Course of Schizophrenia

Question 1

Prodromal Stage

Answer 1

Clear pattern of deterioration in premorbid level of functioning prior to psychotic episode

Question 2

Premorbid

Answer 2

Time prior to psychotic episode

Question 3

Prodromal stage

Answer 3

Increased social withdrawal ␣ Increasingly less attention is paid to personal hygiene and
grooming ␣ Onset of vague hallucinations or delusions
␣ Increased awareness of unusual perceptions ␣ Gradual increase in peculiar and eccentric behaviors ␣ Affect may become increasingly more blunted or
inappropriate

Question 4

Prodromal stage: People report a sense of….

Answer 4

Don’t understand what’s going on ␣ Cannot understand why people are against them
Feel isolated ␣ Feel alone in the world ␣ This is when begin to withdrawal
␣ Anxiety and terror ␣ Afraid they are “descending” into madness
␣ Afraid of content of delusions

Question 5

Prognosis can be based in part on prodromal stage: Poor prognosis

Answer 5

if long, insidious downhill course ␣ Over many years ␣ No clear precipitating stress ␣ No real time for premorbid adjustment

Question 6

Prognosis can be based in part on prodromal stage: Better prognosis

Answer 6

If sudden onset of active psychotic episode ␣ May be clear precipitating stress ␣ Longer period for good level of premorbid functioning

Question 7

Active Stage: psychotic episode

Answer 7

Presence of psychotic behaviors/symptoms
 Hallucinations 
Delusions 
Disturbance in speech 
Affective disturbance  
Psychomotor disturbance

Question 8

Residual Stage

Answer 8

radual improvement in functioning ␣ Level of functioning expected for return is similar to
prodromal stage ␣ May be near premorbid stage ␣ Statistically, some impairment will follow

Question 9

Residual Stage Features of the active stage will persist

Answer 9

Typically are not as strong ␣ Beliefs are less troublesome or identifiably not based in
reality ␣ Hallucination “volume” is decreased
␣ Problem with social withdrawal remains ␣ Compliance with and continued response to
medications will predict how long this phase lasts
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Question 10

Favorable Prognostic Signs

Answer 10

Absence of premorbid personality disorders
␣ Social skills
␣ Adequate premorbid social functioning
brupt onset
␣ Presence of a clear precipitating event ␣ Later age of onset
␣ First episode at 17 vs late 20s or early 30s

Question 11

Complications Associated with Schizophrenia: Shorter life expectancy

Answer 11

Some schizophrenic patients lead long lives ␣ For most part life span is shorter

Question 12

Complications Associated with Schizophrenia:Increased suicide rate

Answer 12

Up to 10% with schizophrenia ␣ Highest period of risk is residual stage
␣ Generally individual has been through cycle and expects it again
␣ Decide to take action while they can

Question 13

Complications Associated with Schizophrenia

␣ General decrease in self-care and hygiene ␣ Delusions can be self-threatening

Answer 13

Command hallucinations ␣ e.g., feet amputated because “voices” had told person to
spend the night outside

Question 14

␣ Institutional neglect

Answer 14

Lack of adequate care by hospital ␣ Abuse by staff members ␣ Must be considered as contributing to shorter life-
expectancy

Question 15

Complications Associated with Schizophrenia

␣ Deprived economic circumstances

Answer 15

25 to 50% of America’s homeless suffer from
some mental health disorder ␣ Most are diagnosable with schizophrenia or other severe
mental illness ␣ Also high number of substance abuse disorders

Question 16

Victims of violent crime

Answer 16

More likely to be victim of violent crime than those

not diagnosed with schizophreni

Question 17

Violence and Schizophrenia

␣ Are patients diagnosed with schizophrenia dangerous?

Answer 17

end to be less violent than general population ␣ Control for history of substance abuse and violence prior
to first schizophrenic episode
␣ Patients diagnosed with paranoid schizophrenia can be dangerous at times
␣ Especially if become part of their delusional system ␣ May be “defending themselves”
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Question 18

Research on relapse and remission - 5-year follow-up research results by Zubin et al., 1989

Answer 18

Group 1: 22% one episode, no problems following recovery from episode
78% several episodes and varying degrees of lasting impairment
Group 2: Several episodes with minimal impairment (35%)
Group 3: Impairment after single episode and increased impairment later (no return to normality) (8%)
Group 4: Impairment increasing after several episodes (no return to normality) (35%)

Question 19

Predisposing Factors: Lower socioeconomic status levels (SES) associated with increased prevalence rates

Answer 19

ay be several contributing factors: ␣ Stressors
␣ May be more severe stressors on those in lower SES ␣ Accounting
␣ Poorer people are counted more because of the institutions they are in (county vs. private hospitals)

Question 20

Downward Drift Hypothesis

Answer 20

Person with SMI will drift down to lower SES levels with progression of disorder
Does not matter at which SES level you begin

Question 21

Concordance rates

Answer 21

Monozygotic twins
␣ Typically cited around 48% ␣ Ranges vary wildly
␣ 10% to 55%
Dizygotic twins
␣ Rate is about 15%

Question 22

Psychotic spectrum disorders

Answer 22

May include other disorders such as BD and MDD

Question 23

Disorganized Schizophrenia

Answer 23

Early onset ␣ 15-25 years old ␣ Also known as hebephrenic schizophrenia
␣ All of the following are prominent ␣ Disorganized speech
␣ Lack of systematized delusions ␣ Disorganized behavior ␣ Flat or inappropriate affect
␣ Worst prognosis of disorder subtypes ␣ Extreme social impairment ␣ Few or only short periods of remission during

Question 24

Catatonic Schizophrenia

Answer 24

ssential feature is psychomotor disturbance
␣ Diagnostic criteria (two or more) ␣ Motoric immobility
␣ Catalepsy ␣ Including waxy flexibility
␣ Stupor ␣ Excessive motor activity
␣ Catatonic agitation ␣ Apparently purposeless ␣ Not influenced by external stimuli

Question 25

Catatonic Schizophrenic: Motor activity continued

Answer 25

Periods of stupor may alternate with periods of
excitement ␣ Complications of stupor or excitation
␣ Malnutrition ␣ Self-inflicted injury ␣ Exhaustion ␣ Risk of head injury
␣ Extreme negativism or mutism ␣ Apparently motiveless resistance to all instructions ␣ Maintenance of rigid posture against attempts to be
moved

Question 26

Paranoid Schizophrenia

Answer 26

Preoccupation with one or more delusions or frequent auditory hallucinations
␣ Often see delusions of grandiosity or delusions of persecution
␣ Cannot have any prominent disorganized speech, disorganized or catatonic behavior, or flat or inappropriate affect

Question 27

Undifferentiated Schizophrenia

Answer 27

Any disorder diagnosed as schizophrenic, but does not quite fit any of the other subtypes
␣ There’s a little bit of everything in this ␣ Some prominent psychotic features
must be present to warrant diagnosis

Question 28

Residual Type

Answer 28

Individual must have history of at least one schizophrenic episode with prominent psychotic features
␣ Must not at the present time be suffering from prominent hallucinations or delusions
␣ Usually see social withdrawal ␣ Often see some negative symptoms ␣ May see continued hallucinations or delusions
␣ Much less troubling to patient

Question 29

Dopamine (DA) Hypothesis

␣ Most popular hypothesis today

Answer 29

Schizophrenia caused by excessive amounts of dopamine
␣ Could be hypersensitivity to DA at post synaptic receptor
␣ Could be problems with particular receptor DA (DA2, 3, 4) sites

Question 30

Bateson’s Double-bind hypothesis

Answer 30

Communications theorist ␣ Required intense relationship with someone child
is dependent upon ␣ Child cares about that ␣ Parent sends conflicting messages simultaneously
␣ “Give me a big hug” and becoming stiff and unreceiving ␣ Child can’t comment on mixed messages and
cannot leave ␣ Child retreats into own inner world
␣ Research does NOT support this

Question 31

Expressed Emotion (EE) Brown, Vaughn & Leff

Answer 31

Refers to type of communication patterns between family members
␣ Types of EE ␣ Hostile
␣ Emotional over-involvement ␣ Critical

Question 32

Expressed Emotion (EE)

Answer 32

Data do NOT support that high EE causes
first episode of schizophrenia
␣ Higher relapse rates when patients released from hospital into high EE families
␣ Implication for treatment come out of relapse rate correlation
␣ Also used with BD I treatments now

Question 33

Differential Relapse Rates

Answer 33

Patients on medications
In families with high
high EE low EE
levels of expressed emotions

Question 34

Treatment

Answer 34

Earlier treatments ␣ Locked up ␣ Sedation ␣ Insulin coma
␣ Electroconvulsive Therapy (ECT) ␣ Controlled studies indicate it is not useful for
schizophrenia
␣ Psychosurgery ␣ Lobotomies (1930s-1950s)

Question 35

Treatment

Answer 35

Advent of drug treatments
␣ Antihistamines had a calming effect
␣ Thorazine discovered as antipsychotic medication
␣ Early 1950s ␣ Major tranquilizing properties ␣ Very commonly used antipsychotic medication ␣ DA receptor blocker

Question 36

Dopamine antagonists

Answer 36

␣ Block post-synaptic receptors

␣ Potent side effects ␣ See Parkinsonian symptom

Question 37

Tardive dyskenesia (TD)

Answer 37

Irreversible damage to nervous system ␣ Involuntary facial movement, grimacing,
tongue protrusion ␣ Very distracting and distressing to patient
␣ These must be used with great caution

Question 38

Atypical Antipsychotics

␣ Clozapine, Risperdal, Zyprexa, Abilify

Answer 38

Do not appear to create same terrible side effects ␣ More effective than older drugs on both positive
and negative symptoms ␣ Tend to act on 5-HT and DA ␣ Some have specific bindings on DA receptors
(possible D3 agonists, too)

Question 39

Milieu Therapy

Answer 39

Put person in healing therapeutic environment ␣ Involves expectation patients behave in “normal”
ways ␣ Expected to
␣ Engage in group activities ␣ Help one another and be supportive ␣ Act responsibly ␣ Participate in decisions affecting functioning of ward
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