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
Define grandiose delusions.
Having special powers or knowledge; being an important public figure
What is disorganized speech?
1) Disorganized speech is the outward expression of disturbed thought
2) Illogical switching from one topic or idea to another
3) Answering questions or responding in conversation with un-related thoughts or ideas
4) Incoherence
What is meant by “Illogical switching from one topic or idea to another”
Derailment, loose associations
What is meant by “Answering questions or responding in conversation with un-related thoughts or ideas”
Tangential speech
What is meant by incoherence?
- Ideas not linked logically
- Grammar may be disturbed
Word salad
What is catatonic behaviour?
1) A wide range of abnormal motor behavior
2) Reduced movement: not responding to the environment
3) Excessive movement
4) Less common when SZ is treated with medication
What are examples of Reduced movement: not responding to the environment? (hint: catatonia)
1) Sitting or standing in the same posture for long periods
2) Immobile face
3) Not talking
Give examples of excessive movement?
1) Pacing, repetitive movements, tics
2) Agitation, excessive speech
3) Repeating others’ speech or movement
What are the Dsm-V Specifiers
1) 1st Episode; Multiple episodes; Continuous:
acute, full or partial remission
2) With catatonia:
May be practically immobile, or moving purposelessly, frantically
3) Severity (optional):
Each symptom rated on a 7-point scale
Why have researchers tried to look for sub-types based on symptom clusters?
Because of the heterogeneity of SZ symptoms
Name the Positive symptoms of SZ
1) Hallucinations
2) Delusions
3) Thought disorder
4) Bizarre or disorganized behavior
Name the negative symptoms of SZ (hint: 5)
1) Lack of motivation – avolition
2) Lack of emotion – anhedonia
3) Reduced or impoverished speech – alogia
4) Asociality
5) Cognitive deficits
Avolition is a lack of _________
Motivation
Lack of emotion is called _____________
Anhedonia
Reduced or impoverished speech
Alogia
In terms of hallucinations, ____ are auditory
60-70%
In terms of hallucinations _______are visual
27%
What are the other modalities of SZ hallucinations that are less common
That they are negative and frightening
Many people report hearing a voice once in their life. But in SZ this experience is ____________
persistent and the content is complex.
Hallucinations may be a misattribution of internally generated percept as being external, which means that _______ may be misattributed and there is a failure of _________. However, _________________
- May be inner speech that is misattributed
- Failure of memory
- None of these explain negative bias
What is the percentage of people with SZ who have delusions?
70%
These delusions are mostly positive or negative?
Negative
- Jumping to conclusions
- Poor evaluation of information, decision making
- Negative attentional bias
are all characteristics of positive symptoms of SZ
What is the criteria which is considered a separate cluster by some?
Disorganization
Thought disorder is common in ______ of people with SZ
50-70%
Thought disorders are ____________
Frequently persistent
Thought disorders are related to _______ before onset
Cannabis use
Thought disorder is likely related ______________
to disturbances in reasoning and cognition
Bizarre or disorganized behavior is less frequent with _______ and may be related to ________
Less frequent with medication
May be related to dopamine depletion
Are Deficits in emotion, motivation, sociality, cognition are a separate cluster?
It’s not clear if these are really a separate cluster
Changes in motivation may be related to __________. They are also _________.
These are________ deficits in emotion, motivation, sociality and cognition.
- poor learning, reward processing and cognitive deficits
- persistent
- primary
What are the two secondary deficits in emotion, motivation, sociality, cognition? (outcomes of the disorder)
1) Depression, anxiety
2) Side effects of medication (reduced or slowed movement, facial expression)
Deficits in cognition are very common, what is the percentage?
85%
Deficits in cognition are ________________
Persistent and non-responsive to medication
Deficits in cognition impact a broad range of functions. What are they?
attention, memory, reasoning
Deficits in cognition present before ___________
onset of positive symptoms
Poor cognitive function is related to _________
poorer outcome
What are the 3 complications of SZ?
1) Suicide
2) Substance and abuse
3) Violence and victimization
In SZ, rates of suicide are _____ than the general population?
Higher
Suicide is more common ____ in the disorder
early
_______ symptoms associated with greater risk of suicide
Positive
Like all people, __________ increase risk of suicide in SZ?
depression, previous suicide attempts, substance use
Substance use and abuse in SZ is ____ times the rate in the general population
Three
Substance use and abuse may related to changes in _______ systems
Dopamine
Substance use is related to _______________
earlier age of onset
People with SZ have a greater risk for ______
being victims of violence
What are mood disorder with psychotic or catatonic features?
- Bipolar disorder
- Depression
- Schizoaffective disorder (rare, controversial)
What are the characteristics of Schizophreniform or Brief Psychotic disorder?
- SZ-form = symptoms for >6 month
- Brief Psychotic = symptoms for >1 month
What are the differential diagnosis of SZ? (hint: 7)
1) Mood disorder with psychotic or catatonic features
2) Schizophreniform or Brief Psychotic disorder
3) Delusional disorder
4) Personality disorders
5) PTSD
6) Developmental disorders
7) Substance/medical
What are the personality disorders included in the differential diagnosis of SZ? (hint: 3)
- Borderline, Schizotypal or avoidant personality disorders
- OCD
- Social anxiety disorder
What are the characteristics of PTSD?
1) Flashbacks may appear hallucinatory; fears delusional or paranoid
2) Ideation linked to specific past experiences
What are the Developmental disorders in the differential diagnosis of SZ?
1) Autism-spectrum
2) Developmental delay
What are differential diagnosis for SZ in regard to Substance/medical?
Drug-induced psychosis
Delirium
