominate the majority of the total
duration of the illness, the diagnosis leans towards schizophrenia.
* Also, schizophrenia requires 6 months of prodromal or residual
symptoms; schizoaffective disorder does not require this criterion.
Differential diagnosis
MDD + Psychotic Features and Schizoaffective Disorder
Patients with major depression with psychotic features (MDD with
PF) only experience psychotic features during their mood episodes.
* In contrast, schizoaffective requires at least 2 weeks in which there
are only psychotic symptoms (delusions and hallucinations) without
mood symptoms. Patients with MDD with PF do not meet criterion A
of schizoaffective disorder
Differential diagnosis
Bipolar Disorder and Schizoaffective Disorder
Similar to the contrasts with MDD w/ PF, patients with bipolar
disorder with psychotic features only experience psychotic features
(delusions and hallucinations) during a manic episode.
* Again, schizoaffective requires a period of at least 2 weeks in which
there are only psychotic symptoms without mood symptoms.
Psychotic features in bipolar disorder do not meet criterion A of
schizoaffective disorder
Schizophrenia and Bipolar disorder
Depressive symptoms manic episode= Bipolar with psychotic features
* If psychotic symptoms continue = schizoaffective disorder
* The treatment of schizoaffective disorder typically involves both
pharmacotherapy and psychotherapy
Markers of Schizophrenia
Cognitive Deficits & Eyetracking
Dysfunctions
Slowness writing symbols paired with numbers
(processing speed)
* Impaired ability to filter out redundant information
(sensory gating)
* Impaired learning and recall of words and stories
(verbal memory)
* Impaired ability to attend to one message and
ignore another (dichotic listening)
* Reduced ability to generate words rapidly
(phonemic word fluency)
* Slow and inaccurate detection of specified letters
(Continuous Performance Test)
Theories of Schizophrenia
Diathesis-Stress
Neurodevelopmental diathesis
* inherited or fetal injury
* “Switches” in the brain turned on by stress
* A biological vulnerability that is inherited or acquired early in life
* Risk factors:
* Urban upbringing
* Migration
* Childhood trauma
* Low intelligence
* Drug abuse
Biological factors
- larger ventricles - sign of compression or loss of nerve tissue
- reduced gray matter volume - deficits in processing informarion
- functional activation changes in the left temporal lobe, amygdala and hippocampus
Antipsychotic medication
- Chlorpromazine
- Risperidone
- Olanzapine
Treatment of Schizophrenia
CBT - focusing on four problems
- emotional disturbance
- psychotic symptoms
- social disabilities
- risk of relapse
Dopamine hypothesis
Chlorpormazine blocks dopamine receptors
