Schizophrenia

Question 1

Major psychological disorder

Answer 1

Severe Mental Illness (SMI)

Question 2

“Schiz” means splitBetween thoughts and reality

Answer 2

Between thoughts and reality

␣ NOT between 2 separate minds ␣ NOT Dissociative Identity Disorder

Question 3

Profound in its consequences

Answer 3

Impaired thought processes
␣ Misperceptions of the environment ␣ General life functioning usually quite impaired ␣ Impaired concentration ␣ Problems with motor activity ␣ Abnormal emotional style

Question 4

Diagnostic Criteria Schiz

Answer 4

Problems present for at least 6 months
␣ Must be active period with psychotic episode for at least one month
␣ Course may or may not include a prodromal stage
␣ Cannot be due to a substance ␣ Very important differential diagnosis

Question 5

The Course of Schizophrenia:

ot every patient diagnosed with schizophrenia manifests symptoms for life

Answer 5

ven though diagnostically will always carry diagnosis [schizophrenia, residual type]

Question 6

Historically, used one-third rule

Answer 6

1/3 deteriorate for life ␣ 1/3 have chronic episodes of schizophrenia ␣ 1/3 show substantial improvement

Question 7

Research on Relapse and Remission

Answer 7

5-year follow-up research results ␣ Zubin et al., 1989

Question 8

22% one episode Research on Relapse and Remission

Answer 8

Group 1: One episode only; no impairment and improved

functioning (22%)

Question 9

78% several episodes and varying degrees of

lasting impairment Group 2:Research on Relapse and Remission

Answer 9

Several episodes with minimal impairment

35%

Question 10

Group 3:Research on Relapse and Remission

Answer 10

Impairment after single episode and increased
impairment later (no return to normality) (8%)

Question 11

Group 4: Research on Relapse and Remission

Answer 11

Impairment increasing after several episodes (no return to normality) (35%)

Question 12

Gender Differences

Answer 12

Roughly similar prevalence rates for men and women
␣ Males diagnosed much earlier in life then rates decrease
␣ Women more frequently diagnosed later in life
␣ Age of onset has potential prognostic value

Question 13

Symptoms of Schizophrenia1/2

Answer 13

No single feature seen invariably or only in schizophrenia
␣ No pathognomonic sign
␣ A constellation of features must exist for a diagnosis of schizophrenia to be made
␣ Talk about as positive and negative symptoms

Question 14

Symptoms of Schizophrenia 2/2

Answer 14

Two (or more) during a 1-month period ␣ Delusions

␣ Hallucinations ␣ Disorganized speech ␣ Grossly disorganized or catatonic behavior ␣ Negative symptom

Question 15

Negative Symptoms

Answer 15

correlated with more problems ␣ Higher rates of permanent disability
␣ Affective flattening ␣ Alogia ␣ Avoiltion ␣ Apathy
␣ Anhedonia ␣ Asociality

Question 16

Thought Disorders

Answer 16

positive symptom
␣ Considered a “hallmark” of schizophrenia
␣ Remember NO pathognomonic signs! ␣ Thought disorders manifest in
␣ Content and/or ␣ What the thought is about
␣ Form ␣ How the production of thought appears

Question 17

Thought disorders of Content

Answer 17

Major feature is presence of delusions ␣ False, fixed beliefs
␣ Not based in reality ␣ Maintained in the light of overwhelming
evidence to the contrary ␣ Many types of delusions

Question 18

Delusion of persecution

Answer 18

Perhaps most common ␣ Belief that agency, group, or individual is out to
get person

Question 19

Delusion of grandiosity

Answer 19

Person is extremely special, capable of special

feats ␣ Not based in reality ␣ Example: God, Christ, etc.

Question 20

Delusion of reference

Answer 20

Events, objects, or people given unusual
significance ␣ . e.g., Nurse may be the Angel of Death
18

Question 21

Delusions: Thought broadcasting

Answer 21

person believes can send thoughts to

minds of others

Question 22

Delusion: Thought insertion

Answer 22

Belief that thoughts are being inserted into

one’s mind from some external source

Question 23

Thought removal or extraction:

Answer 23

Belief that external agent is removing thoughts from one’s brain or head

Question 24

Formal thought disorders

Answer 24

How the thought is expressed

Question 25

Loose associations

Answer 25

Person jumps from topic to topic with no awareness that the topics are not (or are only obliquely) related

e.g., Q: “how are you feeling today?”

Question 26

Disturbances of Perception

Answer 26

positive symptom ␣ Most common are hallucinations
-Perception of a stimulus where one does not exist
␣ Cf. delusion ␣ Must differentiate from keen sense or
sharpened sense in a trade ␣ E.g. “smelling when fluorescent lights go bad”

Question 27

Hallucinations1/2

Answer 27

May be ongoing throughout problem and into remission

• Not necessarily every moment
• More sporadic than that

Question 28

Hallucinations2/2

Answer 28

Different types indicate different problems

Psychological, substance induced, neurological

Question 29

Auditory Hallucinations

Answer 29

-Most common in schizophrenia
- Hear sounds someone sitting next to person cannot hear because there is no sound
- Experienced externally
-Person with auditory hallucinations may not be
able to concentrate on any other task because “the voices” will not let them focus
-May be sounds or voices
-If voices, may be in form of narration or command -Command hallucinations can be risky

Question 30

Tactile Hallucinations

Answer 30

Feeling something that is not present
␣ Much less common
␣ Include such things as tingling and burning sensations
␣ Frequently induced by substance
␣ Psychostimulants ␣ Crack cocaine, methamphetamine

Question 31

Visual Hallucinations

Answer 31

Seeing what isn’t there ␣ Not typically found with patients diagnosed with
schizophrenia ␣ Often more indicative of substance induced
psychosis ␣ Hallucinogens, psychostimulants, MDMA, PCP
␣ May also be sign of organic (neurological) mental disorder
␣ Malignant neoplasm (tumor)

Question 32

Olfactory Hallucinations

Answer 32

Perception of odors which are not present
␣ So uncommon warrant a complete set of neurological tests
␣ Must rule out possibility of brain tumor or other biological problem
␣ Stroke, preictal phase of seizure

Question 33

Disturbance of Affect

Answer 33

Negative symptom ␣ Disturbance in emotional experience or expression

Question 34

Restriction of affect

Answer 34

Reduction in range of emotions

Question 35

Blunting of affect

Answer 35

Reduction in intensity of affective expression

Question 36

Flattened affect

Answer 36

Complete absence of affective expression in the face or voice

Question 37

Inappropriate affect

Answer 37

Responsiveness is inappropriate to the subject being discussed
␣ e.g., laughing when being told others will view and remove thoughts from you

Question 38

Disturbances of Psychomotor Behavior

Answer 38

Catatonic features ␣ Catatonia refers to problems with movement ␣ Catatonic stupor-No movement, non-respondent ␣ Catatonic excitement
-Agitated, intense, or exaggerated movements