Schizophrenia Spectrum Disorders

Question 1

Origin of schizophrenia

Answer 1

*E. Kraepelin
-Dementia Praecox (Schizophrenia)
>catatonia
>Hebephrenia -silly, immature
>paranoia
-Manic Depressive Psychosis (Bipolar)

• Eugen Bleuler
• coined the term “schizo” which means split of mind

Question 2

Schizophrenia

Answer 2

• delusions, hallucinations, catatonia

- 2 or more positive, negative, disorganized symptoms present for at least 1 months and persists more than 6 months

Question 3

Positive symptoms

Answer 3

> Bizarre behavior

> Hallucinations

• in Broca’s area of the brain
• poor Emotional Prosody Comprehension (emotion and meaning of words)
• hypnogogic (awake) and hypnopompic (asleep)

> Ambivalence
Abnormal thought form

> Delusion

• thought insertion
• thought broadcasting
• grandiose delusions
• ideas of reference
• nihilistic delusions
• somatic delusions
• delusions of control
• persecutory delusions
• Motivational view- beliefs to deal with anxiety and stress
• Deficit view -beliefs from brain dysfunction that create disordered cognitions

> Develops over a short time

Question 4

Negative Symptoms

Answer 4

> Avolition -lack of motivation
Asocialty -severe impairments in social relationships
Anhedonia -loss of interest or pleasure
Affective Flattening -lack of outward expression of emotion
Alogia -significant reduction in the amount of speech

Question 5

Disorganized Symptoms

Answer 5

> Disorganized speech

• word salad/incoherence
• loose associations/derailment -do not stay on one topic
• tangentiality -Replies to questions are off-point or totally irrelevant.
• circumstantiality -delay in getting to the point because of the interpolation of unnecessary details and irrelevant remarks

> Disorganized Behavior

• inapproriate affect
• unusual clothes
• collect garbage
• hoard food

Question 6

Movement Symptoms

Answer 6

> Catatonia

• Cataplexy -uncontrollable muscle weakness (kalit ug katawa)
• Negativism -opposition or no response to instructions
• Stupor -not actively relating to environment
• Waxy Flexibility -completely unresponsive to stimuli and remains immobile for long periods of time
• Mutism -very little or no verbal response
• Posturing -spontaneous and active maintenance of posture against gravity
• Mannerism -odd, circumstantial distortions of normal actions
• Stereotypy -repetitive, abnormal non-goal-directed movement
• Agitation -anxiety/nervous excitement
• Grimacing -ugly, twisted face expressions
• Echolalia -mimick another speech
• Echopraxia -mimick another movement

> Anosognosia -a person with some disability seems unaware of its existence

Question 7

Course of Schizophrenia

Answer 7

>Prodromal phase 
-symptoms not obvious but deterioration begins
-withdraw socially, express little emotion, negative symptoms start to manifest
>Active phase
-symptoms are apparent
-triggered by life stress, trauma
>Residual phase
-negative symptoms

Question 8

Schizophreniform Disorder

Answer 8

• onset psychotic symptoms within 4 weeks of the first noticeable change in unusual behavior
• same symptoms with schizophrenia but lasts only 1 to 6 months

Question 9

Schizoaffective Disorder

Answer 9

• mixed mood disorders and schizophrenia symptoms
• major depressive/mood episode on active, residual phase
• negative symptoms are less persistent
• less severe anosognosia

Question 10

Delusional disorder

Answer 10

• persistent belief that is contrary to reality in the absence of other characteristics of schizophrenia
• at least 1 month or more
• not a result of an organic factor
• imagined events could be happening but aren’t (not in schizophrenia)
• Shared Psychotic Disorder (folie a deux)
• an individual develops delusions simply as a result of a close relationship with a delusional disorder
• a separate disorder in previous DSM but now a type of delusion in DSM V
• aware that others view their beliefs as irrational but cant accept it themselves
• if delusion occur during mood episodes, is called depressive/bipolar with psychotic features

Question 11

Brief Psychotic Disorder

Answer 11

• Psychosis -loss of contact with reality
• presence of one or more positive symptoms lasting 1 day to 1 month
• precipitated by extreme stress
• duration of episode at leasy 1 day with eventual full return to premorbid level of functioning

Question 12

Attenuated psychosis syndrome

Answer 12

• less severe presentation of delusions, hallucinations or disorganized speech in past month occuring at least once a week
• aware of troubling and bizarre nature of symptoms

Question 13

Causes of Schizophrenia

Answer 13

• Biological
• high genetic contribution
• diathesis-stress model
• twin studies
• dopamine is too active
• increased norepinephrine levels
• decreased GABA, glutamate
• enlarged ventricles
• reduced activity in prefrontal cortex

*Psychodynamic
-result of the disintegration of ego
-abnormal upbringing by a schizophrenogenic (cold, dominant, rejective) mother result in a weak and fragile ego
-delusional projection of reality
-psychotic denial of reality
-psychotic reaction formation of reality
-psychotic distortion of reality
-double bind communication (communication style that produced conflicting messages)
-Expressed Emotion (George brown)
family or environment can contribute to the relapse of patient

• Cognitive view
• rational path to madness (reject feedback from others and develop beliefs that they are being persecuted)
• misinterpretation of sensory problems

Question 14

Treatment for Schizophrenia

Answer 14

> Medications
-antipsychotic drugs (old term) or the neuroleptics
Psychosocial
-social skills training
-family therapies (educate families)
-CBT(test out delusional beliefs)
-Mileu Therapy (create social climate the promotes activity, self-respect, individual responsibility)
-Token Economy (incentive system; operant conditioning)