Schizophrenia

Question 1

clinical psychosis components

Answer 1

• Disordered Thought Form
• Disordered Thought Content
• Hallucinations (stimulus ≠ perception)
• Bizarre behavior
• Other: time, “boundaries,” etc.

^all areas in which “reality” can slip away

Question 2

Mood Disorders

Answer 2

• Bipolar d/o

- Major Depression with psychosis

Question 3

Personality Disorders

Answer 3

Borderline
Schizotypal
Paranoid
Schizoid

Question 4

sudden psychosis - what to consider?

Answer 4

Consider medical or toxic conditions
- not exclusively during delirium

OVERALL: psychosis often is not due to mental illness

Question 5

Schizophrenia diagnostic criteria

Answer 5

1) Two or more for a month (Psychotic Sx)...
Delusions
Hallucinations
Disordered Speech
Disorganized or Catatonic Behavior
Negative Symptoms

2) Social / Occupational Dysfunction
3) 6 Months (Time)
4) Not Schizoaffective or Mood d/o
5) Not substance related, not medical
6) Not Pervasive Development d/o

OVERALL: psychosis+loss of function+time

Question 6

Schizophrenia is

Answer 6

chronic, degenerative, psychosis

Question 7

Schizophrenia subtypes

Answer 7

Catatonic
Disorganized
Paranoid
Undifferentiated
Residual

OVERALL: HETEROGENEITY, little clinical utility and not in DSM-5

Question 8

Schizophreniform d/o

Answer 8

Schizophrenia-like psychosis (criteria A)

Not enough time

Provisional; not a valid construct

Prevents over-dx of Schizophrenia

OVERAL: schizophrenia-like, maybe not chronic or degenerative

Question 9

Schizoaffective d/o

Answer 9

Schizo/Mood psychosis w/ Schizophrenia criteria A

Psychotic when not moody

Loss of function (not criteria)

Time (not criteria)

OVERALL: chronic, degenerative moody psychosis

Question 10

Delusional d/o

Answer 10

do NOT meet criteria A for schizophrenia

Delusional

Preserved functioning

Unknown cause

Rare

OVERALL: thought content psychosis only

Question 11

Brief Psychotic d/o

Answer 11

Psychosis under stress (schizophrenia criteria A)

Brief

Self-resolving

OVERALL: Possible universal toxicity of stress

Question 12

Other Schizophrenia / Psychotic Spectrum Disorders

Answer 12

• Persistent Auditory Hallucinations
• Delusions with overlapping mood episodes
• Attenuated psychosis syndrome
• Delusion in context of relationship w/ delusional person(once called “Folie á deux”)

VAGUE, NOT USEFUL

Question 13

Positive vs. negative psychotic sx

Answer 13

All psychotic disorders include “positive” symptoms

“Negative” symptoms are a core feature of schizophrenia and S/A d/o - these represent degeneration and functional loss.

Question 14

Hallucinations

Answer 14

perceptions w/o stimulus

Types:
Auditory
Visual
Olfactory, gustatory, tactile

Question 15

Delusions

Answer 15

• Fixed, false beliefs
• Untrue and “contrary” to persons education/culture
• In any psychotic d/o

Exp.:

• Paranoid / persecutory
• Nihilistic
• Ideas of reference
• Thought delusions: Broadcasting, insertion or made thoughts, thought withdrawal
• Made feelings
• Delusions of Control
• Jealous
• Guilty
• Grandiose
• Sexual
• Religious
• Somatic (think body is rotting)

Question 16

We measure quality of formal thought by

Answer 16

studying person’s SPEECH

Question 17

Formal thought disorder types

Answer 17

• Speech poverty/content poverty (alogia - negative symptom)
• Perseveration (repeat similar phrase over and over)
• Distractibility
• Blocking
• Echolalia, clang/bang, neologisms (made up words)
• Tangentiality
• Circumstantiality
• Loose Associations / derailment
• Incoherence / illogical

Question 18

Psychotic behavior

Answer 18

goal directed
odd
out of context

• Catatonia, echolalia, echopraxia
• Pacing, rocking, talking to self
• Wearing heavy coat in summer
• Collecting excrement
• Mannerisms

Question 19

Catatonia requires 3 or more …

Answer 19

• Stupor (no psychomotor activity)
• Catalepsy (passive, inactive posture)
• Waxy Flexibility (Gumby effect)
• Mutism (little or no verbal response)
• Negativism (opposition to instructions/ stimuli)
• Stereotypy (repetitive, purposeless)
• Posturing, Mannerisms,
• Grimacing
• Echolalia, Echopraxia, Mitgehen
• Agitation

catatonia is a SPECIFIER for various psychotic and medical disorders

Question 20

Negative Symptoms

Answer 20

Affective flattening or blunting 
Apathy
Avolition (apathy)
Alogia (poverty of speech)
Anhedonia
Asociality
Attention
Poor Self-monitoring

Question 21

Schizophrenia Epidemiology

Answer 21

Prevalence: 1%
Lifetime incidence: 1-2%
2+ million people in US
25-50% attempt suicide, 10% complete suicide

personal/social burden, economic motive to find drugs

Question 22

Schizophrenia course/prognosis

Answer 22

onset

course (prodromal/active/residual)

prognosis (variable)

*longitudinal features (neurodegenerative)

Question 23

Schizophrenia heritability genetics

Answer 23

One affected parent: 4-9% schizophrenia risk

Two affected parents: 40-50% risk

One affected sibling: 15% in other sibs

Fraternal Twins: 28% concordant

Identical Twins: 60% concordant

Question 24

Schizophrenia is __% heritable

Answer 24

70-85% heritable

Question 25

Genes associated w/ schizophrenia

Answer 25

Dysbindin1

Neuregulin1

Question 26

COMT: Catechol-O-Methyltransferase

Answer 26

breaks down catecholamines in frontal lobes

Question 27

ValVal COMT

Answer 27

break down catecholamines much faster

reduced working memory

schizophrenia susceptibility factor

Question 28

Tolcapone

Answer 28

brain penetrant COMT inhibitor (which normally breaks down catecholamines)

improves working memory

does not improve schizophrenia

Question 29

neurotransmitter theory of schizophrenia (3 theories(

Answer 29

dopamine
Serotonin (5HT)
glutamate

Question 30

schizophrenia diagnostic utility

Answer 30

have validity as a designed construct

categorization, communication, public health, billing

Question 31

disordered thought form

Answer 31

disorganized mental processes

Question 32

disordered thought content

Answer 32

delusions (fixed, false beliefs not explained by culture; bizarre or implausible beliefs)