Module 13.3: Clinical Picture of Schizophrenia Flashcards
Delusions
+ An erroneous belief that is fixed and firmly held despite clear contradictory evidence
+ People with delusions believe things that others who share their social, religious, and cultural backgrounds DO NOT believe
Percentage of Patients with Schizophrenia who have Delusions
90% of patients with schizophrenia have delusions
Do all people who have delusions have schizophrenia?
No. Not all people who have delusions have schizophrenia, but delusions are common in schizophrenia.
What are the different kinds of delusions?
- Made feelings or impulses
- Thought broadcasting
- Thought insertion
- Thought withdrawal
- Delusions of reference
Made feelings or impulses
beliefs that one’s thoughts, feelings, or actions are being controlled by external agents
Thought broadcasting
one’s private thoughts are being broadcast indiscriminately to others
Thought insertion
thoughts are being inserted into one’s brain by some external agency
Thought withdrawal
some external agency has robbed one of one’s thoughts
Delusions of reference
some neutral environment (such as a television program or a song on the radio) is believed to have special and personal meaning intended only for the person
Hallucination
+ A sensory experience that seems real to the person having it, but occurs in the absence of any external perceptual stimulus
+ It can occur in any sensory modality (auditory, visual, olfactory, tactile, or gustatory)
Illusion
a misperception of a stimulus that ACTUALLY EXISTS
Hallucination vs Illusion
Hallucination occurs in the absence of any external perceptual stimulus, while an illusion occurs in the presence of a stimulus and is just a misperception.
What are the most common hallucinations in patients with schizophrenia?
Auditory hallucinations are the most common in patients with schizophrenia
What is the percentage of sensory hallucinations?
+ Auditory: 75%
+ Visual: 39%
+ Olfactory, tactile, & gustatory: 1-7%
What kind of voices do hallucinating patients usually hear?
The hallucinated voices were often from people known to the patient in real life, but sometimes, unfamiliar voices or the voices of God or the devil can be heard by them
How many voices do patients with schizophrenia hear?
Most heard more than one voice
When are auditory hallucinations worst for a patient with schizophrenia?
It is worse when they are alone
What are the possible tones of auditory hallucinations?
+ Rude and vulgar expletives; were critical (“You are stupid”)
+ Bossy (“Get the milk”)
+ Abusive (“Ugly bitch”)
+ Pleasant and supportive – this only occurred with some voices (“My darling”)
What do neuroimaging studies say about why patients with schizophrenia have auditory hallucinations?
Neuroimaging studies suggest that patients with speech hallucinations have a reduction in brain (gray matter) volume in the left hemisphere auditory and speech perception areas
Reduced brain volume in these areas could lead to a failure to correctly identify internally generated speech, erroneously tagging it as coming from an external source
What area of the brain shows increased activity in auditory hallucinating patients?
Hallucinating patients show increased activity in Broca’s area
Broca’s area
an area of the temporal lobe that is involved in speech production
What is a conclusion about auditory hallucinations?
Auditory hallucinations are a form of misperceived subvocal speech
Disorganized Speech
+ The external manifestation of a disorder in thought form
+ A person fails to make sense even though they seem to use language in a conventional way and follows the right grammar rules
+ The failure is NOT attributable to low intelligence, poor education, or cultural deprivation
+ The words and word combinations sound communicative, but the listener is left with little or no understanding of the point the speaker is trying to make (e.g. use of neologisms)
Disorganized Speech vs Delusions
Disorganized speech is the external manifestation of a disorder in thought FORM, while delusions reflect a disorder in thought CONTENT or in the ideas being expressed
Formal thought disorder
a term clinicians use to refer to problems in the way that disorganized thought is expressed in disorganized speech
Disorganized Behavior/Symptoms
+ Includes rambling speech, erratic behavior, and inappropriate affect
+ It is an impairment that can show itself in a variety of ways and can occur in areas of routine daily functioning, such as work, social relations, and self-care
Examples of situations that showcase disorganized behavior
- The person no longer maintains minimal standards of personal hygiene or may exhibit a profound disregard of personal safety and health
- Can appear as silliness or unusual dress like wearing an overcoat, scarf, and gloves on a hot summer day
Symptoms that fall under disorganized behavior
- Inappropriate affects
- Bizarre behaviors
- Catatonia
- Waxy flexibility
Inappropriate affects
any behavior that is inappropriate to the situation; e.g. laughing or crying at improper times
Bizarre behaviors
such as hoarding of objects or acting in an unusual way in public
Catatonia
motor dysfunction that ranges from wild agitation to immobility; may show a virtual absence of all movement and speech (called catatonic stupor) or at other times, may hold an unusual posture for an extended period of time without any seeming discomfort
Waxy Flexibility
tendency to keep bodies and limbs in a position placed by someone else
(if you were to move someone’s arms, they would show very light resistance, but in the end, you would still be able to move them like a waxed candle)
Prefrontal Region of the Cerebral Cortex
the disruptions of behavior to impairment is attributed to the functioning of this part of the brain
Positive symptoms
those that add to the experience and behavior; the symptoms that distort reality
Symptoms under positive symptoms
- Delusions
- Hallucinations
Negative symptoms
the symptoms that take away a person’s ability to live normally; refers to deficits in normal behavior such as in areas of speech, blunted affect, and motivation
Two domains of negative symptoms
- Reduced expressive behavior (voice, facial expression, gestures of speech)
- Reduced motivation or experience of pleasure
Symptoms under Negative Symptoms
- Alogia
- Affect flattening
- Avolition
- Anhedonia
What is more damaging for the future outcome of a patient? Positive or negative symptoms?
Negative symptoms.
Most patients exhibit positive and negative symptoms during the course of their disorder, but the presence of negative symptoms in the clinical picture is not a good sign for the patient’s future outcome
True or false. Patients with negative symptoms cannot feel things at all.
FALSE. Although patients with negative symptoms may seem emotionally unexpressive, how they appear and how they are feeling are two different things.
Studies suggest that even though patients with schizophrenia may sometimes appear emotionally unexpressive, they are nonetheless experiencing plenty of emotion
What are the active-phase symptoms of schizophrenia?
- Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganized or catatonic behavior
- Negative symptoms
What are active-phase symptoms?
These are the symptoms referred to in the Diagnostic Criterion A of schizophrenia.
How many active-phase symptoms should be present before a person is diagnosed with schizophrenia?
Two or more. In addition to that, one of the symptoms should be delusions, hallucinations, and disorganized speech.
For how long should the active-phase symptoms be present before a person is diagnosed?
It should be for one month or less if schizophrenia has been successfully treated.
What are the other criteria for schizophrenia?
- The person must have below their usual functioning in their work, relationships with others, or in their self-care. If they are a child or adolescent, they must be able to fail to achieve the expected level of work, academic, and interpersonal functions (or how they treat others)
- The continuous signs of the disturbance should continue for at least 6 months (including the 1 month period of active-phase symptoms) which may include prodromal or residual periods. During prodromal or residual periods, the disturbance may be manifested by only negative symptoms or by two or more active-phase symptoms in a reduced way.
- Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because (1) no major depressive or manic episodes have happened with the active-phase symptoms or (2) the mood episodes were only experienced for a super small period during the experience of active-phase symptoms.
- The symptoms are not because of medicine or drugs.
- If the person has autism or communication disorder during childhood, schizophrenia is only made if the delusions and hallucinations are incredibly prominent in addition to the other symptoms of schizophrenia.
