Schizophrenia

Question 1

What are the positive symptoms of schizophrenia?

Answer 1

delusions
hallucinations
disorganized speech
grossly disorganized or catatonic motor behavior

Question 2

What are the negative symptoms of schizophrenia?

Answer 2

avolition
social deficits
flattened affect
cognitive deficits

Question 3

What are the different types of schizophrenic and psychotic disorders?

Answer 3

schizotypal personality disorder

delusional disorder

brief psychotic disorder

schizophreniform disorder

schizophrenia

schizoaffective disorder

Question 4

What are the common symptoms within the spectrum of schizophrenic disorders?

Answer 4

delusions

hallucinations

disorganized speech

disorganized motor behavior or catatonia

negative symptoms

Question 5

What is the prevalence of schizophrenia?

Answer 5

lifetime prevalence of schizophrenia 1%

schizophrenic patients may account for up to 50% of repeat hospital admissions and 25% of inpatient beds

vastly overrepresented in prison and homeless populations

estimated 1/3 of homeless in US
estimated 20% of prison population

Question 6

What is the morbidity of schizophrenia?

Answer 6

suicidality is estimated at up to 60%: 20% attempt suicide, 5-7% die by suicide

up to 50% co-morbid with substance abuse

psychiatric co-morbidities include mood and anxiety disorders

Question 7

What is the mortality of schizophrenia?

Answer 7

decreased life expectancy of 10-25 years

Question 8

What are delusions?

Answer 8

fixed beliefs that are not amenable to change despite conflicting evidence

Question 9

What are the types of delusions?

Answer 9

persecutory: belief of pursuit, harassment, or harm from an individual or group

referential: belief that gestures, comments, or cues are directed at oneself

control: belief that one’s thoughts or actions are under external influence

grandiose: belief in special abilities or status

erotomanic: belief that another has fallen in love with oneself

nihilistic: belief in impending disaster or calamity

somatic: belief in an adverse health condition

Question 10

What are common delusions in schizophrenia?

Answer 10

though broadcasting: belief in thoughts being cast to the outside world

though insertion: belief in thoughts implanted from an outside source

thought withdrawal: belief that thoughts have been removed from mind

Question 11

What are bizarre delusions?

Answer 11

a delusion that is neither plausible not understandable and des not derive from normal life experiences

Question 12

What are hallucinations?

Answer 12

sensory or perceptual disturbances that are difficult or impossible to distinguish from reality

Question 13

What are types of hallucinations?

Answer 13

auditory: occur in up to 60% of cases

tactile: tingling, burning or electrical sensations

somatic: e.g., feeling snakes writhing in one’s belly

visual: much rarer

gustatory and olfactory: tasting or smelling things that are not present

Question 14

What are “normal” hallucinations?

Answer 14

hallucinations can occur as a normal experience

normal when falling asleep or waking (hypnogogic or hypnopompic)

induced by sensory deprivation

religious experiences and normal grieving

considered symptomatic of mental illness only when experienced in a clear sensory state

“normal” hallucinations can typically be recognized as such by the experiencer

Question 15

What are speech and thought disturbances in schizophrenia?

Answer 15

disturbances in coherent, meaningful speech

believed to represent a though disorder

loss of connections or associations between thoughts

leads to disorganized, illogical thought patterns

Question 16

What are examples of altered speech patterns?

Answer 16

derailment: loss of connectivity, changes of topic

tangentiality: unrelated content to conversation

word salad: lack of connection between words within a single utterance

distractibility: loss of train of thought

Question 17

What are rare and severe speech disturbances?

Answer 17

neologisms: words made up by the speaker

perseveration: persistent repetition of a word or phrase

clang associations: stringing together rhyming words

echolalia: verbatim repetitions of phrases directed at patient

blocking: inability to complete sentences due to internal distraction

Question 18

What is the disorganized/abnormal motor behavior in schizophrenia?

Answer 18

widely ranging expression

severe motor agitation

unpredictable agitation

inappropriate behavior: childlike silliness, inappropriate facial expressions, giggling

purposeless activities

catatonia

Question 19

What is catatonia in schizophrenia?

Answer 19

resistance to instruction (negativism)

lack of verbal or motor response (mutism, stupor)

excessive activity without cause (catatonic excitement)

maintaining rigid, bizarre posture

waxy flexibility (positionable catatonia)

Question 20

What is diminished social expression in schizophrenia?

Answer 20

blunting of affect
reduced facial expression
lack of eye contact
reduced intonation, gesturing

Question 21

How do schizophrenic patients retain emotional reactions?

Answer 21

different from anhedonia

patients are particularly deficient in non-verbal expression

Question 22

What is avolition in schizophrenia?

Answer 22

lack of motivation to initiate or engage in activity

apathy or indifference to consequences

Question 23

What are the attentional deficits in schizophrenia?

Answer 23

difficulty filtering irrelevant or distracting stimuli

Question 24

What are the social deficits in schizophrenia?

Answer 24

social withdrawal

decreased pleasure from social interactions

Question 25

What are the cognitive deficits in schizophrenia?

Answer 25

alogogia or poverty of speech

attention, long-term memory, working memory, abstraction and planning

Question 26

What is the course and modifiers of schizophrenia?

Answer 26

early onset (75% of cases present before 25)

no gender differences (but earlier presentation in males)

4 phases to the course of schizophrenia

Question 27

What is the premorbid phase of schizophrenia?

Answer 27

preclinical and usually only described retrospectively

lower performance at school: decline between 13-16

poor social adjustment: less socially responsive, less positive emotional valence

delayed or abnormal motor development

Question 28

What is the prodromal phase of schizophrenia?

Answer 28

marks a period of observable functional decline

last months to few years

typically begins in adolescence: waning social interest, irritability, depression, antagonistic thoughts and behaviors, reduced care of appearance

non-specific psychiatric symptoms typically retrospectively identified as schizophrenic prodrome

subtle psychotic behaviors: suspiciousness or perceptual distortions

may represent the ideal therapeutic window

Question 29

What is the florid phase of schizophrenia?

Answer 29

emergence of psychotic symptoms

high prevalence of substance abuse may act as a precipitant: associations between alcohol, cannabis, and amphetamine use and “first break”

early age of onset ad delayed treatment are associated with worse prognosis

leading cause of involuntary hospitalization

Question 30

What is the residual phase of schizophrenia?

Answer 30

return to behavioral state of the prodromal phase after treatment: negative symptoms: social impairment, cognitive impairments remain, remission varies among individuals

residual phase typically marked by episodic psychotic illness with persistent “clinical deterioration” - failure to recover to pre-episodic level

positive symptoms are typically episodic while negative symptoms are progressive

20% show favorable outcomes, recovery is rare