Schizophrenia Flashcards
Who first coined the term “Dementia Praecox”?
Emile Kraepelin.
What does “Dementia Praecox” mean?
Early-onset dementia with progressive deterioration.
Who coined the term “Schizophrenia”?
Eugen Bleuler.
What does “Schizophrenia” literally mean?
“Split mind” – referring to a disconnection from reality.
What core feature did Bleuler identify in Schizophrenia?
Disorganization of thought processes.
Is Schizophrenia the same as Multiple Personality Disorder?
No, Schizophrenia involves a split from reality, not multiple identities.
What are examples of positive symptoms in schizophrenia?
Hallucinations, delusions, inappropriate affect.
What are examples of negative symptoms?
Blunted affect, alogia (poverty of speech), avolition (lack of motivation).
Which type of symptoms typically respond better to medication?
Positive symptoms.
What are the six major symptom domains of schizophrenia?
1) Perception, 2) Content of Thought, 3) Form of Thought, 4) Affect, 5) Psychomotor, 6) Relating to Others.
What is the hallmark perceptual symptom in schizophrenia?
Hallucinations.
Which sensory modalities can hallucinations affect?
All – auditory, visual, olfactory, tactile, somatic, gustatory.
What are some typical auditory hallucinations in schizophrenia?
Voices commenting, conversing, or criticizing the person.
What are delusions?
False beliefs held with conviction despite contrary evidence.
What are some common types of delusions in schizophrenia?
Grandiose, persecutory, jealous, somatic, nihilistic, reference.
What are “made” experiences in schizophrenia?
Beliefs that one’s impulses, feelings, or actions are controlled by external forces.
What is derailment?
A sudden switch in topic without logical connection.
What is a “word salad”?
Speech that is incoherent and nonsensical.
What are neologisms?
Made-up words that only have meaning to the person.
What is alogia?
Poverty of speech, or poverty of content.
What is inappropriate affect?
Emotional responses that don’t match the situation.
What is catatonia?
Abnormal movement or behavior, often involving immobility or resistance.
What is waxy flexibility?
Limbs remain in any position they’re placed.
What are echolalia and echopraxia?
Repeating others’ words (echolalia) or movements (echopraxia).
What is disordered volition?
people with schizophrenia will often report having little motivation to do things, no sense of free will, no intact motivational system.
True or false: a lot of people have only negative symptoms of schizophrenia?
False. Very few have only negative symptoms
What are the DSM-5 diagnostic criteria for schizophrenia?
At least 2 symptoms, with at least 1 from the first three:
- Delusions
- Hallucinations
- Disorganized speech
- Disorganized or catatonic behavior
- Negative symptoms
Functional impairment, symptoms ≥ 6 months (with ≥ 1 month active), and exclusion of mood or substance-induced conditions.
How long must schizophrenia symptoms be present according to DSM-5?
At least 6 months, including 1 month of active symptoms.
What is schizoaffective disorder?
A disorder with features of both schizophrenia and severe mood disorders (bipolar or unipolar).
What is required for a schizoaffective disorder diagnosis?
Do they have symptoms of schizophrenia?
– Like hallucinations, delusions, or disorganized thinking?
Do they also have a mood disorder?
– Either major depression or bipolar disorder (mania/depression)?
Have they had hallucinations or delusions for at least 2 weeks
without any mood symptoms at all during that time?
→ This helps rule out it being just a mood disorder with psychotic features.
Has the mood disorder been present for most of the time during their illness?
→ This separates it from schizophrenia, where mood symptoms are less central.
Are these symptoms not due to drugs, alcohol, or a medical issue?
What is the key diagnostic feature of schizoaffective disorder?
The person has symptoms of both schizophrenia and a mood disorder at the same time, but also experiences at least 2 weeks of psychotic symptoms (like delusions or hallucinations) without any mood symptoms.
How is schizoaffective disorder different from a mood disorder with psychotic features?
In schizoaffective disorder, psychotic symptoms can occur without mood symptoms for at least 2 weeks.
In mood disorders with psychotic features, psychotic symptoms only happen during mood episodes.
How reliable is the diagnosis of schizoaffective disorder?
It has poor reliability & is controversial
What is the prognosis for schizoaffective disorder compared to schizophrenia?
Better than schizophrenia, but worse than mood disorders.
What is the prevalence of schizophrenia in the general population?
About 0.7% to 1% of people will develop schizophrenia in their lifetime
What are some positive prognostic indicators for schizophrenia?
- Good premorbid adjustment
- Acute onset
- Presence of mood symptoms
- Confusion during psychosis
- Family history of mood disorder
What are poor prognostic indicators for schizophrenia?
- Poor premorbid adjustment: Before getting sick, the person had trouble with social relationships, school, or work
- Gradual onset
- Prominent negative symptoms: emotions, lack of motivation, social withdrawal
- Family history of schizophrenia: A stronger genetic load for schizophrenia may lead to a more severe form of the illness.
- Possibly lower IQ
What’s the percentage that lives independently vs have persistent moderate symptoms vs have severe, lifelong impairment
20–30% live independently
20–30% have persistent moderate symptoms
50% have severe, lifelong impairment
What percentage has one or more periods of recovery in 15 years?
only 40%
How common is substance abuse in people with schizophrenia?
Very common—especially alcohol and nicotine. Substances may also trigger or worsen symptoms.
What’s the risk of suicide in schizophrenia?
Around 20% attempt suicide, and about 5% die by suicide—particularly young men with good premorbid functioning.
Are people with schizophrenia violent?
Slightly increased risk in young men with substance use, but most are not violent. In fact, they are more often victims of violence or suicide.
What do twin studies tell us about the heritability of schizophrenia?
MZ twins have a 28% concordance rate, DZ twins have a 6% rate, showing schizophrenia is partly genetic but also influenced by environment.
What is the role of chorionic arrangement in schizophrenia risk among MZ twins?
MZ twins sharing a placenta (monochorionic) have higher concordance than those with separate placentas (dichorionic), showing prenatal factors matter.
What is the relationship between genotype, endophenotype, and phenotype in schizophrenia?
Genotype is genetic makeup → endophenotype is a measurable intermediate trait (e.g., eye-tracking deficits) → phenotype is the outward expression (e.g., hallucinations).
What makes a good endophenotype for schizophrenia?
It must be heritable, found in affected families, present even in remission, measurable, and more common in patients than in the general population.
What are examples of biological risk factors for schizophrenia?
Advanced paternal age, prenatal viral exposure, birth complications, malnutrition during pregnancy, and second-trimester neurodevelopmental disruptions.
What does the “season of birth” effect suggest about schizophrenia risk?
People born in late winter/early spring have a slightly increased risk, likely due to higher exposure to maternal infections during the 2nd trimester.
What key neural process occurs in the 2nd trimester relevant to schizophrenia?
Neural migration.
What can disruption of neural migration lead to?
Reduced cortical connectivity, gray matter loss, and cell death.
What structural brain changes are seen in schizophrenia?
Decreased whole brain volume and progressive gray matter loss.
In what order does gray matter loss spread in the brain in schizophrenia?
Parietal → Temporal → Frontal cortex.
What does the “downward-shift” phenomenon describe?
Abnormal concentration of cells near white matter due to disrupted migration.
Why is gray matter loss in schizophrenia likely genetic?
Evident in discordant monozygotic twins.
The brain changes are not just a consequence of having schizophrenia or taking medications. It supports the idea that schizophrenia is a neurodevelopmental disorder — some brain differences are present before symptoms emerge.
What is the dopamine hypothesis of schizophrenia?
Excess dopamine in the striatum and reduced dopamine in frontal lobes contribute to symptoms.
What symptoms are associated with excess dopamine activity?
Psychosis, delusions, hallucinations, and motor symptoms.
What is aberrant salience in schizophrenia?
A state where patients give too much attention to irrelevant stimuli due to DA dysregulation.
What cognitive process is disrupted in schizophrenia and linked to dopamine?
Working memory (WM), regulated by the DLPFC.
They did a study where they asked participants if they could put finger exactly where the target was. People with schizophrenia could not recall where the target was.
How is cannabis use related to schizophrenia?
People with schizophrenia are about 2x more likely to use cannabis.
Does cannabis cause schizophrenia or is it just correlated?
Cannabis predicts onset of schizophrenia, even after controlling for early symptoms.
Even if someone already had strange thoughts or behaviors in childhood, cannabis use still adds an extra risk of developing schizophrenia later on. It’s not just because those kids were already at risk — cannabis itself seems to increase the chances.
What effect does THC have on dopamine?
THC increases dopamine synthesis (meaning more dopamine), which can exacerbate psychotic symptoms.
What brain change is observed in schizophrenia patients who use cannabis?
More gray matter loss over 5 years compared to non-users and healthy controls.
What is Expressed Emotion (EE)?
A family environment characterized by criticism, hostility, and emotional overinvolvement.
What does high EE predict in schizophrenia?
Higher risk of relapse, regardless of patient characteristics.
How can reducing EE affect outcomes?
Decreases relapse rates in people with schizophrenia. Suggest that EE may play a causal role.
Is EE specific to schizophrenia?
No — it also predicts worse outcomes in depression and bipolar, but may help in BPD (bc familiar, makes them feel cared for)
Is CBT effective for negative symptoms of schizophrenia?
No, it’s generally not very helpful for negative symptoms.
Helpful to reduce positive symptoms, prevent relapse, and reduce social disability.
What is the Hearing Voices Network?
A peer-support group for people who hear voices, aiming to reduce distress rather than stop the voices.
What are some strategies used in HVN?
Rules of engagement with voices, selective listening, using phones/toys to talk back in public (pretend to be on a phone call to help maintain dignity and control in public spaces.)
What is the current evidence for HVN’s effectiveness?
Limited—may reduce distress and offer social contact, especially for those with low social functioning.
