Schizophrenia Spectrum/Psychosis Flashcards
What is Capgras Syndrome?
The belief that people in one’s life have been replaced by exact doubles (35% of such cases are organic in aetiology).
- has been seen in CNS lessons, vit B12 deficiency, hepatic encephalopathy, diabetes, and hypothyroidism. K&S, p 512
What is Cotard’s Syndrome?
The belief that one is dead, or it is after the end of the world.
“In the 19th century, the french psychiatrist Jules Cotard described nihilistic delusional disorder or Cotard syndrome. Pts with this complain of having lost not only possessions, status, and strength, but also their heart, blood, and intestines. The world beyone them is reduced to nothingness”. K&S, p 510
What is a neologism?
Nonsensical words condensed or combined from two or three different words.
What is echopraxia?
Repetition or imitation of observed gestures or physical expressions.
Auditory hallucinations are reported in what % of patients with schizophrenia?
50-70% (Andreasen and Flaunt, 1991; Hoffman et al., 2001)
What is alogia?
Deficient fluency or productivity of speech or thought.
True or false: schizoaffective disorder is more common in married females with late onset.
True.
- Prevalence lower in men than in women, particularly married women
- age of onset for women is later than for men, as in schizophrenia
- men with schizoaffective disorder are likely to exhibit antisocial behaviour and to have a markedly flat or inappropriate affect.
- depressive type more common in older pts and bipolar type more common in younger pts
K&S p. 501-504
Name Eugene Bleuler (1857-1939) fundamental and accessory symptoms in schizophrenia.
Fundamental
- Association
- Affect
- Autism
- Ambivalence
Accessory
- Hallucinations
- Delusions
- Disorganization
- Somatization
uOttawa and K&S p.467
What are the first-rank symptoms of schizophrenia described by Kurt Schneider (1887-1967)?
- audible thoughts
- voices arguing or discussing or both
- voices commenting
- somatic passivity experiences
- thought withdrawal and other experiences of influenced thought
- thought broadcasting
- delusional perceptions
- all other experiences involving volition made affects, and made impulses
K&S p. 468
What is the peak age of onset in men and women for schizophrenia?
Men = 10-25 years Women = 25-35 years with a second peak occurring in middle age.
K&S p. 468
True or false: the marriage and fertility rates among persons with schizophrenia is increasing.
True.
- increase in marriage and fertility = continually increasing number of children born to parents with schizophrenia.
- the fertility rate for persons with schizophrenia is close to that of the general population (fertility rate increased from before use of antipsychotics, deinstitutionalization, community care etc.)
K&S p. 469
People with schizophrenia are more likely to have been born in what season?
- winter and early spring
Note: in the northern hemisphere often born in january to april. In the southern hemisphere often born july to september.
K&S p. 469
Up to ___ % of schizophrenic patients may be dependent on nicotine. Why is this important?
90% (brain abnormalities in nicotinic receptors in schizophrenia)
- smoking-associated mortality
- nicotine decreases blood concentrations of some antipsychotics
- nicotine may improve some cognitive impairments and parkinsonism
- may decrease positive symptoms by its effet on nicotine receptors that reduce the perception of outside stimuli, especially noise.
K&S p. 469
What is the connection between population density and schizophrenia prevalence?
Prevalence correlated with local population density in cities with more than 1 million people. Weaker correlation with smaller cities.
Also the incidence of schizophrenia in children of either one or two parents with schizophrenia is twice as high in cities as in rural communities.
K&S p. 470
Prevalence of Schizophrenia in Specific Populations:
Population Prevalence %
- General population ?
- Non-twin sibling of schizophrenia patient ?
- Child with 1 parent with schizophrenia ?
- Dizygotic twin of schizophrenia patient ?
- Child of 2 parents with schizophrenia ?
- Monozygotic twin of schizophrenia patient ?
Prevalence 1 % 8 % 12 % 12 % 40 % 47 %
K&S p. 470
PET studies of dopamine receptors document an increase in D2 receptors in the ____________ of drug-free patients with schizophrenia. There have also been reports of increased dopamine concentrations in the amygdala.
caudate nucleus
K&S p. 471
One theory, based in part on the observation that patients often develop schizophrenic symptoms during adolescence, hold that schizophrenia results from _____________ of synapses during this phase of development.
excessive pruning
K&S p. 471
CT scans of patients with schizophrenia have consistently shown lateral and ____ ventricle enlargement and some reduction in ______ volume.
third ventricle
cortical volume
K&S p. 471
True or false: “The hippocampus is not only larger in size in schizophrenia, but is also functionally abnormal as indicated by disturbances in glutamate transmission”.
False
- it is smaller in size
K&S p. 472
Some studies of the thalamus show evidence of volume shrinkage or neuronal loss, in particular sub nuclei. The total # of neurons, oligodendrocytes, and astrocytes in the medial dorsal nucleus of the thalamus is reduced by ______ % in schizophrenic patients.
30-45%
- the volume of the thalamus is similar in size between schizophrenics treated chronically with medication and neuroleptic-naive subjects.
K&S p. 472
True or False: No well-controlled evidence indicates that a specific family pattern plays a causative role in the development of schizophrenia.
True.
- Many studies have indicated that in families with high levels of expressed emotion, the relapse rate for schizophrenia is high.
K&S p. 475
What is criteria A for Schizophrenia in DSM-5?
A. TWO (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated. At least one of these must be 1, 2, or 3.
- Delusions
- Hallucinations
- Disorganized speech (e.g., frequent derailment or incoherence)
- Grossly disorganized or catatonic behaviour
- Negative symptoms (i.e., diminished emotional expression or avolition).
(note the absence of needing only 1 criteria if delusions are bizarre, or hallucinations consist of a voice keeping up a running commentary or 2 or more voices conversing which was present in DSM-IV-TR)
What is hebephrenic schizophrenia?
- disorganized schizophrenia.
This wording is used in the ICD-10 as a subtype of schizophrenia.
K&S p. 476
Name the subtypes of schizophrenia in DSM-IV TR.
- Paranoid type
- Disorganized type
- Catatonic type
- Undifferentiated type
- Residual type
Note the subtypes were elimated in DSM-5 due to limited validity, reliability, diagnositic stability.
What does the term oneiriod schizophrenic refer to?
Refers to a dream-like state in which patients may be deeply perplexed and not fully oriented to time and place. Patients are engaged in their hallucinatory experiences to the exclusion of the real world.
- look for medical/neurological causes.
K&S p. 479
Schizophreniform Disorder: an episode of the disorder lasts at least ___ month but less than ___ months.
at least 1 month but less than 6 months
DSM-5
Several studies have shown that patients with schizophreniform disorder have more affective symptoms (especially _______) and a better outcome than patients with schizophrenia.
mania
Note: Because of the generally good outcome, the disorder probably has similarities to the episodic nature of mood disorders. Some data, however, indicate a close relation to schizophrenia
Note: DSM-5 highlights its relationship to schizophrenia and does not mention any relationship to mood disorders.
K&S, p 498
True or False: the diagnosis of schizophreniform disorder does not require impaired social and occupational functioning.
True
DSM-5, p 97-98
Which is untrue?
Good prognostic features of schizophreniform disorder include:
a. onset of prominent psychotic sx’s within 4 weeks of the first noticeable change in usual behaviour or functioning.
b. lack of confusion or perplexity
c. good premorbid social and occupational functioning
d. absence of blunted or flat affect
b. confusion or perplexity is a GOOD prognostic feature
DSM-IV TR and DSM-5
About ____ of patients with an initial diagnosis of schizophreniform disorder recover within the 6-month period and this remains their final diagnosis.
1/3
DSM-5 and K&S p. 500
The neurologic conditions most commonly associated with delusions affect the ______ and the ________.
limbic system and basal ganglia.
K&S, p 506
Which is untrue? Risk factors associated with Delusional Disorder: a. younger age b. sensory impairment or isolation c. family history d. social isolation e. personality features (e.g., unusual interpersonal sensitivity) f. recent immigration
a. younger age, is untrue.
- Advanced age is a risk factor (mean age of onset is 40 yrs old).
K&S, p 506