Schizophrenia Spectrum and Other Psychotic Disorders

Question 1

T or F. You cannot be diagnosed with schizophrenia until months have passed, even though you show all the signs of the disorder.

Answer 1

T, six months

Question 2

T or F. Due to wide differences in cultures, rates of schizophrenia vary among the developed and developing nations throughout the world

Answer 2

F, despite these differences rates are similar

Question 3

Even if you have two parents with schizophrenia, your chances of developing the disorder are …

Answer 3

less than 1 in 2!

Question 4

This disorder touches every facet of an affected person’s life

Answer 4

Schizophrenia

Question 5

Acute episodes of schizophrenia are characterized by:

Answer 5

delusions, hallucinations, illogical thinking, incoherent speech and bizarre behaviour

**between episodes, people may still be unable to think clearly and may lack appropriate emotional responses to people and events in their lives

Question 6

Emil Kraeplin

Answer 6

• Dementia Praecox
• “the loss of inner unity of thought, feeling, and acting”
• hallucinations, motoric abnormalities, delusions

Question 7

Who introduced the term Schizophrenia?

Answer 7

Eugen Bleuler ; “split brain”; recognized variability in the course of the disorder

Question 8

4 A’s according to Bleuler

Answer 8

• Association: loosening of associations
• Affect: being flat or inappropriate emotional responses
• Ambivalence: ambivalent or conflicting feelings toward others, such as loving and hating them at the same time
• Autism: tendency to retreat into oneself and to avoid social contact to a degree that is unusual for that individual prior to the development of the condition

Question 9

Kurt Schneider

Answer 9

• 4 As overlapped too much with other disorders!

- First- and second-rank symptoms

Question 10

Schneider’s first- and second-rank symptoms

Answer 10

First:

• central to diagnosis of Sz, initially thought to be unique to Sz
• ABCD (auditory hallucinations, broadcasting of thought, controlling of thought, delusions)

Second:
- frequently associated with Sz, but not exclusively
> mood problems
> non-auditory hallucinations (visual, olfactory, haptic, gustatory)

Question 11

Controlling of thought (ABCD) subtypes

Answer 11

• Echo: inner thoughts can be heard aloud
• Insertion: somebody planted thoughts into their brain
• Withdrawal: their own thoughts are somehow being removed

Question 12

Schneider’s second-rank symptoms are …

Answer 12

not 100% necessary for diagnosis but frequently associated with schizophrenia

Question 13

Likelihood of people with schizophrenia to complete suicide

Answer 13

20x as likely as members of general population

Question 14

Phases of Schizophrenia:

Answer 14

• Prodromal: gradual decline; before first psychotic episode
• Acute: symptoms develop
• Residual: revert back to the prodromal stage; continued disturbance (negative symptoms)

Question 15

Early signs of a mental disorder

Answer 15

lack of self-care

Question 16

Neologisms

Answer 16

new words; not aware of the fact that these words don’t mean anything to other people nor do they care! May combine two or more words as well ; ex shuthead instead of shithead

Question 17

Perseveration

Answer 17

continued use or persistence on same topic; coming to it over and over again

Question 18

Clanging and blocking

Answer 18

clanging - like rap; rhyming!!

blocking - abruptly changing from one thing to the next

Question 19

Word salad

Answer 19

words not unique but sentence structure makes no sense

Question 20

Theories of what causes hallucinations

Answer 20

• sub-vocal speech: centers in our brain; some indivs may be experiencing it as alien (something else telling them); Listening on their own formative thought ; talking to themselves but don’t realize it’s their own thoughts …
• dopamine hypothesis: dopaminergic receptors are too sensitive!!) hypothesis kind of opposite of sub-vocal ; somewhere along pathway, enough dopamine that results in meaningless stimulation of various sites which as a result – can be experienced as speech or sound perceived by brain in the absence of any verifiable input from outside world

Question 21

Previous Subtypes of Schizophrenia (NOT in DSM-5)

Answer 21

• Disorganized (speech or behaviour)
• Catatonic: waxy flexibility or rigid
• Paranoid
• Undifferentiated: exhibits behaviours which fit into two or more of the other types of schizophrenia, including symptoms such as delusions, hallucinations, disorganized speech or behaviour, catatonic behaviour

Question 22

Crow, 1980

Answer 22

Type I (positive symptoms) and Type II (negative)
-> premorbid functioning: poorer in type II

Question 23

Biological Approaches of Treatment

Answer 23

• Antipsychotic drugs: Phenothiazines; Haloperidol (TD)

- Atypical antipsychotics: agranulocytosis

Question 24

Agranulocytosis

Answer 24

acute condition involving a severe and dangerous leukopenia (lowered white blood cell count)

Question 25

Tardive dyskinesia

Answer 25

side effect of antipsychotic drugs like Phenothiazines as they tend to be really good at ameliorating positive symptoms but not negative ones!
–> phantom tongue movement, jittering, rocking back and forth, etc.

Question 26

Blocking

Answer 26

(1) Disruption of self-expression of threatening or emotionally laden material. (2) In people with schizophrenia, a condition of suddenly becoming silent with loss of memory for what they have just discussed.

Question 27

Hallucinations in people without psychiatric conditions are often triggered by…

Answer 27

unusually low levels of sensory stimulation (lying in the dark in a soundproof room for an extended time) or low levels of arousal
**Unlike psychotic individuals, these people realize their hallucinations are not real and feel in control of them

Question 28

Blunted affect

Answer 28

significant reduction in emotional expression

Question 29

Flat affect

Answer 29

absence of emotional expression

Question 30

T or F. Negative symptoms tend to persist even when positive symptoms have abated and often have a greater effect on the person’s functioning than positive symptoms.

Answer 30

T! They are also less responsive than positive symptoms to treatment with antipsychotic drugs

Question 31

Dopamine theory

Answer 31

People with schizophrenia do not appear to produce more dopamine. Instead, they appear to use more of it. But why? Research suggests that people with schizophrenia may have a greater than normal number of dopamine receptors in their brains or have receptors that are overly sensitive to dopamine
*associated with positive symptoms; decreased reactivity associated with negative symptoms

Question 32

What do neuroleptic drugs do?

Answer 32

AKA major tranquilizers (phenothiazines)
Neuroleptic drugs block dopamine receptors, thereby reducing the level of dopamine activity. As a consequence, neuroleptics inhibit excessive transmission of neural impulses that may give rise to schizophrenic behaviour.

Question 33

Brain abnormalities in people with Sz

Answer 33

enlargements of brain ventricles (the hollow spaces in the brain). Ventricular enlargement is a sign of structural damage involving loss of brain cells. It is found in about three out of four schizophrenia patients. Still, not all people with schizophrenia show evidence of enlarged ventricles or other signs of brain damage; sometimes have something to do with frontal/temporal lobe

Question 34

Diathesis-stress model

Answer 34

Meehl suggested that certain people possess a genetic predisposition to schizophrenia that is expressed behaviourally only if they are reared in stressful environments
Environmental stressors may include psychological factors such as family conflict, child abuse, emotional deprivation, or loss of supportive figures, as well as physical environmental influences, such as early brain trauma or injury. On the other hand, if environmental stress remains below the person’s stress threshold, schizophrenia may never develop—even in individuals at genetic risk

Question 35

schizophrenogenic mother

Answer 35

described as cold, aloof, overprotective, and domineering. She was characterized as stripping her children of self-esteem, stifling their independence, and forcing them into dependency on her. Children reared by such mothers were believed to be at special risk for developing schizophrenia if their fathers were passive and failed to counteract the pathogenic influences of the mother. Despite extensive research, however, mothers of people who develop schizophrenia do not fit the stereotypical picture of the schizophrenogenic mother

Question 36

Double-bind communications contributed to the development of schizophrenia

Answer 36

double-bind communication transmits two mutually incompatible messages. In a double-bind communication with a child, a mother might freeze up when the child approaches her and then scold the child for keeping a distance. Whatever the child does, she or he is wrong. With repeated exposure to such double binds, the child’s thinking may become disorganized and chaotic. The double-binding mother prevents discussion of her inconsistencies because she cannot admit to herself that she is unable to tolerate closeness.

Question 37

Communication deviance

Answer 37

describes a pattern characterized by unclear, vague, disruptive, or fragmented parental communication and by parental inability to focus in on what the child is saying

Question 38

Expressed emotion

Answer 38

involves the tendency of family members to be hostile, critical, and unsupportive of their family member with schizophrenia. People with schizophrenia whose families are high in EE tend to show poorer adjustment and have higher rates of relapse following release from the hospital than those with more supportive families

Question 39

Learning-based treatment

Answer 39

Therapy methods include techniques such as:

(1) selective reinforcement of behaviour (e.g., providing attention for appropriate behaviour while extinguishing bizarre verbalizations through the withdrawal of attention);
(2) the token economy, in which individuals on inpatient units are rewarded for appropriate behaviour with tokens, such as plastic chips, that can be exchanged for tangible reinforcers such as desirable goods or privileges; and
(3) social skills training, in which clients are taught conversational skills and other appropriate social behaviours through coaching, modelling, behaviour rehearsal, and feedback.