Phenomenology of Schizophrenia

Question 0

What are Bleuler’s 4 A’s of schizophrenia?

Answer 0

Abnormal associations
Autistic behavior (social withdrawal)
Abnormal affect
“Ambivalence”

Question 1

What did Bleuler mean when he termed “schizophrenia” i.e. “split-mind” disease?

Answer 1

He was getting at the disconnect between thought, emotion, and behavior that is seen.

Question 2

What are Schneider’s 4 first-rank symptoms? (what’s the significance of a “first-rank” symptom?)

Answer 2

You just need 1** of these to meet the criteria for schizophrenia:

• Auditory hallucination of voices (esp. arguing, discussing, or commenting upon affected person’s behavior).
• Thought insertion, withdrawal, broadcasting.
• Made (by someone else) feelings/impulses/behaviors.
• Delusional perceptions.
• *CORRECTION: Only the voices and “bizarre delusions” criteria are by themselves sufficient for diagnosis.**

Question 3

What is meant by “insertion, withdrawal, broadcasting”?

Answer 3

Insertion - “somebody placed this thought in my head”
Withdrawal - “somebody just removed that thought from my head”
Broadcasting - “everybody can hear my thoughts”

Question 4

Geographic risk factors for schizophrenia? (name 3)

Answer 4

Northern latitude, migration, and urbanicity.

Question 5

Why is there a greater incidence of schizophrenia in men, but an equal prevalence between men and women?

Answer 5

Men with schizophrenia have increased mortality such that prevalence levels out.

Question 6

Prevalence of schizophrenia worldwide?

Answer 6

About 0.5%

Question 7

What’s the biggest cost (in terms of money) of schizophrenia?

Answer 7

Lost employment. (then homelessness, criminal system, medical care, and disability benefits)

Question 8

When in relation to the onset of frank schizophrenia does the “prodomal” psychosis occur?

Answer 8

3-5 years beforehand.

Question 9

3 aspects of “prodromal” psychosis?

Answer 9

Attenuated psychotic symptoms: illusions, mild delusions that can be reality tested.
Early mild negative symptoms: social withdrawal, etc.
Difficulty with cognition.

Question 10

What’s a take-home point from the Harper’s magazine article about the woman who came to believe people were made of paper?

Answer 10

Minds to tend to make narratives to rationalize perceptual changes.

Question 11

What are the 4 categories of criteria for schizophrenia in the DSM-IV-TR?

Answer 11

A. Characteristic symptoms
B. Social/occupational dysfunction (including self-care)
C. Duration: prodrome/acute/residual symptoms lasting >6 mo
D. Not due to something else.

Question 13

What are 5 schizophrenia subtypes that won’t be in DSM V but you should know for exams? Brief description of each?

Answer 13

Paranoid: Delusions/hallucinations prominent.
Disorganized: Speech messed up. Flat/inappropriate affect.
Catatonic: Abnormal posturing, speech.
Undifferentiated
Residual: Negative Sx often prominent.

Question 14

What’s the “disorder of salience” hypothesis for schizophrenia? Parts of brain involved?

Answer 14

Too much significance attributed to random stimuli produces delusions, hallucinations, and ideas of reference.
Involving mesolimbic dopaminergic systems.

Question 15

What is an “idea of reference”?

Answer 15

From Wikipedia: “…having a belief or perception that irrelevant, unrelated or innocuous phenomena in the world refer to [the patient] directly or have special personal significance.”
E.g. The belief that things said on TV are actually about you, the arrangement of chairs in the cafe has a secret message meant specifically for you, etc.

Question 16

What is a nihilistic delusion?

Answer 16

Not believing in one’s own existence as a human being. (recall the woman who believed she was expired meat, and was afraid that her mother would eat her and get sick)

Question 17

What’s catatonia? What pharmacotherapy helps it? What does that therapy suggest about the cause?

Answer 17

Not moving at all.

Benzos help, which may suggest that the state is induced by anxiety. (but it’s probably more than just that)

Question 18

5 A’s of the negative symptoms of schizophrenia?

Answer 18

Alogia - reduced verbal communication.
(Flat) Affect
Anhedonia
Avolition
Asociality
(in some ways, these are actually the worst part of schizophrenia)

Question 19

3 mood co-morbidities of schizophrenia?

Answer 19

Depression, Anxiety, Suicide

Question 20

How does schizoaffective disorder differ from schizophrenia?

Answer 20

During psychotic episodes, criteria for mania or MDE are met. The psychosis extends beyond the duration of the mood symptoms (at least 2 weeks).

Question 21

How bad are the typical cognitive deficits in schizophrenia patients?

Answer 21

1-2 standard devs below the mean… which is not honors.

This corresponds to an IQ of 70-85.

Question 22

5 areas of greatest cognitive deficit?

Answer 22

Visual memory and learning.
Verbal memory and learning.
Attention.
Speed of cognition.
Executive function.

Question 23

How early are the cognitive deficits of schizophrenia detectable?

Answer 23

It’s been seen in kids as young as 6 or 7 years old… but the most dramatic divergence of development is in adolescents.

Question 24

Do antipsychotics treat positive or negative Sx or both?

Answer 24

They really just treat the positive Sx. (clozapine may have some effects on the negative Sx)

Question 25

What’s the “rule of thirds” for schizophrenia outcomes?

Answer 25

1/3 are treatment refractory.
1/3 have episodic relapses.
1/3 have good response with prolonged remission.

Question 26

What are the 5 characteristic symptoms of schizophrenia in the DSM-IV-TR?

Answer 26

1. Delusions
2. Hallucinations
3. Disorganized speech
4. Disorganized or catatonic behavior
5. Negative symptoms