Chapter 10: Schizophrenia Spectrum Disorders

Question 1

Schizophrenia

Answer 1

a chronic psychotic disorder characterized by acute episodes involving a break with reality, as manifested by such features as delusions, hallucinations, illogical thinking, incoherent speech, and bizarre behavior

Question 2

Four A’s

Answer 2

in Bleuler’s views, the primary characteristics of schizophrenia

loose associations, blunted or inappropriate affect, ambivalence, and autism

Question 3

Looseness of Associations

Answer 3

ideas are strung together with little or no relationship among them

Question 4

Affect

Answer 4

the behavioral expression of emotions

Question 5

First-Rank Symptoms

Answer 5

in Kurt Schneider’s view, the primary features of schizophrenia, such as hallucinations and delusions, that distinctly characterize the disorder

Question 6

Second-Rank Symptoms

Answer 6

in Schneider’s view, symptoms associated with schizophrenia that also occur in other psychological disorders

Question 7

Prodromal Phase

Answer 7

(1) stage in which the early features or signs of a disorder become apparent

(2) in schizophrenia, the period of decline in functioning that precedes the development of the first acute psychotic episodes

Question 8

Acute Episode

Answer 8

in schizophrenia, the phase in which psychotic symptoms develop, such as hallucinations, delusions, and disorganized speech and behavior

Question 9

Residual Phase

Answer 9

in schizophrenia, the phase of the disorder that follows an acute phase, characterized by a return to a level of functioning typical of the prodromal phase

Question 10

Thought Disorder

Answer 10

disturbances in thinking characterized by various features, especially a breakdown in logical associations between thoughts

Question 11

Neologisms

Answer 11

type of disturbed thinking associated with schizophrenia involving the coining of new words

Question 12

Perservation

Answer 12

persistent repetition of the same thought or train of thought

Question 13

Clanging

Answer 13

in people with schizophrenia, the tendency to string words together because they rhyme or sound alike

Question 14

Blocking

Answer 14

(1) disruption of self-expression of threatening or emotionally laden material

(2) in people with schizophrenia, a condition of suddenly becoming silent with loss of memory for what they have just discussed

Question 15

Catatonia

Answer 15

gross disturbances in motor activity and cognitive functioning

Question 16

Stupor

Answer 16

state of relative or complete unconsciousness in which a person is not generally aware pf or responsive to the environment, as a catatonic stupor

Question 17

Waxy Flexibility

Answer 17

feature of catatonia involving adopting a fixed posture into which people with schizophrenia have been positioned by others

Question 18

Positive Symptoms

Answer 18

the more flagrant features of schizophrenia characterized by the presence of abnormal behavior, such as hallucinations, delusions, thought disorder, disorganized speech, and disorganized behavior

Question 19

Negative Symptoms

Answer 19

features of schizophrenia characterized by the absence of normal behavior, negative symptoms are deficits or behavioral deficiencies, such as social-skills deficits, social withdrawal, flattened affect, poverty of speech and thought, psychomotor retardation, or failure to experience pleasure in pleasant activities

Question 20

Blunted Affect

Answer 20

significant reduction in emotional expression

Question 21

Flat Affect

Answer 21

absence of emotional expression

Question 22

Cross-Fostering Study

Answer 22

method of determining heritability of a trait or disorder by examining differences in prevalence among adoptees reared by either adoptive parent or biological parents who possessed the trait or disorder in question

evidence that the disorder followed biological rather than adoptive parentage favors the heritability of the trait or disorder

Question 23

Dopamine Theory

Answer 23

biochemical theory of schizophrenia that proposes schizophrenia involves the action of dopamine

Question 24

Hippocampus

Answer 24

one of a pir of structures in the limbic system involved in processes of memory

Question 25

Amygdala

Answer 25

one of a pair of structures in the limbic system involved in emotion and memory

Question 26

Schizophrenogenic Mother

Answer 26

type of mother, described as cold but also overprotective, who was believed to be capable of causing schizophrenia in her children research has failed to support the validity of this concept

Question 27

Double-Blind Communications

Answer 27

pattern of communication involving the transmission of contradictory or mixed messages without acknowledgement of the inherent conflict; posited by some theorists to play a role in the development of schizophrenia

Question 28

Expressed Emotions

Answer 28

a form of disturbed family communication in which the family members of the individual with schizophrenia have a tendency to be hostile, critical, and unspportive

Question 29

Tardive Dyskinesia

Answer 29

movement disorder characterized by involuntary movements of the face, mouth, neck, trunk, or extremities caused by long-term use of antipsychotic medications

Question 30

What is schizophrenia?

Answer 30

schizophrenia is among the most puzzling and disabling clinical syndromes schizophrenia touches every facet of an afflicted person's life acute episodes are characterized by delusions, hallucinations, illogical thinking, incoherent speech and bizarre behavior between episodes, people may still be unable to think clearly and may lack appropriate emotional responses to people and events in their lives

Question 31

What was Emil Kraeplin's (1856-1926) perspective on schizophrenia?

Answer 31

dementia praecox (losing their mental capacities before old age) "the loss of inner unity of thought, feelings, and acting" progressive disease process (develops early in life) hallucinations, motor abnormalities, delusions

Question 32

What was Eugen Bleuler's (1857-1939) perspective on schizophrenia?

Answer 32

Four A's: associations (jumping from one topic to another without correlation), affect (withdraw socially), ambivalence (no form of strong decisions), autism (withdraw into internal delusions) introduced the term "schizophrenia", "split brain" recognized variability in the course of the disorder

Question 33

What was Kurt Schneider's (1887-1967) perspective on schizophrenia?

Answer 33

thought the four A's overlapped too much with other disorders and wanted better differential criteria first rank and second rank symptoms

Question 34

What are first rank symptoms?

Answer 34

central to diagnosis of Sz, initially thought to be unique to Sz ABCD: auditory hallucinations, broadcasting of thought, controlling of thought (echo, insertion, withdrawal), delusions

Question 35

What are second rank symptoms?

Answer 35

things that are often present but not exclusively frequently associated with Sz, but not exclusively mood problems non-auditory hallucinations (visual, olfactory, haptic, gustatory)

Question 36

What is the prevalence of schizophrenia?

Answer 36

1% of the population; fifth leading cause of disability social isolation early adult onset, few cases spontaneously enter remission permanently consequences can be devastating in virtually all main functional areas

Question 37

Why is homelessness and victimization common in schizophrenia?

Answer 37

properly treated, individuals with Sz are no more harmful than members of the general population often suspicious of family and professionals, so avoid Tx delusions may lead to fear that medications are poison or thought control agents medication side effects can be nasty poor compliance with social services and out reach workers make permanency planning difficult may be reluctant to allow others into their residence to assess safety of home environment about 20x as likely as members of the general population to complete suicide

Question 38

What are the phases of schizophrenia?

Answer 38

prodromal phase: deterioration of self-care acute phase: positive symptoms start residual phase: still have some features, retain the belief that some delusions have merit, even if they acknowledge they are false

Question 39

What are major features of schizophrenia?

Answer 39

disturbances of thought and speech disturbances in the content of thought delusions of persecution, being controlled, grandeur

Question 40

What are common forms of delusions?

Answer 40

thought broadcasting thought insertion thought withdrawal

Question 41

What are disturbances in the form of thought?

Answer 41

neologisms: terms they make up that don't make sense preservations: keep using same phrases, words, or topics of conversation over and over clanging: non-sensical rhyming blocking: stopping mid-sentence

Question 42

What are attentional deficiencies in schizophrenia?

Answer 42

hypervigilance: looking over shoulder, immediately suspicious of anyone who enters the room

Question 43

What are perceptual disturbances in schizophrenia?

Answer 43

auditory hallucinations and self-talk (sub-vocal speech) auditory hallucinations in 60% of cases command hallucinations

Question 44

What are the emotional disturbances in schizophrenia?

Answer 44

flatness of affect inappropriate affect often in facial expression

Question 45

What are the previous subtypes of schizophrenia that are no longer in the DSM-5?

Answer 45

disorganized: sat around and giggled, act drunk but no motor impairment catatonic: without movement waxy flexibility: can be moved rigid: can't be moved paranoid: term that trumped everything else undifferentiated: features are evenly distributed between all three

Question 46

What are Type I and Type II schizophrenia?

Answer 46

positive symptoms and negative symptoms premorbid functioning: poorer in type II

Question 47

What is the DSM-5 criteria of schizophrenia?

Answer 47

two (or more) of the following: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms level of functioning in one or more areas is markedly below the level achieved prior to the onset continuous signs of the disturbance persist for at least 6 months, may include period of prodromal or residual symptoms schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out if there is a history of ASD or a communication disorder, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations

Question 48

What are the specifiers of schizophrenia?

Answer 48

first episode, currently in acute episode first episode, currently in partial multiple episodes, currently in acute episode multiple episodes, currently in full remission continuous unspecified with catatonia

Question 49

What is the DSM-5 criteria for schizoaffective disorder?

Answer 49

an uninterrupted period of illness during which there is a major mood episode delusions or hallucinations for 2 or more weeks in the absence of a major mood episode

Question 50

What are differentials of schizophrenia?

Answer 50

mood disorder with psychotic features brief psychotic disorder delusional disorder: positive symptoms in the absence of others substance-induced psychotic disorder schizophreniform disorder: Sz. except the time period has not been met schizotypal personality disorder: positive symptoms schizoid personality disorder: negative symptoms the boundaries between these can be so unclear that many scholars have argued for the removal of separate diagnostic categories

Question 51

What are the psychodynamic perspectives on schizophrenia?

Answer 51

primary narcissism Harry Stack Sullivan: ego defenses are completely overwhelmed, when defense collapses fully they will revert to oral phase, perceives delusions of the Id as being real, don't have distinction between themselves and the environment mother-child relationships: arise from moms who do not meet the child's emotional needs, so they retreat into themselves for social stimulation, cause social withdrawal

Question 52

What are the learning perspectives on schizophrenia?

Answer 52

Ulmann and Krasner: arose from environment where social reinforcement is hard to come by, then they partake in unusual, attention-seeking behavior to gain reinforcement, increase behavior to increase attention reinforcement for behaving in a manner consistent with Sz. secondary gains: inadvertent reinforcement of bizarre behavior

Question 53

What are the biological perspectives on schizophrenia?

Answer 53

genetic factors: cross-fostering studies biochemical factors: dopamine theory, neuroleptic drugs viral infections brain abnormalities: hippocampus, amygdala

Question 54

What is the research evidence supporting the diathesis-stress model?

Answer 54

acute stress tends to predict onset: people who have already had a psychotic break people with COMT gene more likely to develop psychosis with cannabis genetic liability

Question 55

What is a schizophrenogenic mother?

Answer 55

cold, aloof, withholding affection child withdraws, foreclosing on opportunities to socialize retreats into a fantasy world and begins to behave according to that imagined

Question 56

What is double-bind communications theory?

Answer 56

children being shaped to say what they think parents "want" to hear learned that if they speak up they will get in trouble, being shaped to speak in a way the authority figure wants incompatible with true feelings

Question 57

What is communication deviance?

Answer 57

mimicking unclear, vague, communication modelled by others, especially parents

Question 58

What are biological approaches to the treatment of schizophrenia?

Answer 58

antipsychotic drugs

Question 59

What are the psychoanalytic approaches to the treatment of schizophrenia?

Answer 59

personal therapy Freud was of the opinion that psychoanalysis was not helpful in the treatment of Sz.

Question 60

What are the learning based approaches to the treatment of schizophrenia?

Answer 60

social skills training lots of evidence speaking to social maladjustment social rejection and lack of support worsen outcomes

Question 61

What are the psychosocial rehabilitation approaches to the treatment of schizophrenia?

Answer 61

focuses on functional practical adaptation public transportation job skills (often in a sheltered environment) appointment of a public guardian/trustee

Question 62

What are the family intervention program approaches to the treatment of schizophrenia?

Answer 62

education: educate family, tell them it's not their fault early intervention is critical