Schizophrenia Spectrum/Other Psychotic Disorders

Question 1

Brief Psychotic Disorder criteria

Answer 1

1. 1+ symptoms, with 1 being first three (delusions, hallucinations, disorganized speech, disorganized or catatonic behavior)
2. Symptoms 1+ days, < 1 month

Question 2

Schizophreniform Disorder criteria

Answer 2

1. 2+ symptoms, with 1 being first three (delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, negative symptoms)
2. Symptoms 1+ months, < 6 months

Question 3

Delusion definition

Answer 3

False belief about reality despite others not sharing the belief and contradictory evidence

Question 4

Hallucination definition

Answer 4

Perception that feels real but does not activate typical sensory organs

Not an illusion, which occurs when an actual stimulus is misperceived

Question 5

Negative symptoms

Answer 5

1. Avolition
2. Alogia
3. Anhedonia

Question 6

Positive symptoms

Answer 6

1. Delusions
2. Hallucinations
3. Disorganized speech
4. Disorganized behavior

Question 7

Schizophrenia criteria

Answer 7

1. Active phase for 1+ months
2. 2+ symptoms, with 1 being first three (delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, negative symptoms)
3. Continuous signs for 6+ months (may include active, prodromal, or residual phases)

Question 8

Prodromal and residual phases of schizophrenia

Answer 8

2+ symptoms in reduced form or only negative symptoms

Prodromal - typically before active phase

Residual - typically after active phase

Question 9

Schizophrenia concordance rates

Answer 9

1. Parent (6%)
2. Biological sibling (9%)
3. Child of one parent w/ schizophrenia (13%)
4. Dizygotic twin (17%)
5. Child of two parents w/ schizophrenia (46%)
6. Monozygotic twin (48%)

Question 10

Schizophrenia twin studies

Answer 10

1. Discordant monozygotic twins =
   risk similar between both twins’ offspring, risk similar to twins’ risk for both offspring
2. Discordant dizygotic twins = risk greater for affected twin’s offspring, risk similar to twins’ risk for affected twin’s offspring only

Question 11

Neurotransmitters linked to schizophrenia

Answer 11

1. Dopamine
2. Glutamate
3. Serotonin

Question 12

Original dopamine hypothesis for schizophrenia

Answer 12

Disorder is due to high levels of dopamine or hyperactive dopamine receptors

Question 13

Updated dopamine hypothesis for schizophrenia

Answer 13

1. Positive symptoms due to more dopamine in subcortical areas (striatal areas)
2. Negative symptoms due to less dopamine in cortical areas (prefrontal cortex)

Question 14

Schizophrenia brain abnormalities

Answer 14

1. Enlarged ventricles
2. Negative/cognitive symptoms = hypofrontality
3. Negative symptoms = dysfunctional temporal-limbic-frontal network
4. Positive symptoms = disinhibited striatum (caudate nucleus, putamen, accumbens)

Question 15

Schizophrenia common comorbidities

Answer 15

1. Anxiety disorders
2. OCD
3. Tobacco use disorder (> 50%)

Question 16

Schizophrenia course (ages)

Answer 16

1. First symptoms = late teens to early 30s
2. Peak onset = early to mid 20s (males), late 20s (females)

Positive symptoms often decrease with age

Question 17

When is schizophrenia prognosis better?

Answer 17

1. Females
2. Late/acute onset
3. Comorbid mood symptoms (depression)
4. Mostly positive symptoms
5. Triggering factors/events
6. Family history of mood disorder
7. Good adjustment before symptoms
8. Living in a non-Western country
9. Immigrant paradox

Question 18

When is schizophrenia prognosis worse?

Answer 18

1. Anosognosia
2. Family w/ high expressed emotion

Question 19

Schizophrenia treatment components

Answer 19

1. Psychosocial interventions
2. Medications for psychosis
3. Medications for comorbid disorders

Question 20

Psychosocial interventions for schizophrenia

Answer 20

1. CBTp
2. Cognitive remediation for schizophrenia
3. ACT
4. Assertive community treatment
5. Family psychoeducation
6. Illness self-management training
7. Social skills training
8. Supported employment services

Question 21

Medications for psychosis

Answer 21

1. Second-generation antipsychotics (SGAs) = clozapine* for treatment-resistant schizophrenia
2. First-generation antipsychotics (FGAs)

Question 22

Factors to consider when choosing FGAs or SGAs

Answer 22

1. Benefits and side effects
2. Interactions with existing medications
3. Patient preference
4. Past response to antipsychotics
5. Existing health conditions

Question 23

Treatment-resistant schizophrenia definition

Answer 23

Schizophrenia symptoms have shown suboptimal or no response to two antipsychotics for > 6 weeks

Question 24

NAVIGATE

Answer 24

Team-based early intervention for schizophrenia (high risk and/or early symptoms) that targets first episode of psychosis

Question 25

NAVIGATE components

Answer 25

1. Family education
2. Individual resiliency training (based on CBTp)
3. Supported employment and education
4. Medications

Question 26

Schizoaffective Disorder criteria

Answer 26

1. Symptoms of schizophrenia
2. Concurrent mood episode for most of psychosis
3. Delusions or hallucinations for 2+ weeks without mood symptoms

Question 27

Delusional Disorder criteria

Answer 27

1. 1+ delusions
2. Symptoms 1+ months
3. Little impairment outside of direct effects of delusions

Question 28

Delusional Disorder subtypes

Answer 28

1. Erotomanic (someone in love with them)
2. Grandiose (great talent/insight)
3. Jealous (unfaithful partner)
4. Persecutory (conspiracy, spying)
5. Somatic (bodily functions, sensations)