Schizophrenia

Question 1

Psychosis refers to loss of contact with external reality characterised by…

Answer 1

impaired perceptions and thought processes

Question 2

In 1911, Bleue introduced the idea of the ‘Split mind’ which consists of which 3 elements?

Answer 2

1. Fragmentation of thoughts
2. Splitting of thoughts from emotions
3. Withdrawal from reality

Question 3

What is schizophreniform disorder?

Answer 3

A provisional diagnosis; someone with psychotic symptoms >1 month <6months

Question 4

To be diagnosed with schizophrenia, Criterion A states you need to have 2 of the following features:
At least one must be 1, 2 or 3

Answer 4

1. Delusions
2. Hallucinations
3. Disorganised speech (formal thought disorder)
4. Grossly disorganised or catatonic behaviour
5. Negative symptoms

Question 5

Continuous signs of disturbance need to be present for

Answer 5

6 months, may see a gradual deterioration in functioning

Question 6

What are the positive symptoms (presence of problematic behaviours)?

Answer 6

• Hallucinations
• Delusions
• Formal thought disorder
• Behavioural/motor disturbances
• lack of insight (unawareness that what they’re experiencing is not reality)

Question 7

What are the negative symptoms (absence of healthy behaviours)?

Answer 7

Affective flattening

• social withdrawal
• anhedonia
• emotional blunting (not responding emotionally)
• confusion

Avolition

• Amotivation
• Apathy
• Self-neglect (eg lack of hygiene)

Alogia

• Poverty of speech
• Poverty of content

Question 8

Presence of negative symptoms predicts…

Answer 8

poorer response to treatment

Question 9

____ of schizophrenic patients report experiencing hallucinations, which come in many forms:

Answer 9

75%

• auditory
• visual
• olfactory (smell)
• gustatory (taste)
• tactile (feeling something crawling on their skin)

Question 10

Delusions are beliefs that are not …

Answer 10

culturally accepted

Question 11

Delusions are categorised on content and bizarreness:

Answer 11

eg

• paranoid/persecutory delusions
• referential delusions
• grandiose delusions
• nihilistic delusions
• erotomanic delusions

Question 12

What are referential delusions?

Answer 12

Neutral event (TV news) interpreted to hold personal meaning

Question 13

What is formal thought disorder?

Answer 13

Disorganised thinking - disturbances in flow and/or form of speech (not content as in delusions)

Question 14

What are some positive manifestations of formal thought disorder?

Answer 14

1. circumlocution or circumstanciality (very indirect, long-winded descriptions)
2. derailment (slipping from one topic to another)
3. tangentiality (irrelevant responses to questions)
4. echolalia (seen in acute phase, person involuntarily has parrot like repetition)
5. word salad (incomprehensible stream of words)
6. clang association (phrases linked through sound rather than meaning eg pass me the spoon, moon, i’m cocoon)

Question 15

What is catatonic behaviour?

Answer 15

A marked decrease in reactivity to the environment
- in terms of posture or behaviour
eg
Stupor - no psychomotor activity; not actively relating to the environment
Catalepsy - rigid posture/position of limbs despite gravity
Waxy flexibility
Echopraxia - imitating another’s movements
Grimacing
Negativism
Mutism

Question 16

What is the male:female ratio?

Answer 16

3:2

Question 17

Early onset is associated with…

Answer 17

poorer outcomes

Question 18

____ of sufferers unable to work,

Answer 18

50%, 25%

Question 19

____ attempt suicide

Answer 19

30%

Question 20

What are the 4 main phases in the clinical course of schizophrenia?

Answer 20

Premorbid phase - subtle cognitive, motor or social deficits

Prodromal phase - change in behaviour, functional decline, lasts ~2 years

Psychotic phase - lasts around 1 year, florid psychotic symptoms

Recovery phase

Question 21

one parent, child =

two parents, child =

Answer 21

10%

40%

Question 22

What is the dopamine hypothesis?

Answer 22

Overproduction and oversensitivity of dopamine receptors

Question 23

Abnormally large responses to low amphetamine doses suggests…

Answer 23

over-sensitivity rather than excessive dopamine level

Question 24

How do patients respond to anti-dopaminergic medication?

Answer 24

effective in 60%, especially for treating positive symptoms

Question 25

There may be two separate syndromes:

Answer 25

1. caused by dopamine activity and associated with positive symptoms 2. caused by brain degeneration and associated with negative symptoms

Question 26

What is the most consistent neuroanatomical finding?

Answer 26

Schizophrenics have much larger ventricles (twice the size of normals), which indicates a loss of brain tissue

Question 27

Schizophrenics lose brain tissue in the ________. This is linked to ________

Answer 27

Prefrontal cortex, negative symptoms (damage to executive functioning system)

Question 28

Structural brain abnormalities (eg in hippocampus) appear to _____ onset of psychosis and to ________ with progressive illness

Answer 28

predate, worsen | Indicates schizophrenia as a degenerative brain disorder

Question 29

Early neurodevelopmental damage eg _____ may play a key role

Answer 29

viruses

Question 30

Greater likelihood of _______ birth as it is associated with _________

Answer 30

winter or spring | Vitamin D deficiency

Question 31

Pregnant mothers' exposure to ______ has also been associated with schizophrenia

Answer 31

viral illnesses eg measles

Question 32

_______ increase for urban births | ________ increase among lower socioeconomic classes

Answer 32

Twofold | eightfold

Question 33

obstetric complications such as _________, _________ are implicated

Answer 33

poor nutrition | viral infections

Question 34

Once the patient is stabilised and on medication, you can start to address the _______ symptoms. Ie....

Answer 34

negative | help people notice when stressors arrive and how to cope

Question 35

What is the difference between primary and secondary delusions?

Answer 35

Primary delusions = formed without a prior psychopathological event or process having led to the false conclusion ie belief appeared out of the blue Secondary delusions = theoretically secondary to abnormal changes in mood, memory or perception (esp hallucinations) eg auditory hallucinations might form the source of evidence for the patient's persecutory delusion

Question 36

_________ is less responsive to treatment for schizophrenia, which suggests that it may have an underlying neurobiological basis separate from other psychotic symptoms

Answer 36

Catatonia

Question 37

Approx. ___ of patients with psychosis report current use of cannabis, which has been shown to be a predictor of increased risk of relapse of psychosis

Answer 37

23%

Question 38

A NZ study of note has supported the theory that the use of ________ may trigger psychosis in young people with a specific genetic profile. As well as increasing the risk of developing psychosis in genetically vulnerable individuals, the use of ______ is associated with earlier onset of psychosis.

Answer 38

cannabis

Question 39

Increased prevalence rate of psychotic conditions among ______ and in _______ countries compared to ________ countries.

Answer 39

migrants, developed, developing

Question 40

The duration of untreated psychosis (DUP) is related to...

Answer 40

the time taken to respond to treatment once it commences

Question 41

Relapse of psychosis is associated with..

Answer 41

1. discontinuation of antipsychotic medication 2. cannabis and amphetamine use 3. poorer premorbid adjustment 4. conflictual interpersonal relationships (high EE)

Question 42

Amphetamines, which release ______, can produce symptoms of schizophrenia

Answer 42

dopamine

Question 43

At the core of Morrison (2001)'s cognitive model of psychosis is the idea that psychosis entails...

Answer 43

culturally unacceptable interpretations of 'intrusions into awareness', which are defined as thoughts, images or impulses that intrude upon the individual's consciousness and are uncontrollable