Psychopathology: Schizophrenia Spectrum/Other Psychotic D/O

Question 1

Brief Psychotic Disorder Requirements

Answer 1

• 1+ of 4 sx: delusions, hallucinations, disorganized speech**, and grossly disorganized/catatonic bx
• 1-30 days

** = 1 of the symptoms must be one of these

Question 2

What are delusions

Answer 2

false belief based on incorrect inference about external reality that is firmly held despite proof/evidence to the contrary

Question 3

What are hallucinations

Answer 3

Perception-like experience with the clarity and impact of a true perception without the external stimulation of the relevant sensory organ

Question 4

What are illusions

Answer 4

Actual stimulus is misperceived or misinterpreted

**Not to confuse with hallucination that does not have an actual stimulus

Question 5

Schizophreniform D/O

Answer 5

• 2+ of 5 sx: delusions, hallucinations, disorganized speech**, grossly disorganized/catatonic bx + Negative sx (avolition, alogia, anhedonia)
• 1-6 MONTHS

** = 1 of the symptoms must be one of these

Question 6

Schizphrenia

Answer 6

• 2+ of 5 sx: delusions, hallucinations, disorganized speech**, grossly disorganized/catatonic bx + Negative sx (avolition, alogia, anhedonia)
• 1+ MONTH of ACTIVE PHASE
  *6+ MONTHS of Sx

Other phases include:
Prodromal Phase=2+ characteristics in a reduced form
Residual Phase=2+ characteristics in negative symptoms only

** = 1 of the symptoms must be one of these

Question 7

Genetic factors/Concordance rates of 1st degree relatives (Gottesman, 1991)

Answer 7

Relationship to Person with Schizophrenia
Parent =6%

Biological sibling=9%

Child of one parent with schizophrenia=13%

Dizygotic (fraternal) twin=17%

Child of two parents with schizophrenia=46%

Monozygotic (identical) twin=48%

Question 8

Concordance rates for discordant twins (twins in which only one twin has schizophrenia)

Answer 8

Discordant MONOzygotic twins = increased risk of schizophrenia being similar for offspring of affected and non-affected twins

Discordant DIzygotic twins = risk for offspring of affected twins was SIMILAR to risk for offspring MONOzygotic twins and GREATER than risk for non-affected twins

Discordant MZ twins have significant genetic liability that can be transmitted to children even though they do not manifest it themselves

Question 9

Dopamine hypothesis for Schizophrenia

Answer 9

Due to HIGH levels of dopamine or HIGH activity of dopamine rceptors

AMPHETAMINES increase dopamine and produce schizophrenia-like symptoms.

Question 10

Updated Dopamine hypothesis for Schizophrenia (Kuepper, Skinbjerg & Abi-Dargham, 2012)

Answer 10

Positive sx due to Dopamine HYPER activity in the SUBcortical regions of the brain (striatal areas–basal ganglia)
Negative sx due to Dopamine HYPOactivity in CORtical regions (prefrontal cortex)

Question 11

Brain abnormality associated with Schizophrenia

Answer 11

*Enlarged Ventricals
* HYPOFRONTALITY=lower-than normal activity in prefrontal cortex (contribute to negatie sx)
* Dysfunction of Temporal-Limbic-Frontal network causes negative symptoms
* Disinhibition in striatum (caudate nucleus, putamen, and nucleus accumbens within basal ganglia) causes positive symptoms

Question 12

Comorbid d/o with Schizophrenia

Answer 12

Anxiety D/O
OCD
Tobacco use (70-85% aka over half meet criteria for tobacco use d/o)

Question 13

Onset of Schizophrenia

Answer 13

1st appears between late teens and early 30ths
Peaks early- to mid-20’s for men and late-20s for women

Question 14

Course of Schizophrenia

Answer 14

Psychotic sx decrease with age.
Negative and cognitive sx persist

Question 15

Better prognosis for schizophrenia

Answer 15

female gender
acute & late onset of sx
comorbid mood symptoms (esp Depression)
Premoninantly positive symptoms
Precipitating factors
Family Hx of mood disorder
Good premorbid adjustment

Question 16

Impact of Anosognosia on Schizophrenia

Answer 16

Anosognosia=lack of insight or denial of illness

Leads to non-adherence to treatmen and elevated risk for relapse

Question 17

Factors that increase risk of relapse of schizophrenia

Answer 17

Anosognosia
High Expressed Emotion (emotional response of family members to patient with criticism/hostility/emotional overinvolvement)

Question 18

Cultural differences in onset, course, and prognosis of Schizophrenia

Answer 18

non-Western developing countries=acute onset, shorter course, and higher rate of remission

Question 19

Immigrant Paradox

Answer 19

Newly arrived immigrants have better health outcomes than much more acculturated immigrants with longer US residence/US born natives of the same ethnicity

Applies to schizophrenia and ETOH use d/o among other psychiatric d/o

Question 20

Treatment of Schizophrenia

Answer 20

Psychosocial interventions, antipsychotic drug, and adjunctive medications to treat comorbid disorders

Question 21

Psychosocial treatments for Shizophrenia

Answer 21

CBT for psychosis (CBTp)
Cognitive remediation for schizphrenia
ACT
Assertive Community Treatment
Family psychoeducation
Illness self-management training
Social skills training
Supported employment services

Question 22

Factors to consider for medication treatment for Schizophrenia

Answer 22

Drug’s likely benefits and side effects
Potential interactions w/other drugs
Health conditions that might be affected by the drug’s side effects

Question 23

Best med for treatment-resistant schizophrenia

Answer 23

2nd Generation Antipsychotic Clozapine

Question 24

Multicomponent Early Interventions for individuals at high risk or early stages of Schizophrenia

Answer 24

NAVIGATE (exp 1st eps of psychosis) = family education, individual reiliency training, supported employment/education, and individualized medication treatment

Individualized resiliency training (based on CPTp) = teaches patients the skills they need to manage their illness

Question 25

Sx of SchizoAFFECTIVE d/o

Answer 25

Concurrent schizophrenia + Major Depressive or Manic episode for most of the duration of illness Presence of delusions/hallucinations for 2+ weeks w/out mood symptoms

Question 26

Sx of Delusional d/o

Answer 26

* 1+ delusions for a duration of at least 1 month * Overall functioning has NOT been markedly impaired except for direct effects of delusion

Question 27

Erotomanic Subtype of Delusional d/o

Answer 27

Person believes that another person is in love with him/her

Question 28

Grandiose Subtype of Delusional d/o

Answer 28

Person believes he/she has great but unrecognized talent or insight

Question 29

Jealous Subtype of Delusional d/o

Answer 29

Person believes his/her spouse/partner is unfaithful

Question 30

Persecutory Subtype of Delusional d/o

Answer 30

Person believes he/she is being conspired against, spied on, poisoned, or maliciously maligned

Question 31

Somatic Subtype of Delusional d/o

Answer 31

Person's delusion involves bodily functions or sensations

Question 32

A poor prognosis for people with schizophrenia is least associated with which of the following? A. female gender B. anosognosia C. early age of onset D. predominantly negative symptoms

Answer 32

A. female gender Answers B, C, and D are related to poor prognosis of schizophrenia

Question 33

A person who abuses an amphetamine or other ________-enhancing drug may develop symptoms similar to those associated with schizophrenia. A. ACh B. dopamine C. serotonin D. GABA

Answer 33

B. dopamine A person who abuses an amphetamine or other ________-enhancing drug may develop symptoms similar to those associated with schizophrenia. A. ACh B. dopamine C. serotonin D. GABA

Question 34

As reported by I. I. Gottesman (1991), the concordance rate for schizophrenia is about ___% for monozygotic twins and ____% for dizygotic twins. A. 50; 30 B. 50; 25 C. 48; 24 D. 48; 17

Answer 34

D. 48; 17

Question 35

A person whose biological mother and father have both received a diagnosis of schizophrenia is about _____ times more likely to receive the same diagnosis as a person whose only biological relative with schizophrenia is his or her non-twin sibling. A. 50 B. 16 C. 5 D. 2

Answer 35

C. 5 you need to know that the risk for receiving a diagnosis of schizophrenia is about 46% for a person whose biological mother and father have received the diagnosis, while the risk is about 9% for a person whose biological non-twin sibling is the only relative who has received the diagnosis. Forty-six divided by 9 is 5.1, which means that a person whose biological mother and father have received the diagnosis of schizophrenia is about 5 times more likely to receive the diagnosis than a person whose only relative with schizophrenia is a biological non-twin sibling

Question 36

Which of the following is considered the most effective antipsychotic drug for treatment-resistant schizophrenia? A. haloperidol B. chlorpromazine C. clozapine D. risperidone

Answer 36

C. clozapine