Schizophrenia Spectrum Disorders I

Question 1

describe the 5 psychotic symptom domains

Answer 1

1, 2 and 3 are “core” domain symptoms

1. delusions
2. hallucinations
3. disorganized speech
4. disorganized behavior
5. negative symptoms

Question 2

contrast negative vs positive symptoms (from the 5 domains)

Answer 2

• positive = symptom domains 1-4
  
  • thoughts, behaviors or perceptions that are distorted or in excess of normal function
  • overactivity of mesolimbic DA
• negative = symptom domain 5
  
  • thoughts, behaviors or perceptions that normally exist that are now absent or markedly diminished
  • underactivity of mesocortical DA

Question 3

describe the domain of delusion

Answer 3

• a fixed belief that is not amenable to change even in light of conflicting evidence
• examples of delusional themes:
  
  • delusion of grandeur (grandiose)
  • delusion of persecution (paranoid)
  • delusion of control (external force controlling behavior)
  • delusion of reference (belief that an outside action refers directly to the person)
  • thought broadcasting delusion: thoughts being transmitted to others

Question 4

describe the domain of hallucinations

Answer 4

• a sensory perception without an external stimulus
• typical features:
  
  • auditory
  • single voice, voices conversing, running commentaries
  • “command” hallucinations
  • derogatory

Question 5

describe the domain of disorganized thinking (speech)

(aka formal though disorder)

Answer 5

• tangentiality: shifting to a slightly-related topic
• flight of ideas: rapid shifting of thoughts with discernible links between ideas (extreme tangentiality)
• derailment (“loose associations”): no apparent connections between ideas
• clang association: word association based on rhyming
• word salad: no meaningful relationship between words

Question 6

describe a differential diagnosis for disorganized speech

Answer 6

• differential diagnosis: disorganized speech in post-stroke aphasias
• presence of phonemic paraphasic errors
  
  • speech errors characterized by additions/deletions of syllables
    
    • more likely seen in stroke-patient
  • pronunciation is good in psychotic patients–the problem is with the logical connection between words

Question 7

describe the domain of grossly disorganized or catatonic behavior

Answer 7

• disorganized: non-goal oriented behavior
  
  • unable to take care of activities of daily living, inappropriate mood/affect
• catatonia: multiple motor/behavioral abnormalities that reflect diminished reactivity to the environment such as:
  
  • posturing, waxy flexibility, stereotypies
  • non-responsiveness, mutism

Question 8

describe the domain of negative symptoms

Answer 8

• dimished emotional expression (verbal and nonverbal)
• avolition (decrease in self-initiated, purposeful activities)
• alogia (dimished speech output)
• anhedonia
• asociality (disinterest in social life)

Question 9

describe the diagnostic criteria for schizophrenia

Answer 9

• an active-phase for ≥ 1 month, defined as:
  
  • at least 2 psychotic domain symptoms with at least 1 being a core symptom (1-3 bolded)
    
    1. delusions
    2. hallucinations
    3. disorganized speech
    4. grossly disorganized behavior
    5. negative symptoms
• at least 1 symptom persists for ≥ 6 months

Question 10

describe the timeline of schizophrenia

Answer 10

• duration: signs of the disturbance for ≥ 6 months (including any prodromal and/or residual phases)
• prodromal and residual phases often manifest as only negative symptoms and/or psychotic symptoms in subthreshold forms

Question 11

explain the diagnoses of these patients:

Answer 11

Question 12

what are associated features of schizophrenics?

Answer 12

• low socioeconomic attainment
  
  • due to disability causing a drift down the socioeconomic scale (downward drift)
• nicotine addiction
• suicide risk and aggressive tendencies
  
  • if patient experiences “command hallucinations”
  • if patient feels threatened due to paranoid delusions

Question 13

describe the onset of schizophrenia

Answer 13

• onset:
  
  • typical onset: late teens with slightly later onset in women
  • late-onset (> 40 yrs): more likely female with positive symptoms and less severe course
  • childhood onset (< 13 yrs): severe form of disorder with notable neurodegeneration

Question 14

describe predictors of outcome in schizophrenia

Answer 14

Question 15

describe the dopamine hypothesis in schizophrenia neuropathology

Answer 15

• overactivity of mesolimbic DA relates to positive symptoms
• underactivity of mesocortical DA relates to negative symptoms

Question 16

describe neurostructural changes seen in schizophrenia

Answer 16

• enlarged lateral ventricles (ventriculomegaly)
• cortical and hippocampal atrophy
• decreased volume of thalamus

Question 17

describe neurofunctional changes in schizophrenia

Answer 17

• hypofrontality: decreased prefrontal metabolism

Question 18

describe neurocognitive effects seen in schizophrenia

Answer 18

• impairment in multiple areas including attention, memory, executive functions, etc.

Question 19

describe what is seen in this image

Answer 19

the schizophrenic patient on the right has hypofrontality = decreased prefrontal metabolism

Question 20

describe the neurodevelopmental theory in schizophrenia

Answer 20

• a lesion occurs during early brain development
  
  • no immediate effects of lesion
  • effects of lesion are seen as the affected structure come “on-line” with brain maturation
  • effects of lesion can also be influenced by impact of enviornmental factors (stress, drug use) throughout maturation

Question 21

describe evidence for a neurodevelopmental lesion

Answer 21

• hippocampal cellular disorganization
• increased neurological soft-signs
• increased minor physical anomalies