Schizophrenia/Psychosis

Question 1

What are positive symptoms in schizophrenia?

Answer 1

Things that are present but shouldn’t be there.
- Halluzinations -> Perceiving things that aren’t there
- Delusions -> Convictions and certain thoughts that do not aline with the believes that most people in the world would see as valid

Question 2

What are negative Symptoms in schizophrenia ?

Answer 2

Things that should be present but are not.
- difficulties expressing emotions and planning
- disinterest in activities of daily life
- lack of motivation
- isolating

Question 3

What are cognitive symptoms in Schizophrenia?

Answer 3

Difficulty with attention and applying information to make decisions.
- eg.: executive functioning, memory

Question 4

What are the consequences if all of these symptoms occur?

Answer 4

Loss of reality and disconnection with the surroundings.

Question 5

How is the definition for hallucinations?

Answer 5

= a sensory perception without an external source while being awake

Question 6

How can you explain bottom-up processing?

Answer 6

Perceiving sensory information (eg.: seeing, hearing,…) and trying to integrate it. (data driven)
-> eg.: “What am I seeing?”

Question 7

How can you explain top-down processing?

Answer 7

Using previous knowledge, theories, models (background knowledge) to interpret/categorize sensory information.
- eg.: “Is that something that I have seen before?”
- makes processing faster (the more knowledge the faster it is) -> eg.: seeing head of a horse, you immediately know that it is a horse, so you don’t have to see the whole horse to know that

Question 8

What happens if you have no sensory information for some time (no bottom-up processing)

Answer 8

• sensory deprivation
• Studies showed that individuals who don’t perceive anything (no seeing, no hearing,…) start hallucinating (eg.: Black box study)

Question 9

What showed the Black box study?

Answer 9

individuals who don’t perceive anything (no seeing, no hearing,…) start hallucinating
- eg.: hearing sounds of traffic (because they expect to hear that)

Question 10

How can the expectation of something happening influence hallucinations?

Answer 10

eg.: if somebody is expecting a phone call, they can actually feel the phone vibrating or hear it ringing from time to time

Question 11

Do individuals with a hearing impairment experience hallucinations?

Answer 11

Yes, the worse the hearing impairment the more hallucinations. -> BUT not when they are born blind.
=> the more deprived sensory organs are, the higher the chance/percentage of hallucinations

Question 12

What types of hallucinations exist?

Answer 12

• Visual hallucinations
• Auditory
• gustatory
• tactile
• olfactory
• proprioceptive -> hallucinating about the position of a body part
• thermoceptive
• nociceptive -> pain
• equilibrioceptive -> balance

Question 13

What are the most typical hallucinations in psychosis?

Answer 13

Auditory verbal hallucinations (AVH) -> hearing voices

Question 14

Describe auditory verbal hallucinations (AVH)?

Answer 14

• hearing speech while there is no source
• speech is not recognized as self-derived
• it’s a perceptual phenomenon, not thoughts or ideas
• the voices can be heard inside or outside of the head

Question 15

Can hallucinations also occur in other psychiatric disorders or healthy individuals?

Answer 15

Yes. eg.: bipolar disorder, lewy-body dementia, anxiety,…

Question 16

What showed the study of Sommer et al. (2012) about hallucinations in other disorders?

Answer 16

It showed that hallucinations are also common in other psychiatric disorders (but still often taboo topic) and showed the important to differ between hallucinations due to neurological or psychiatric diagnosis:
- Neurological disorders: visual hallucinations are more common
- Psychiatric disorders: auditory hallucinations are more common
- Age of onset: is early in psychiatric disorders
- individuals with neurological disorders often experience also other types of symptoms -> eg.: hearing loss

Question 17

What is the psychosis continuum?

Answer 17

Psychotic experiences: 8% of population
- Eg.: hearing the door bell ring while waiting for a zalando package
- Psychotic symptoms: 4% of population
- Psychotic disorder: 3% of population

Question 18

In which age group are auditory hallucinations most prevalent?

Answer 18

In children and adolescents (12%).

Question 19

How do hallucinations differ in schizophrenia patients and healthy individuals with frequently non-clinical hallucinations (Sommer et al.,2010; Daalmann et al., 2012)?

Answer 19

Schizophrenia patients:
- hallucinations are unpleasant (even threatening)
- Age of onset: on average adolescents
non-clinical hallicinating individuals:
- less frequently and shorter duration than S
- hallucinations are mostly pleasant or neutral
- more controllability than S
- no distress or interruption in their daily life due to the hallucinations
- Age of onset: often young
=> but location, loudness, and number of voices are often similar

Question 20

What are risk factors to develop a psychosis?

Answer 20

• Genetics
  
  • Social and environmental factors:
    ○ Immigration
    ○ Urbanicity
    ○ Drug abuse (cannabis)
    ○ Pre- and perinatal infections
    ○ Stress
• Childhood trauma

Question 21

How much increases the experience of childhood trauma the risk to develop psychosis?

Answer 21

about approx. 3 times

Question 22

Does childhood trauma only lead to pathological AVH?

Answer 22

No, the early experience of trauma can also lead to non-pathological AVH in individuals.
=> childhood trauma triggers a general vilnerability for AVH

Question 23

What did the study of Begemann et al. (2022) show about the association of childhood trauma clusters and AVH?

Answer 23

Low trauma cluster:
□ they score low at every type of trauma
□ Mostly even distribution of patients, controls, and non-clinical AVH
Emotion-focused cluster:
□ They showed Intermediate score on physical and sexual abuse, but high scores on emotional neglect and emotional abuse
□ Half of the participants were non-clinical AVH, 35% patients, and 15% healthy controls
□ Voices:
- Greater control over voices (vs. Multi-trauma cluster)
- voices start at an Earlier age (vs. Low trauma cluster)
- Voices are perceived as more benevolent (=wohlwollend)
Multi trauma cluster:
□ They scored high on every or multiple type of trauma
□ 75% of paticipants were patients, 23% non-clinical AVH, barely healthy controls
□ Voices:
- More negative content
- Less control (vs. Emotion-focused cluster)
- Voices are perceived as more malevolent & omnipotent (vs. Low trauma cluster)
- Increased resistance towards voices

Question 24

What new treatment perspectives are induced due to the childhood trauma findings?

Answer 24

trauma treatment for schizophrenic individuals who experienced childhood abuse