Schizophrenia - Layde

Question 1

Describe the epidemiology of Schizophrenia: How many people does it affect? Is there a gender preference?

When does schizophrenia onset?

Answer 1

About 1% of the worldwide population, with women equally affected as men.

Onset generally in late teens (may be earlier in men).

Question 2

Explain the contributions made by Drs. Kraepelin, Bleuler, and Schneider towards the characterization of Schizophrenia.

Answer 2

Kraepelin was the first to identify schizophrenias (“dementia praecox”) as distinct from other mental disorders.

Bleuler described the schizophrenias as having a split among affect, thought, emotion and behavior; he also gave them their current name.

Schneider characterized schizophrenic symptoms (“First-rank”, analagous to Criterion A)

Question 3

Trivia:

What were the four “A”s of Bleuler’s schizophrenias?

What were Kurt Schneider’s 1st-rank symptoms?

Answer 3

Associations (eg word, thoughts), affect, autism (breakdown of ego boundaries; mistakes things are referring to self), and ambivalence (difficulty making decisions).

Thought broadcasting (“You can hear my thoughts”), thought withdrawal (“The martians stole my thoughts”), hearing voices, and somatic passivity (“I’m being controlled by external forces”).

Question 4

Name five characteristic symptoms of schizophrenia.

Which are criterion A?

Answer 4

Delusions (notions that cannot be argued away)

Hallucinations (Usually auditory, but can be of any sense)

**Disorganized speech **(derailments, incoherence)

Disorganized or catatonic behavior

Negative symptoms (flattened affect, alogia, avolition)

Question 5

Compare and contrast the symptomatology required for a diagnosis of schizophrenia in DSM-IV and V.

Answer 5

DSM-IV: 2+ symptoms persisting for >1mo. 1 criterion A is enough if particularly severe (bizarre delusions, hearing multiple or constant voices)

DSM-V: 2+ symptoms persisting for >1mo, of which at least one must be criterion A.

Question 6

How are social or occupational aspects affected in Schizophrenics?

Answer 6

Work, interpersonal relations, or self-care decline precipitously. Some vocations may be maintained, but generally at a lower level (eg a DA working at Goodwill).

Question 7

What are the prodromal or residual phases of Schizophrenia?

Answer 7

Periods during which only negative symptoms (or highly attenuated positive/Criterion-A symptoms) manifest.

Question 8

What must be ruled out for a diagnosis of schizophrenia?

Answer 8

Schizoaffective & mood disorders: No major depressive or manic episodes must have occurred–or at least, they must have been dwarfed in duration and significance by psychotic symptoms.

Substances & general medical conditions causing psychosis.

Question 9

How does the presence of a pervasive developmental disorder affect the diagnosis of Schizophrenia?

Answer 9

(recall: Autism & Asberger’s are pervasive developmental disorders)

Delusions or hallucinations must have been present for at least a month.

Question 10

Categorize the following symptoms as Positive, Negative, or Cognitive.

1. Blunted affect
2. Hallucinations
3. Impaired abstract thinking
4. Behavioral disturbances
5. Poor grooming
6. Disturbed memory

Answer 10

1. Negative
2. Positive
3. Cognitive
4. Positive
5. Negative
6. Cognitive

Question 11

What are the subclasses of schizophrenia?

Does this apply to DSM-IV, DSM-V, or both?

Answer 11

Disorganized, Catatonic, Paranoid, Residual, and Undifferentiated.

DSM-IV; DSM-V has eliminated these classifications.

Question 12

Describe the anatomic changes seen in Schizophrenia.

Is there a genetic component?

Answer 12

Enlargement of the lateral and third ventricle (+width), plus sulcal enlargement.

Yes; the disease has a 50% concordance rate in monozygotic twins, but only an 8% rate in dizygotic twins.

Question 13

Describe the physiologic and biological components of Schizophrenia.

How is it treated?

Answer 13

Reduced activity in the dorsolateral prefrontal cortex; maybe the thalamus and cerebellum too. Increased dopamine is clearly implicated.

Primarily by blocking dopaminergic receptors.

Question 14

Which are generally preferred in the treatment of schizophrenia: Atypical or typical antipsychotics?

Compare and contrast their side effects.

Answer 14

Atypical is generally preferred.

Typical antipsychotics have more motor symptoms (Acute dystonya, parkinsonism, akathisia, tardive dyskinesia), while atypical antipsychotics have a greater risk of weight gain.

Question 15

In addition to medical treatment, what psychosocia interventions are indicated in the treatment of schizophrenia?

Answer 15

Assistance finding housing, case management to ensure treatment compliance, supportive psychotherapy and vocational training.

Question 16

What is the general prognosis of schizophrenia?

How does the disease evolve over time?

Answer 16

Not great; Schizophrenia is progressive and lifelong, with more than half experiencing moderate to significant impairment. Many affected end up homeless or exploited.

Positive symptoms improve, while negative symptoms worsen.

Question 17

What role can family play in the outcome of schizophrenia?

Answer 17

Either supportive or detrimental; families with high expressed emotion (eg Criticism, hostility, over-involvement) show worse outcomes for the affected.

Question 18

For the following cases, name the specific psychotic disorder.

1. A 24yo man with a 2-week history of psychotic symptoms.
2. A 30yo woman with the behavioral characteristics of one with schizophrenia, but few of the delusions/hallucinations.
3. A 32yo man who is convinced that Kiera Knightley is in love with him, and actively stalks her.

Answer 18

1. Brief psychotic disorder (this may change as symptoms persist, to schizophreniform disorder or full-blown schizophrenia)
2. Schizotypal disorder (a personality disorder!)
3. Delusional disorder (this is an example of someone with erotomania; the belief that a stranger, usually of high status, is in love with him or her)

Question 19

Name some medical conditions or drugs that can lead to psychosis.

Answer 19

Thyrotoxicosis was given in class as an example. Others: Vitamin deficiencies, cancers, infections, neurodegenerative and autoimmune disorders…

Mostly street drugs: Cocaine, amphetamines, hallucinogens, alcohol.

Question 20

(These are the ARS questions from lecture)

1. What is the historical name that preceded “Schizophrenia”?
2. How did DSM-V change the classificaiton of schizophrenia?
3. Name the three positive symptoms of schizophrenia.

Answer 20

1. Dementia praecox
2. Changed the defining symptomology, eliminated subtyping.
3. Delusions, hallucinations, and disorganized speech.