Schizophrenic/Psychotic Disorders

Question 1

Onset of schizophrenia
Gender
Prevalence
What socio-economic levels

Answer 1

15-45 years old
Equal risk between men and women
- Men tend to display symptoms earlier and are more severe
- Women most likely to have onset after 45
1% of pop
Occurs at all socio-economic levels

Question 2

History of schizophrenia

Answer 2

Lunacy in the past
- But indicated that onset could occur any age

Auditory hallucinations rare in cases before 1700s but are common today
- Industrialization and enviro changed may have caused change

Question 3

Diagnostic criteria for schizophrenia

Answer 3

During 1 month period, 2+:
- Delusions, hallucinations, disorganized speech, catatonic behav, negative symptoms (anhedonia, apathy)

Question 4

Types of schizophrenic delusions

Answer 4

Persecutory (Everything is against them)
Referential (Hidden meanings not actually related to them)
Somatic (About body and inner organs)
Religious (Demons, angels)
Grandiose (Belief of divine power)

Question 5

Catatonia
Waxy flexibility
(Schizophrenia)

Answer 5

Decrease in reactivity to enviro
- Waxy flexibility: Staying in seemingly uncomfortable position for long period of time (now less frequent)

Question 6

Difference between positive and negative symptoms
(Schizophrenia)

Answer 6

Positive symptoms: Exaggerated and distorted adaptations if normal behav

Negative symptoms: Absence of typical behavs and expression

Question 7

How to tell that schizophrenia is not schizoaffective disorder, depression, or bipolar disorder?

Answer 7

1) No depressive or manic episodes occur at same time as active-phase symptoms

2) Mood episodes that have occurred during active-phase symptoms are present for minority of total duration

Question 8

What is the differential diagnosis between:
Schizophrenia and depression w/ psychotic features
Schizophrenia and schizoaffective disorders

Answer 8

MDD only exp psychotic features during mood episodes

Schizoaffective requires min 2 weeks of only psychotic symptoms w/out mood symptoms

Both don’t meed criterion A of schizophrenia

Question 9

What is the differential diagnosis between bipolar disorder and schizoaffective disorder?

Answer 9

Bipolar w/ psychotic features only exp them during manic episodes
Bipolar would have mood symptoms, which doesn’t match with schizoaffective’s 2-week requirement of only psychotic symptoms

Question 10

What happens when depressive symptoms occur with manic episode? What happens if this continues?

Answer 10

Bipolar w/ psychotic features
If continued, becomes schizoaffective disorder

Question 11

Why is subjectivity a drawback of diagnosing schizophrenia?

Answer 11

DSM-5 relies on person’s symptoms and history
- But symptoms are private experiences
- And a reliable diagnosis ≠ valid diagnosis

Question 12

Endophenotypes

Answer 12

Bio or behav predispositions that make a disorder more likely

Question 13

What are endophenotypes or markers of schizophrenia that can be seen on cognitive tests?
(6)

Answer 13

Slow processing speed
Impaired sensory gating
Impaired verbal memory
Impaired dichotic listening
Slow phonemic word fluency
Slow detection of specified letters (continuous performance test)

Question 14

Visual tracking in schizophrenia

Answer 14

Eye movements more erratic
More saccades
- Could be what causes impairments in Continuous Performance Test

Question 15

Diathesis-Stress Theories of schizophrenia

Answer 15

1) Inherited or fetal injury

2) Switches in the brain turned on by stress

3) Biological vulnerability that’s inherited or acquired early in life

Question 16

Meehl’s theory of schizophrenia
Hypokrisia
Cognitive slippage
Aversive drift
Schizotype

Answer 16

Hypokrisia occurs thru brain, making nerve cells mire reactive to stimuli
- Causes cognitive slippage: Info becomes more disorganized, causing exaggerated connections between emotions and ideas
- Aversive drift: Cog drift causes more unpleasant social exp and the brain amplifies feelings of pain and weakens pleasure, which causes negative symptoms such as social withdrawal and disinterest

Schizotype: Person experiencing cognitive slippage and aversive drift

Question 17

Why is the familiarity effect not convincing in schizophrenia?

Answer 17

Incomplete penetrance: Some ppl w/ the dominant gene for schizophrenia don’t show expected effects

Question 18

Pregnancy complications that may cause schizophrenia

Answer 18

Exposure to flu in utero
- More common for winter babies

Pronged labour or premature delivery

Question 19

Wisconsin Card Sorting Test
(schizophrenia)

Answer 19

Match one card to key card based on colour, shape, or number (only one principle at a time tho)
- Examiner doesn’t say actual principle but will give feedback on correctness
- Will change principle after some time without telling

Ppl w/ prefrontal brain damage had similar result to schizophrenia:
- Had few correct matches
- Tend to repeat incorrect responses

Question 20

Brain findings of patients w/ schizophrenia:
CT and MRI
PET and fMRI

What is the problem with these findings?

Answer 20

1) CT and MRI
- Larger ventricles
- Reduced grey matter volume

2) PET and fMRI
- Activation changes in left temporal lobe, amygdala, and hippocampus

Problem: Frontal brain volumes only reduced in 25% cases and blood flow/metabolism only reduced in less than 50% of cases

Question 21

The dopamine hypothesis (schizophrenia)

Answer 21

Best antipsychotic drugs found were those that blocked dopamine receptors
Schizophrenics had more dopamine receptors than normal (but recent findings are failing to support this)
Multiple hits most likely cause dopamine dysregulation instead, which ends up w/ psychosis in schizophrenia

Question 22

1st gen and 2nd gen antipsychotic medication

Answer 22

1st gen:
- Promethazine and Chlorpromazine (first antipsychotic medication)
- Had more severe side effects but were very effective in reducing symptoms

2nd gen:
- Risperidone and Olanzapine
- Could control symptoms as long as medication was continued and has less side effects
- Main side effect was weight gain and migraines

Question 23

Treatments for schizophrenia:
Cognitive behavioural therapy
Social skills training / Cognitive remediation
Family therapy

Answer 23

Cognitive behavioural therapy
- Focus on emotional disturbance, making sense of psychotic symptoms, social disabilities, self-care methods to reduce risk of relapse

Social skills training / Cognitive remediation
- Learning-based
- Promotes independence and reduces stressors

Family therapy
- Conceptualizes patient as member of a famuly
- Aims for involvement of family
- Supports deinstitutionalization