XII - Schizophrenia

Question 1

Schizophrenia Spectrum and Other Psychotic Disorders

Answer 1

• Schizophrenia
• Other Psychotic Disorders
• Schizotypal Personality Disorder

Note that Schizotypal Disorder is also in Personality Disorders - only disorder that is in two categories

Question 2

Hallmark of schizophrenia

Answer 2

Psychosis - a significant loss of contact with reality. Symptoms - delusions, hallucinations, disorganized speech, disorganized and catatonic behavior

Question 3

Etymology - “Split Mind”

Answer 3

Does not refer to multiple personalities. Bleuler believed there is a split from reality. Name refers to split within intellect, between intellect and emotion, between intellect and external reality.

Question 4

Risk of developing schizophrenia

Answer 4

Around 1%; higher for those with older fathers. Typically starts in late adolescence. Earlier onset, more severe in men than women

Question 5

Schizophrenia DSM-V Diagnostic Criteria

Answer 5

(A) 2+ of following present for significant portion of 1-month period. At least one from 1-3: (1) Delusions, (2) Hallucinations, (3) Disorganized speech, (4) Disorganized or catatonic behavior, (5) Negative symptoms such as diminished emotional expression or avolition.

(B) Dysfunction in work, interpersonal relationships, or self-care

(C) Signs of disturbance for at least 6 months, with 1+ month of symptoms in (A)

(D) Rule out schizoaffective, depressive, bipolar disorders

(E) Symptoms not from physiological effect of substance or medical condition

(F) If with autism or communication disorder, must have delusions or hallucinations for 1+ months

Question 6

Delusions

Answer 6

Erroneous belief that is firmly held despite contradictory evidence. Examples include: made feelings or impulses (one’s thoughts/feelings/actions being caused by external agents); thought broadcasting (private beliefs are known to others); thought insertion or withdrawal (thoughts given and taken by outside source); reference (neutral environmental event believed to have special and personal meaning)

Question 7

Hallucinations

Answer 7

Sensory experience that seems real but occurs in absence of external stimulus. May have personal meaning. Can occur in any sensory modality, but auditory most common. Studies suggest may be misperceived subvocal speech

Question 8

Disorganized speech

Answer 8

Failure to make sense despite conforming to semantic/syntactic rules of speech. Words and word combinations sound communicative but listener is left without understanding.

Question 9

Disorganized and catatonic behavior

Answer 9

Impairments of goal-directed activity in areas such as work, social relationships, self-care. Catatonia involves almost no movement, sometimes in an unusual posture.

Question 10

Positive vs. Negative Symptoms of Schizophrenia

Answer 10

Positive symptoms: excess or distortion in normal behavior or experience (delusions, hallucinations, disorganized speech, disorganized behavior.

Negative symptoms: absence or deficit of certain behaviors (blunted emotions, alogia, avolition)

Question 11

Other psychotic disorders

Answer 11

Schizoaffective, Schizophreniform, Delusional, and Brief Psychotic Disorders.

Question 12

Schizoaffective Disorder

Answer 12

Hybrid of schizophrenia and mood disorder. Mood symptoms have met full criteria and present for 50% of illness

Question 13

Schizoaffective vs. Schizophrenic Disorders

Answer 13

Find info

Question 14

Schizophreniform Disorder

Answer 14

Like schizophrenia but only 1-6 months long

Question 15

Schizophreniform vs. Schizophrenic Disorder

Answer 15

Schizophreniform lasts for shorter period of time than schizophrenia (1-6 vs. 6+ months)

Question 16

Delusional disorder

Answer 16

Have delusions but otherwise with normal behavior

Question 17

Delusional vs. Schizophrenic Disorder

Answer 17

Schizophrenia requires delusions + another symptom; delusional disorder involves delusions but otherwise normal behavior.

Question 18

Delusional vs. Schizotypal Personality Disorder

Answer 18

Must find

Question 19

Brief Psychotic Disorder

Answer 19

Usually lasts only several days

Question 20

Genetic factors of schizophrenia

Answer 20

Genetic factors clearly implicated - having relative with the disorder significantly increases chances. Revealed by twin studies, adoption studies, molecular genetic studies (unlikely that linked to a single gene). Genetically influenced but not determined - interplay between genetic and environmental factors

Question 21

Prenatal and Perinatal Factors of Schizophrenia

Answer 21

Prenatal infection, rhesus incompatibility, early nutritional deficiencies, perinatal birth complications

Question 22

Neurodevelopmental Perspective of Schizophrenia

Answer 22

Thought that a lesion in brain lies dormant until some normal development changes expose the problems that result from brain abnormality. May involve abnormalities in cell migration during second trimester. May notice developmental traits such as motor abnormalities, low positive facial emotion, high negative face emotion

Question 23

Brain abnormalities

Answer 23

There are abnormalities associated with schizophrenia but they are not found in all patients. Enlarged brain ventricles for ex.

Question 24

Dopamine Hypothesis

Answer 24

Believed that too much dopamine leads to schizophrenia. Evidence: pharmacological success of Chlorpromazine, amphetamine induced psychosis, L-Dopa, Dopamine and Salience, Increased density of D2 receptors and increased sensitivity.

Question 25

Glutamate Hypothesis

Answer 25

Schizophrenia involves dysregulation in glutamate systems. Evidence: dopamine inhibits glutamate

Question 26

Familial hypotheses

Answer 26

Were hypotheses about bad parenting causing schizophrenia but it looks like schizophrenia may cause the communication problems. Critical, hostile, over-involved expressed emotion (of family member about patient) seems to have something to do with relapse.

Question 27

Psychosocial/cultural factors

Answer 27

Urban living, immigration, cannabis abuse

Question 28

Diathesis-Stress Model of Schizophrenia

Answer 28

Genetic Factors + Prenatal/Perinatal Factors -> Brain Vulnerability. + Stress/Developmental Processes -> Psychosis

Question 29

Recovery rate

Answer 29

Antipsychotic drugs improved prognosis. Currently 38% percent function well 15-25 years later. Long-term institutionalization for 12%. Shorter life expectancy and higher suicide rates.

Question 30

Pharmacological Approaches to Schizophrenia

Answer 30

First-Generation Antipsychotics: Dopamine Antagonists to tackle positive symptoms. Side effects - involuntary movements, tardive dyskinesia, neuroleptic malignant syndrome

Second-Generation Antipsychotics: fewer extrapyramidal (motor abnormality) side effects, no support for belief that these are more effective. Side effects - drowsiness, weight gain, diabetes.

Question 31

Psychosocial approaches to schizophrenia

Answer 31

Family therapy, case management, social-skills training, cognitive remediation, cognitive-behavioral therapy.