Lecture 2: symptoms and diagnosis Flashcards
How do we define SZ in terms of Psychosis and deterioration of function?
1) Hallucinations and delusions
2) Reduced motivation, emotion, social interaction
3) Disorganized thought and behaviour, problems communicating and understanding others, poor planning
SZ has a ____________of symptoms
SZ has a wide variety of different symptoms
Psychotic symptoms seem easy to recognize, but are ______________
shared with other disorders
Social and emotional problems in SZ resemble ____________
depression
Disorganized thought and behaviour can be difficult to distinguish from ____________________
developmental or cognitive delays/disabilities
In the DSM-V, what are the disorders that are part of the SZ spectrum?
1) Schizophrenia
2) Schizophreniform disorder
3) Schizoaffective disorder
4) Paranoid, Schizoid and Schizotypal personality disorders
5) Delusional disorder
6) Brief Psychotic disorder
7) Substance- or medication-induced psychotic disorder
Schizophreniform disorder
- Short form of SZ
- Many have the symptoms but not the full criteria.
- When the clinician is not sure.
Schizoaffective disorder
This one is rare.
It’s SZ + independent affective disorders
Delusional disorder consist of only delusions and is ______
Very rare.
Brief psychotic disorder
The symptoms are not clear enough to make a diagnosis
What is the first criteria for SZ in the DSM?
At least 2 of the following symptoms. Present for 1 month. At least one of the symptoms must be 1, 2 or 3
1) Delusions
2) Hallucinations
3) Disorganized speech (sign of thought disorder)
4) Grossly disorganized behavior (e.g. dressing inappropriately, crying frequently) or catatonic behavior
5) Negative symptoms: Diminished emotional expression, motivation (avolition) or speech (alogia)
Another criteria of SZ is social or occupational dysfunction in one or more areas, such as work, interpersonal relations, or self-care for a significant period since _________
onset of symptoms
The patient must show continuous signs of disturbance for _____months.
6 months
Brief psychotic disorder must include ___ month of symptoms.
1
During the rest of the period must show ___________ symptoms.
prodromal or residual
Which of the following does not represent a negative symptom of schizophrenia?
A. Affective flattening. B. Decreasedmotivation. C. Impoverished thought processes. D. Sadness over loss of functionality. E. Social disinterest.
D. Sadness over loss of functionality
2.12 Which of the following patient presentations would not be classified as psy- chotic for the purpose of diagnosing schizophrenia?
A. A patient is hearing a voice that tells him he is a special person.
B. A patient believes he is being followed by a secret police organization that
is focused exclusively on him.
C. A patient has a flashback to a war experience that feels like it is happening
again.
D. A patient cannot organize his thoughts and stops responding in the middle
of an interview.
E. A patient presents wearing an automobile tire around his waist and gives
no explanation.
C. A patient has a flashback to a war experience that feels like it is happening
again.
2.13 In which of the following disorders can psychotic symptoms occur?
A. Bipolar and depressive disorders. B. Substanceusedisorders.
C. Posttraumatic stress disorder.
D. Other medical conditions.
E. All of theabove.
E. All of the above
2.19 Schizophrenia spectrum and other psychotic disorders are defined by abnor- malities in one or more of five domains, four of which are also considered psy- chotic symptoms. Which of the following is not considered a psychotic symptom?
A. Delusions.
B. Hallucinations.
C. Disorganized thinking.
D. Disorganized or abnormal motor behavior.
E. Avolition.
E. Avolition.
Explanation: Avolition is a negative symptom of schizophrenia, not a positive (psychotic) symptom.
A 32-year-old man presents to the emergency department distressed and agi- tated. He reports that his sister has been killed in a car accident on a trip to South America. When asked how he found out, he says that he and his sister were very close and he “just knows it.” After putting him on the phone with his sister, who was comfortably staying with friends while on her trip, the man expressed relief that she was alive. Which of the following descriptions best fits this presentation?
A. He had a delusional belief, because he believed it was true without good warrant.
B.He did not have a delusional belief, because it changed in light of new evidence.
C. He had a grandiose delusion, because he believed he could know things happening far away.
D. He had a nihilistic delusion, because it involved an untrue, imagined catas- trophe.
E. He did not have a delusion, because in some cultures people believe they can know things about family members outside of ordinary communica- tions.
Correct Answer: B. He did not have a delusional belief, because it changed in light of new evidence.
2.20 What is the most common type of delusion?
A. Somatic delusion of distorted body appearance. B. Grandiose delusion.
C. Thought insertion.
D. Persecutory delusion.
E. Formerliferegression.
Correct Answer: D. Persecutory delusion.
Which of the following statements about negative symptoms of schizophrenia
is false?
A. Negative symptoms are easily distinguished from medication side effects such as sedation.
B.Negative symptoms include diminished emotional expression.
C. Negative symptoms can be difficult to distinguish from medication side ef-
fects such as sedation.
D. Negative symptoms include reduced peer or social interaction.
E. Negative symptoms include decreased motivation for goal-directed activities.
Correct Answer: A. Negative symptoms are easily distinguished from medi- cation side effects such as sedation.
Positive symptoms include:
active hallucinations, delusions, disorganized behaviors, and disorganized thinking.
The primary negative symptoms include: (hint 3)
1) diminished emotional expression
2) reduced interaction with others
3) decreased motivation for goal-directed activities.
2.26 Which of the following symptom combinations, if present for 1 month, would meet Criterion A for schizophrenia?
A. Prominent auditory and visual hallucinations.
B. Grossly disorganized behavior and avolition.
C. Disorganized speech and diminished emotional expression.
D. Paranoid and grandiose delusions.
E. Avolition and diminished emotional expression.
Correct Answer: C. Disorganized speech and diminished emotional expression.
What are hallucinations?
Perceptions in the absence of external stimuli
Most common hallucinations are : A) auditory B) visual, C) tactile, D) olfactory
A. Auditory
Most common voices are:
Commenting on the person’s activities
Commanding, instructing, giving “special” information
Multiple voices
Delusions may be so “real” that they _______
have the quality of hallucinations
Hallucinations may be the result of faulty brain activity that makes the __________________
internally generated percept “feel” like an externally generated one
Name the 4 types of delusions? (hint: 5)
1) Paranoid
2) Ideas of reference
3) Somatic
4) Religious
5) Grandiose
Define the delusion of paranoia
Being followed, spied on, deceived, persecuted
Define the delusions of Ideas of reference.
Events have special meaning – e.g., news reports; messages on websites, tv; cars passing, sounds;
Define a somatic delusion.
Heart is replaced by a computer; mice in hair; electrodes implanted in brain
Define a religious delusion.
- Instructed by god; being a divine being; pursued by the devil
- Features depend on cultural context
