Lecture 10 Textbook

Question 1

What is the lifetime risk of schizophrenia?

Answer 1

About 0.7% (1 in 140 people).

Question 2

When does schizophrenia usually start?

Answer 2

Late adolescence to early adulthood (18-30 years old).

Question 3

Is onset earlier in men or women?

Answer 3

Men (peaks ages 20–24); women can have a later second peak (~40 or 60s).

Question 4

What are the main DSM-5 symptoms for schizophrenia?

Answer 4

Delusions, hallucinations, disorganized speech, disorganized/catatonic behavior, negative symptoms.

Question 5

How long must symptoms last for diagnosis?

Answer 5

6 months, with at least 1 month of active symptoms.

Question 6

What are delusions?

Answer 6

Fixed, false beliefs despite evidence (e.g., being mind-controlled, thought broadcasting).

Question 7

What are hallucinations?

Answer 7

Perceptions without real stimulus; most commonly auditory (hearing voices).

Question 8

Are delusions or hallucinations required for diagnosis?

Answer 8

At least one of delusions, hallucinations, or disorganized speech must be present.

Question 9

What gender differences are seen in schizophrenia?

Answer 9

More common and severe in men; women have later onset and better outcomes, possibly due to estrogen.

Question 10

What are auditory hallucinations?

Answer 10

Hearing voices that aren’t real, most common in schizophrenia, but can occur in healthy people with stress, caffeine, or spicy food.

Question 11

How do hallucinated voices often behave?

Answer 11

Often rude, critical, commanding, or sometimes supportive.

Question 12

What is disorganized speech in schizophrenia?

Answer 12

Speech that’s hard to follow, illogical, or has made-up words (neologisms), reflecting disordered thinking.

Question 13

What is disorganized behavior?

Answer 13

Odd, inappropriate, or unpredictable actions; includes neglecting self-care or showing catatonia (lack of movement).

Question 14

What is catatonia?

Answer 14

A state where a person may not move at all or may hold odd positions for a long time.

Question 15

What are negative symptoms of schizophrenia?

Answer 15

Reduced expression (flat affect), little speech (alogia), low motivation (avolition), and inability to feel pleasure (anhedonia).

Question 16

What is the difference between positive and negative symptoms in schizophrenia?

Answer 16

Positive = extra or distorted experiences (hallucinations, delusions); Negative = lack of normal function (emotion, speech, motivation).

Question 17

Name four other psychotic disorders and one way each is different from schizophrenia.

Answer 17

1. Schizoaffective disorder (includes mood disorder symptoms).
2. Schizophreniform disorder (shorter duration than schizophrenia).
3. Delusional disorder (mainly delusions, few other symptoms).
4. Brief psychotic disorder (psychotic symptoms last less than a month).

Question 18

What is schizoaffective disorder?

Answer 18

A disorder with both schizophrenia symptoms and major mood episodes (depression or mania) for more than 50% of the illness duration.

Question 19

What is schizophreniform disorder?

Answer 19

Psychotic symptoms similar to schizophrenia but lasting at least 1 month and less than 6 months.

Question 20

What is delusional disorder?

Answer 20

One or more delusions for 1 month or more, with no major disorganization or significant functional impairment.

Question 21

What is brief psychotic disorder?

Answer 21

Sudden onset of psychotic symptoms lasting at least 1 day but less than 1 month, with a full return to normal.

Question 22

What is the genetic risk for schizophrenia in the general population?

Answer 22

About 1%.

Question 23

What is the risk for first-degree relatives (parents, siblings, children)?

Answer 23

About 10%.

Question 24

What is the risk for identical twins?

Answer 24

Up to 50%.

Question 25

What is the difference between delusional disorder and schizophrenia?

Answer 25

Delusional disorder does not show the disorganized behavior or functional decline seen in schizophrenia.

Question 26

What does Fischer’s Study show?

Answer 26

Children of the “well” twin in identical twin pairs (where the other twin has schizophrenia) have elevated risk, showing a genetic component.

Question 27

What do adoption studies show about schizophrenia risk?

Answer 27

Children of mothers with schizophrenia, adopted into other families, still have higher risk than controls, showing genetic influence.

Question 28

Can a good family environment reduce schizophrenia risk for at-risk children?

Answer 28

Yes, a low-stress, supportive environment can protect even those with high genetic risk.

Question 29

What is “communication deviance” in families, and why does it matter?

Answer 29

It refers to vague, unclear, or hard-to-follow family communication, which increases risk of thought disorder in genetically at-risk children.

Question 30

How many genes are involved in schizophrenia?

Answer 30

Many (possibly hundreds or more), each with a small effect.

Question 31

What is a GWAS and why is it important for schizophrenia research?

Answer 31

Genome-Wide Association Study; it scans the entire genome to find small genetic variants (SNPs) linked to schizophrenia.

Question 32

What is an endophenotype?

Answer 32

A stable, measurable trait (e.g., cognitive problems, magical thinking) linked to genetic risk for schizophrenia.

Question 33

What is the role of prenatal exposures in schizophrenia risk?

Answer 33

Viral infections (like influenza) during pregnancy can increase risk, especially if infection happens in the first or second trimester.

Question 34

How can maternal infection during pregnancy affect schizophrenia risk?

Answer 34

The mother’s immune response can increase inflammation, which may disrupt fetal brain development and raise the child’s risk for schizophrenia.

Question 35

What is rhesus incompatibility and how does it relate to schizophrenia?

Answer 35

It’s a blood type mismatch between mother and fetus; it may increase risk for schizophrenia, possibly via oxygen deprivation or immune issues.

Question 36

What pregnancy/birth complications raise risk for schizophrenia?

Answer 36

Complications that reduce oxygen supply to the fetus (e.g., prolonged labor, umbilical cord around neck).

Question 37

How does early nutrition affect schizophrenia risk?

Answer 37

Severe malnutrition during pregnancy (e.g., famine) increases the risk for the child.

Question 38

What effect does severe maternal stress have during pregnancy?

Answer 38

High stress, especially in the first/second trimester, increases risk of schizophrenia in the child.

Question 39

What early signs might indicate future schizophrenia?

Answer 39

Subtle differences in motor skills, facial expressions, and emotional responses in early childhood.

Question 40

What is attenuated psychosis syndrome?

Answer 40

Mild psychotic symptoms not severe enough for a psychotic disorder, but may indicate risk for future psychosis.

Question 41

What cognitive problems are seen in schizophrenia?

Answer 41

Impaired attention, memory, language, and working memory.

Question 42

When do cognitive problems begin in schizophrenia?

Answer 42

Often before the illness is diagnosed; they worsen with illness progression but may stabilize after the first episode.

Question 43

What is eye-tracking dysfunction and why is it important?

Answer 43

Difficulty smoothly tracking moving targets with the eyes; seen in many with schizophrenia and some relatives, indicating a possible genetic marker.

Question 44

What is sensory gating and how is it affected in schizophrenia?

Answer 44

The brain’s ability to filter out repeated stimuli; people with schizophrenia show poor “P50 suppression” and do not filter stimuli well.

Question 45

What is the relationship between IQ and schizophrenia?

Answer 45

Lower IQ increases risk for schizophrenia, and cognitive decline often worsens as illness develops.

Question 46

What cognitive difficulties are common in schizophrenia?

Answer 46

Problems with concentration, attention, memory, social understanding, and recognizing emotions.

Question 47

What is social cognition and how is it affected in schizophrenia?

Answer 47

Social cognition is understanding social information and emotions; it’s often severely impaired in schizophrenia.

Question 48

What brain changes are seen in schizophrenia?

Answer 48

Enlarged ventricles, loss of gray matter (especially prefrontal cortex and temporal lobes), and reduced white matter connections.

Question 49

When does brain tissue loss begin in schizophrenia?

Answer 49

Early in the illness, often before full symptoms develop, and it continues over time.

Question 50

What is the significance of gray matter loss?

Answer 50

Linked to worsening cognitive function and may signal transition to psychosis.

Question 51

What is white matter, and how is it affected?

Answer 51

White matter is the brain’s wiring (nerve fibers covered by myelin); schizophrenia reduces white matter volume and disrupts connections.

Question 52

What is the disconnection hypothesis?

Answer 52

Symptoms may arise from poor connectivity between different brain regions, especially involving the frontal lobes.

Question 53

What is “hypofrontality” in schizophrenia?

Answer 53

Low activity in the frontal lobes during thinking tasks.

Question 54

Which brain regions are affected in schizophrenia?

Answer 54

Frontal lobe, temporal lobe, basal ganglia, limbic system, hippocampus, auditory system.

Question 55

What is cytoarchitecture, and how is it abnormal in schizophrenia?

Answer 55

The organization of brain cells; in schizophrenia, neuron organization is disrupted and some types (like inhibitory interneurons) are reduced.

Question 56

Why is adolescence a critical period for schizophrenia risk?

Answer 56

Major brain changes (synaptic pruning, white matter increases) happen then—problems here can lead to illness.

Question 57

How does head injury affect schizophrenia risk?

Answer 57

Childhood head injury, especially ages 11–15, greatly increases risk, regardless of family history.

Question 58

What are “functional circuits” in the brain?

Answer 58

Networks linking brain areas; dysfunction in these circuits can cause schizophrenia symptoms.

Question 59

What do problems in the default mode network cause?

Answer 59

Difficulty switching from rest to task-focused thinking, leading to broad cognitive problems.

Question 60

What are inhibitory interneurons and why are they important?

Answer 60

Neurons that help calm brain activity; fewer of them in schizophrenia may mean less ability to control brain excitability and stress.

Question 61

Are brain abnormalities in schizophrenia always severe?

Answer 61

No, sometimes the changes are very subtle.

Question 62

What is the dopamine hypothesis of schizophrenia?

Answer 62

It’s the idea that too much dopamine activity in the brain leads to schizophrenia symptoms.

Question 63

What are some ways dopamine can be too high in schizophrenia?

Answer 63

Increased production, more released into synapses, slower breakdown, or less reuptake.

Question 64

How does glutamate relate to schizophrenia?

Answer 64

Blocking glutamate receptors (with drugs like PCP or ketamine) can cause symptoms similar to schizophrenia; patients may have lower glutamate levels in some brain areas.

Question 65

What is “aberrant salience” in schizophrenia?

Answer 65

It’s when dopamine makes people give too much importance to ordinary things, leading to delusions or paranoia.

Question 66

What is expressed emotion (EE) and why is it important for schizophrenia?

Answer 66

EE measures family criticism, hostility, and emotional overinvolvement. High EE in families doubles the risk of relapse for people with schizophrenia.

Question 67

How does urban living affect schizophrenia risk?

Answer 67

Growing up in a city increases the risk of developing schizophrenia—possibly due to social stress or adversity.

Question 68

Why are immigrants at higher risk for schizophrenia?

Answer 68

Immigrants face higher schizophrenia risk due to stress, discrimination, and possibly social defeat, especially if they have darker skin.

Question 69

What is the link between cannabis use and schizophrenia?

Answer 69

Heavy cannabis use, especially in teens, increases schizophrenia risk and can make symptoms worse in those already affected.

Question 70

How does family environment affect schizophrenia relapse?

Answer 70

High emotional tension or criticism in families (high EE) increases relapse risk; lowering EE helps reduce relapses.

Question 71

What biological factor may connect stress and relapse in schizophrenia?

Answer 71

High stress raises cortisol, which affects dopamine and glutamate in the brain, possibly triggering relapse.

Question 72

What effect does cannabis use have on schizophrenia risk and brain changes?

Answer 72

Increases the risk of developing schizophrenia and worsens brain tissue loss.

Question 73

What is the diathesis-stress model?

Answer 73

Schizophrenia results from genetic vulnerability (diathesis) plus environmental stress.

Question 74

What is the general long-term outcome for people with schizophrenia?

Answer 74

About 38% recover well, 12% need long-term care, and one third have ongoing symptoms.

Question 75

Why do patients in less industrialized countries often have better outcomes?

Answer 75

They have less family emotional tension (lower expressed emotion, EE).

Question 76

What is clozapine and when is it used?

Answer 76

A second-generation antipsychotic, used when other medications don’t work.

Question 77

What is a major risk with clozapine?

Answer 77

It can cause a life-threatening drop in white blood cells (agranulocytosis), requiring regular blood tests.

Question 78

What are some psychosocial approaches for schizophrenia?

Answer 78

Case management, family therapy, psychoeducation, social-skills training, and cognitive remediation.

Question 79

What does cognitive remediation target?

Answer 79

Attention, memory, and other cognitive deficits to improve daily function.

Question 80

Is CBT effective for schizophrenia?

Answer 80

It helps some patients, especially with delusions and hallucinations, but results are mixed for negative symptoms.

Question 81

How can exercise help in schizophrenia?

Answer 81

Exercise can reduce symptoms, improve cognition, and counteract weight gain and cardiovascular risk from medications.

Question 82

How does estrogen affect schizophrenia symptoms in women?

Answer 82

Supplementing estrogen can reduce positive symptoms.