Psychosis and Schizophrenia

Question 1

“Normal” psychotic experiences

Answer 1

• Most children who exhibit psychotic or psychotic-like symptoms do not have a true psychotic disorder
  
  • Transient hallucinations are occasionally observed in preschool children (visual and tactile are most common) and are prognostically benign
  • Hypnagogic and hypnopompic hallucinations

DRIVE BY:
- usually anxiety and mood disturbances

Question 2

psychosis (Defintion)

Answer 2

loss of contact with reality

Question 3

hallucination (definition)

Answer 3

false perception

Question 4

delusion (definition)

Answer 4

false belief

Question 5

illusion (definition)

Answer 5

misinterpretation of a real phenomenon or occurrence

Question 6

Catalonia (definition)

Answer 6

Motor immobility and behavioral abnormality manifested by stupor; can include extreme loss of motor skills and purposeless hyperactivity

lack of movement, emotion, speech

Question 7

most common causes of psychosis in children

Answer 7

Hearing things
- Mainly this
Seeing things
Depression
Anxiety

MOST COMMON –> visual and tactile

Question 8

epidemiology of schizophrenia

Answer 8

→ 1:10,000 children
- Rare before age 13, but the incidence steadily increases during adolescence
- Peak onset is aged 15-30 years

• Before puberty
  More common in boys → 2:1
• End of puberty
  Equal for boys + girls –> 1:1
• gray matter loss
• early dementia
• once you have it, it doesn’t go away

Question 9

4 As of schizophrenia
NEGATIVE SYMPTOMS

Answer 9

1. Diminished Emotional Expression
   - Reductions in the expression of emotions in the face, eye contact, prosody of speech (intonation), and movements of the hands, head and face that give emotional emphasis to speech
2. Avolition
   - Decrease in purposeful activities
3. Alogia
   - Decreased speech output
4. Anhedonia
   - Don’t feel motivated or experience pleasure
5. Asociality

Question 10

positive symptoms

Answer 10

DSM favors these
1st rank symptoms
- auditory hallucinatioons
- believing an external force to be acting upon one’s body
- thought withdrawal
- thought insertion
- thought broadcasting
- ideas of reference

Question 11

schizophrenia

Answer 11

1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
5. Negative symptoms (ie., diminished emotional expression or avolition)

• Psychosis can happen for lots of reasons
• Dementia
• Drug use
• Trauma
• PTSD
• Personality disorders

Question 12

schizoaffective disorder

Answer 12

A psychotic disorder that where sometimes the person has major mood swings that can look like mania or depression and meet criteria for that

Question 13

psychotic mood disorders

Answer 13

Mood disorders (BP or PDD) that go on for a long time and sometimes at its worst movements, people may develop a psychotic state

Question 14

neuroimaging studies and gray matter changes in adolescent schizophrenia

Answer 14

• Loss in gray matter loss in adolescence

Children lose 4-5x as much gray matter (e.g., neurons and their branch-like extensions) in their frontal lobes as normal teens!!!!

- Rapid deterioration of the brain 
- A lot of people functioning without the same capacity before puberty or adulthood

Question 15

good prognostic indicators for schizophrenia

Answer 15

• Acute onset
• Short duration of illness
• Lack of prior psychiatric history
• Presence of affective symptoms or confusion
• Good premorbid adjustment
• Steady work history
• Marriage
• Older age at onset

Question 16

bad prognostic indicators for schizophrenia

Answer 16

• Insidious onset
• Long duration of illness
• History of psychiatric problems
• Affective blunting
• Obsessive compulsive symptoms
• History of aggression
• Premorbid personality disorder
• Poor work history
• Celibacy
• Young age at onset

Question 17

differential diagnosis of schizophrenia

Answer 17

• Bipolar disorder
• Depression
• Autism
• Anxiety (particularly OCD)
• PTSD

the first rank symptoms (positive symptoms) can help make determination