Schizophrenia

Question 1

The DSM diagnostic criteria for schizophrenia is that 2 or more of the following symptoms must be present for a sig portion of time during a 1 month period:…

Answer 1

1) Delusions, 2) Hallucinations, 3) Disorganised speech, 4) Grossly disorganised or catatonic behaviour (all +ve symptoms) & 5) -ve symptoms

Question 2

What are the different phases during which +ve & -ve symptoms may occur?

Answer 2

Prodromal (preclinical), active (+ve symptoms most likely) & residual (-ve & cognitive outcomes of the psychotic episode)

Question 3

Name 3 common delusions. Delusions of…1), 2) & 3). Delusions are cognitive ___ of abnormal experiences

Answer 3

Control (of the mind/body by an external force), persecution (X wants to harm you) & reference (remarks, events or objects have special meaning). Explanations

Question 4

Name 3 common auditory hallucinations:…

Answer 4

Audible voices (say the patient’s thoughts out loud), commentary (of the patient’s actions) & voices arguing (2 voices arguing with each other)

Question 5

Give 3 other commons signs of “thought disorder” (3 delusions about your own thoughts)

Answer 5

1) Thought insertion (by an outside force), 2) Thought withdrawal (by an outside force) & 3) Thought broadcast (paranoia that one’s own thoughts have been inserted into others’ minds)

Question 6

What do we mean by disorganised speech?

Answer 6

The production of speech which is incoherent & incomprehensible due to loosening of semantic associations between concepts. The patient may catch onto the sound but not the meaning of a question asked

Question 7

What do we mean by catatonic behaviour?

Answer 7

Disturbances of movement including rigidity, bizzare posturing & repetitive imitations of others’ movements - which fit with the notion of DA dysfunction

Question 8

Give 3 -ve symptoms

Answer 8

1) Affective flattening (lack of mood), 2) Alogia (lack of speech) & 3) Avolition (lack of general desire)

Question 9

Give 2 points which suggest that schizophrenia may not be one disorder

Answer 9

1) No one symptom/ collection of symptoms characterises all patients, 2) All the component symptoms of S can be found in other psychological or medical conditions. I.e. symptoms lack consistency & exclusivity

Question 10

It is possible that S is a group of disorders with different biological causes producing similar/related behavioural symptoms because the DSM…

Answer 10

Classifies disorders on the basis of behaviour only (not biology)

Question 11

Around .%-_% of the population suffer from S. It occurs equally in…& in…

Answer 11

0.5%-1%. All cultures & both genders

Question 12

Are there any typical gender differences in S?

Answer 12

Yes in the nature of how the disorder manifests itself. Men: earlier onset, more schizotypical traits prior to onset, more -ve symptoms (vs. +ve symptoms for women), more often chronic & unresponsive to treatment than when diagnosed in females

Question 13

Define endophenotypes

Answer 13

Brain markers of underlying genetic factors

Question 14

Is S entirely genetically determined? How was this demonstrated in quadruplet S patients?

Answer 14

No. These quadruplets all suffered from S but their illnesses varied in severity & they showed symptom & neuropsychological differences. Whether early brain injury or harsh childhood treatment caused these differences is unknown

Question 15

The average risk for developing S in the population is 1%. What is the % risk for 1) spouses of patients, 2) first cousins (12.5% genes shared = 3rd degree relatives), 3) 2nd degree relatives e.g. nephews (25% genes shared) & 4) first degree relatives e.g. offspring of S parents & siblings/DZ twins vs. MZ twins

Answer 15

1) 2% (due to the shared environment or assortative matching), 2) 2%, 3) 4% & 4) 16.6%, 17% vs. 48% N.B. 3) changes with the amount of shared environment

Question 16

Griffith (1972) found that amphetamine can mimic psychosis after - days in…when administered every hour for 5 days

Answer 16

2-5 days. Experienced amphetamine users

Question 17

Postmortem studies inconsistently show abnormalities in the ___ of dopamine

Answer 17

Metabolities (substances required to chemically process dopamine)

Question 18

Name an example of a radioligand used in the “radioligand displacement technique”

Answer 18

Raclopride

Question 19

Why do typical antipsychotics not treat -ve symptoms, whereas atypical antipsychotics do?

Answer 19

Because typical neuroleptics non-selectively block DA Rs in all pathways, making potential PFC hypofunctioning (& resultant -ve symptoms) worse & causing side effects. In contrast, atypical antipsychotics which block D2 Rs less produce less extra-pyramidal (motor) side effects

Question 20

Atypical antipsychotics may produce differences in the ___ of D2 R occupancy in the striatum vs. cortex which may…

Answer 20

Timing. Be responsible for reduced motor side-effects

Question 21

Atypical antipsychotics additionally target…which may…

Answer 21

Serontonin functioning. Combat side effects

Question 22

Define salience attribution

Answer 22

The process by which events & thoughts grab attention, drive action & influence goal-directed behaviour because of their association with reward or punishment

Question 23

Prolonged use of ___ increases your risk of suffering from schizophrenia due to the impact of ___ on the dopamine system

Answer 23

Dopamine

Question 24

Weinberger’s (1982) _ _ scans of Ss’ brains showed that the ___ ventricles were smaller than in controls

Answer 24

CT. Lateral

Question 25

Steen’s meta-analysis reviewed studies investigating ___ ___ Ss’ whole brain volume, hippocampal volume & ventricular volume - why?

Answer 25

First episode. Because then the structural abnormalities found could be interpreted as causes rather than mere effects of the disorder

Question 26

The seasonality of birth effect in S can be explained in terms of…

Answer 26

Materal influenza causing prenatal brain damage

Question 27

It is said that prenatal brain damage remains silent until the patient’s 20s. Is this completely true?

Answer 27

No, Walker (1993/4) retrospectively analysed home videos of S patients when they were children. Relative to unaffected siblings, the to-be-S children displayed more -ve affect & poorer motor skills

Question 28

Give 3 pieces of evidence against the early neurodevelopmental H1 on the lecture slides

Answer 28

1) Less than 1/3 of Sz show developmental abnormalities (e.g. poor motor skills, -ve affect, speech problems), 2) Most imaging studies are conducted post-onset & so could well reflect degeneration & 3) Programmed cell death (pruning) does not produce gliosis

Question 29

Schizophrenics show a similar but more severe trajectory in cognitive impairments to sufferers of ___ ___ in terms of the relative severity of different symptoms. Deficits are found on…tasks

Answer 29

Bipolar disorder. Verbal, visual, abstraction, memory, executive-motor, perceptual-motor, mental control & vigilance tasks

Question 30

It is possible that some schizophrenic symptoms e.g. cognitive symptoms are the result of other types of symptom. Is this supported by Mesholam-Gately’s (2009) meta-analysis into the cognitive impairments of Szs?

Answer 30

No, even first episode Sxs show cognitive symptoms & cognitive symptoms are not worse in chronic Sxs. However, this leaves open the possibility that the first episode of psychosis causes cognitive symptoms!

Question 31

Give 3 findings which suggest that cognitive symptoms are core trait factors of S

Answer 31

1) They’re present early on in the disease’s course, 2) They do not just reflect lack of motivation or co-operation with lab tasks & 3) They remain present after recovery

Question 32

Cognitive impairments likely reflect an endophenotype (hypofrontality) in patients. Their genetic origins are supported by their presence in…

Answer 32

Unaffected first degree relative of Szs who show impaired WM, set shifting & inhibition of prepotent responses

Question 33

Why should cognitive symptoms be targeted by treatments?

Answer 33

Because they impair vocation & social functioning

Question 34

What % of Sz patients experience AHs?

Answer 34

Over 60%

Question 35

What is used to measure delusions in the normal population? Give some example statements with which one had to agree/ disagree

Answer 35

Peters Delusion Inventory (1996) which contains 40 items e.g. things in magazines were written especially for you, you are being persecuted in some way, you are destined to be someone very important

Question 36

__ % of the normal population endorsed each delusional item. This % was higher for…

Answer 36

30%. Members of religious cults and psychotic patients

Question 37

Peters (1999) found that new religious movement (NRM) members could not be…but could be differentiated from…

Answer 37

differentiated from deluded psychotic patients on 1) the no. of delusional items endorsed & 2) the level of conviction associated with each item. Christians & non-religious people