Schizophrenia

Question 1

How does SZ impair a person’s life?

Answer 1

impairs perception or expression of reality and significant social or occupational dysfunction

Question 2

What is the hallmark of SZ? What are some of its features?

Answer 2

1. cognitive impairments
2. pervasive, disabling, and treatment-resistant

Question 3

What does SZ affect in a person’s life?

Answer 3

affects every aspect: thoughts, behaviors, social relationships, functional ability

Question 4

What are the 4 types of positive symptoms?

Answer 4

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

Question 5

What are delusions?

Answer 5

implausible/bizarre/baseless thoughts; fixed beliefs that are not changeable even with conflicting evidence

Question 6

What are the 6 types of delusions?

Answer 6

1. Persecutory
2. Grandiose
3. Delusions of reference
4. Somatosensory
5. Erotomanic
6. Nihilistic

Question 7

Persecutory Delusion

Answer 7

paranoia; believing one will be harmed or harassed by an individual, group, organization

Question 8

Grandiose Delusion

Answer 8

thinking one is God, above all, untouchable

Question 9

Delusions of Reference Delusion

Answer 9

believing everything is direct to one’s self

Question 10

Erotomanic Delusion

Answer 10

believing others are in love with you when they aren’t; obsessive love

Question 11

Somatic Delusion

Answer 11

dissociating with one’s body parts

Question 12

Nihilistic Delusion

Answer 12

believing one is not dead or alive

Question 13

What is a hallucination? How does it activate the brain?

Answer 13

-sensory events that lack environmental input – a thought causes brain activation (stimulus cannot be seen by others)

Question 14

What are the involved senses in hallucinations?

Answer 14

audio (most common), visual, gustatory, olfactory, somatosensory, tactile

Question 15

What are the two types of audio hallucinations? How do they vary?

Answer 15

-command or narrative
-volume & frequency

Question 16

What is dysfunctional gating?

Answer 16

difficulty separating auditory sense and paying attention

Question 17

What is disorganized speech?

Answer 17

word salad = speech is loosely associated or incoherent enough to impair communication

Question 18

What are the two types of disorganized speech?

Answer 18

tangential; gets off topic, stays off topic
and
circumstantial; there a pattern in the speech enough to figure out what they’re saying

Question 19

What is grossly disorganized behavior?
What is an example of it?

Answer 19

unpredictable agitation, silliness, social, bizarre behavior, disinhibition
Ex: catatonia

Question 20

How are the 3 ways catatonia presented?

Answer 20

wild agitation (flailing limbs)
waxy flexibility
immobility

Question 21

What are the 4 negative symptoms? How is each one presented?

Answer 21

1. Affective flattening
2. Alogia
3. Anhendonia
4. Avolition

Question 22

What is affective flattening?

Answer 22

loss of emotional expression in the face, voice tone, eye contact, body language = constricted, flat, blunted

Question 23

What is alogia? What must be considered?

Answer 23

reduction in speech fluency and productivity
reflected as slow or blocked thoughts = short and empty replies

*this could happen because of medication side effects or the disorder

Question 24

What is anhendonia?

Answer 24

inability to experience pleasure

loss of pleasure in things one used to enjoy by anticipating that it will not be rewarding

Question 25

What is avolition? How is it perceived?

Answer 25

1.experiencing a reduction, difficulty, or inability to start and continue goal directed activity ex: stops brushing teeth, not engaging in any activity 2. laziness

Question 26

What is expressed emotion?

Answer 26

hostile response to the negative symptoms

Question 27

How does expressed emotion range across cultures?

Answer 27

Least to highest: indian, mexican, british, anglo-american

Question 28

What happens if there high or low expressed emotion?

Answer 28

High: person is less likely to take medication, more relapse/hospitalizations Low: leads to an increase in social support and social relationships

Question 29

What is needed for criteria A?

Answer 29

1. must experience delusions, hallucinations, or disorganized speech, at least two, for one month and negative symptoms during the remainder of the time

Question 30

What do you need for criteria B? Adults vs. Youth

Answer 30

while experiencing disturbances one must be fall below their normal level of functioning in 1 or more major areas of their life prior to the onset ex: work, personal relationships, self-care youth must overall fail their expected level of functioning of interpersonal, academic, or occupational functioning

Question 31

What is needed for criteria C?

Answer 31

Must experience continuous disturbances for 6 months and minimum of 1 month of active-phase symptoms

Question 32

What is needed for Criteria D?

Answer 32

one's active-phase symptoms to not occur because of depressive or manic episodes, but if they happen at the same time the mood disorders can only be present for a minority of the time

Question 33

What cannot happen in relation of disturbances and substance use?

Answer 33

symptoms cannot occur due to a substance or another medical condition

Question 34

What can be present in SZ but not in psychosis? What is specifically present in psychosis?

Answer 34

1. negative symptoms: affect flattening, alogia, avolition, anhendonia 2. delusions, hallucinations, and disorganized speech

Question 35

What are some examples that can cause psychosis?

Answer 35

1. head trauma 2. drug use 3. stroke 4. tumors 5. other psychiatric disorders

Question 36

Up to what percentage of SZ patients perform poorly on cognitive tests than would be predicted by their parent's education level? How many SZ patients show cognitive impairment?

Answer 36

1. 98% 2. 85%

Question 37

What are the 3 strongest cognitive deficits? What do they predict? What do they precede?

Answer 37

1. homelessness 2. chronic disability 3. early mortality rates These deficits predict the likelihood of success or failure. They precede the onset of psychosis.

Question 38

What is the relation between a patient's psychosis insight and their mood?

Answer 38

The MORE insight they have the LOWER their mood becomes.

Question 39

What plays a larger role in a patient's inability to perform well? And why?

Answer 39

bad neurocognition outcomes: fails to take medication, antipsychotics have minimal effect, & related to medical comorbidities

Question 40

How does cognitive impairment affect social cognition?

Answer 40

less likely to be cautious/keep self safe negative emotions such as fear are mostly impaired

Question 41

What are the 7 cognitive dimensions affected by SZ?

Answer 41

Attention/vigilance Reasoning/problem solving Social learning Working memory Verbal fluency Verbal learning/memory Visual learning/memory

Question 42

How many years is considered chronic SZ?

Answer 42

5 years or more

Question 43

What did Emil Kraeplin do for SZ?

Answer 43

-distinguished SZ and named it dementia praecox = premature dementia = precocious madness -identified the primary disturbance = COGNITION (hallmark) -no recovery -believed it was organically produced: poisoning of the brain (autointoxication), probably by sex hormones

Question 44

What did Eugene Bleuler do for SZ?

Answer 44

coined SZ Schizen - to split Phren - soul,spririt,mind defined it as "loosening of associations" = fragmented thinking once diagnosed = no recovery for cognitive deficits included the positive and negative symptom diagnosis

Question 45

When is there an onset of psychosis in SZ patients? What is the average onset age for adult males and females?

Answer 45

1. late teens - mid 30's 2. M - 23-25 yrs old 3. F - 25-28 yrs old

Question 46

What happens if there is an early onset of psychosis?

Answer 46

more severe symptoms, more chronic, less remission, more disability, worse quality of life

Question 47

What is the international prevalence of SZ? Which sex has the higher prevalence?

Answer 47

1. approximately 1% 2. slightly higher in males

Question 48

What are the differences between male and female SZ patients?

Answer 48

Males: 1. severe form 2. neg symptoms 3. more chronic Females: 1. less severe 2. depressive symptoms 3. favorable outcomes

Question 49

Where are SZ patients?

Answer 49

6% homeless/shelters & jail/prison 5-6% in hospitals 10% in nursing homes 20% in supervised housing 25% living with family 28% live independently

Question 50

Which cultural factors should be considered for assessment? What cultural frameworks (customs) must be considered for assessment?

Answer 50

1. witch craft 2. ghosts/spirits 3. hearing God's voice 1. level of eye contact 2. body language 3. hygiene 4 alogia/linguistic barriers

Question 51

What is the range of suicide in SZ patients? What is comorbid to suicide risk in SZ patients?

Answer 51

1. 5-6% completed 20% attempted 2. substance use

Question 52

Which disorders present high comorbidity to SZ?

Answer 52

1. substance use disorders 2. OCD 3. panic disorder with social anxiety

Question 53

What reduces life expectancy in SZ patients?

Answer 53

1. metabolic disorder 2. weight gain/obesity 3. diabetes 4. poor hygiene/diet/exercise 5. medication side effects

Question 54

What is the prodromal period? How is it characterized? What are the "soft signs"?

Answer 54

1. 1-2 years before the onset of a psychotic break 2. anxiety, depression, loss of function 3. unusual beliefs (ideas of reference), illusions (NOT hallucinations), vague speech (mostly understandable), unusual behavior (mumbling in public)

Question 55

What are 3 fetal hypoxia risks related to SZ?

Answer 55

1. low oxygen to fetus 2. risk to SZ development if it runs in the family 3. emergency C-section, bleeding while pregnant, preeclampsia

Question 56

What are some related maternal infection risks to SZ?

Answer 56

1. influenza in the 2nd trimester 2. other infections: upper respiratory, genital tract, measles, toxoplasmosis 3. elevation in antibodies bc of infection

Question 57

What are some environmental risk factors of SZ?

Answer 57

1. fathers over 55 2. malnutrition/famine = gene expression change 3. higher incidences in urban areas 4. seasonal/latitude = vitamin D sufficiency 5. birth month = higher in winter months

Question 58

What is the relation of cannabis use and psychosis?

Answer 58

1. worsen illness 2. increases relapse 3. often generates more positive symptoms dependent on the dosage

Question 59

What is the prevalence of trauma in adult SZ patients? Why?

Answer 59

1. there is a higher rate of childhood trauma 2. childhood trauma might puts them at risk of later development

Question 60

What is the Dopamine hypothesis? What drugs are at play?

Answer 60

1. SZ patients have an excess of dopamine 2. Drugs that increase DA: (agonists) cocaine and ketamine 3. Drugs that decrease DA: (antagonists) L-Dopa, neuroleptics

Question 61

What was the concluded prevalence in twins studies with SZ?

Answer 61

40-50% in identical twins (monozygotic 6-10% in fraternal twins (dizygotic)

Question 62

What are two neurobiological abnormalities in the brain related to SZ?

Answer 62

1. enlarges ventricles 2. reduced tissue volume 3. less active frontal lobes = Hypofrontality *key dopamine pathway