Module 13.3: Clinical Picture of Schizophrenia

Question 1

Delusions

Answer 1

+ An erroneous belief that is fixed and firmly held despite clear contradictory evidence
+ People with delusions believe things that others who share their social, religious, and cultural backgrounds DO NOT believe

Question 2

Percentage of Patients with Schizophrenia who have Delusions

Answer 2

90% of patients with schizophrenia have delusions

Question 3

Do all people who have delusions have schizophrenia?

Answer 3

No. Not all people who have delusions have schizophrenia, but delusions are common in schizophrenia.

Question 4

What are the different kinds of delusions?

Answer 4

1. Made feelings or impulses
2. Thought broadcasting
3. Thought insertion
4. Thought withdrawal
5. Delusions of reference

Question 5

Made feelings or impulses

Answer 5

beliefs that one’s thoughts, feelings, or actions are being controlled by external agents

Question 6

Thought broadcasting

Answer 6

one’s private thoughts are being broadcast indiscriminately to others

Question 7

Thought insertion

Answer 7

thoughts are being inserted into one’s brain by some external agency

Question 8

Thought withdrawal

Answer 8

some external agency has robbed one of one’s thoughts

Question 9

Delusions of reference

Answer 9

some neutral environment (such as a television program or a song on the radio) is believed to have special and personal meaning intended only for the person

Question 10

Hallucination

Answer 10

+ A sensory experience that seems real to the person having it, but occurs in the absence of any external perceptual stimulus
+ It can occur in any sensory modality (auditory, visual, olfactory, tactile, or gustatory)

Question 11

Illusion

Answer 11

a misperception of a stimulus that ACTUALLY EXISTS

Question 12

Hallucination vs Illusion

Answer 12

Hallucination occurs in the absence of any external perceptual stimulus, while an illusion occurs in the presence of a stimulus and is just a misperception.

Question 13

What are the most common hallucinations in patients with schizophrenia?

Answer 13

Auditory hallucinations are the most common in patients with schizophrenia

Question 14

What is the percentage of sensory hallucinations?

Answer 14

+ Auditory: 75%
+ Visual: 39%
+ Olfactory, tactile, & gustatory: 1-7%

Question 15

What kind of voices do hallucinating patients usually hear?

Answer 15

The hallucinated voices were often from people known to the patient in real life, but sometimes, unfamiliar voices or the voices of God or the devil can be heard by them

Question 16

How many voices do patients with schizophrenia hear?

Answer 16

Most heard more than one voice

Question 17

When are auditory hallucinations worst for a patient with schizophrenia?

Answer 17

It is worse when they are alone

Question 18

What are the possible tones of auditory hallucinations?

Answer 18

+ Rude and vulgar expletives; were critical (“You are stupid”)
+ Bossy (“Get the milk”)
+ Abusive (“Ugly bitch”)
+ Pleasant and supportive – this only occurred with some voices (“My darling”)

Question 19

What do neuroimaging studies say about why patients with schizophrenia have auditory hallucinations?

Answer 19

Neuroimaging studies suggest that patients with speech hallucinations have a reduction in brain (gray matter) volume in the left hemisphere auditory and speech perception areas

Reduced brain volume in these areas could lead to a failure to correctly identify internally generated speech, erroneously tagging it as coming from an external source

Question 20

What area of the brain shows increased activity in auditory hallucinating patients?

Answer 20

Hallucinating patients show increased activity in Broca’s area

Question 21

Broca’s area

Answer 21

an area of the temporal lobe that is involved in speech production

Question 22

What is a conclusion about auditory hallucinations?

Answer 22

Auditory hallucinations are a form of misperceived subvocal speech

Question 23

Disorganized Speech

Answer 23

+ The external manifestation of a disorder in thought form
+ A person fails to make sense even though they seem to use language in a conventional way and follows the right grammar rules
+ The failure is NOT attributable to low intelligence, poor education, or cultural deprivation
+ The words and word combinations sound communicative, but the listener is left with little or no understanding of the point the speaker is trying to make (e.g. use of neologisms)

Question 24

Disorganized Speech vs Delusions

Answer 24

Disorganized speech is the external manifestation of a disorder in thought FORM, while delusions reflect a disorder in thought CONTENT or in the ideas being expressed

Question 25

Formal thought disorder

Answer 25

a term clinicians use to refer to problems in the way that disorganized thought is expressed in disorganized speech

Question 26

Disorganized Behavior/Symptoms

Answer 26

+ Includes rambling speech, erratic behavior, and inappropriate affect
+ It is an impairment that can show itself in a variety of ways and can occur in areas of routine daily functioning, such as work, social relations, and self-care

Question 27

Examples of situations that showcase disorganized behavior

Answer 27

1. The person no longer maintains minimal standards of personal hygiene or may exhibit a profound disregard of personal safety and health
2. Can appear as silliness or unusual dress like wearing an overcoat, scarf, and gloves on a hot summer day

Question 28

Symptoms that fall under disorganized behavior

Answer 28

1. Inappropriate affects
2. Bizarre behaviors
3. Catatonia
4. Waxy flexibility

Question 29

Inappropriate affects

Answer 29

any behavior that is inappropriate to the situation; e.g. laughing or crying at improper times

Question 30

Bizarre behaviors

Answer 30

such as hoarding of objects or acting in an unusual way in public

Question 31

Catatonia

Answer 31

motor dysfunction that ranges from wild agitation to immobility; may show a virtual absence of all movement and speech (called catatonic stupor) or at other times, may hold an unusual posture for an extended period of time without any seeming discomfort

Question 32

Waxy Flexibility

Answer 32

tendency to keep bodies and limbs in a position placed by someone else

(if you were to move someone’s arms, they would show very light resistance, but in the end, you would still be able to move them like a waxed candle)

Question 33

Prefrontal Region of the Cerebral Cortex

Answer 33

the disruptions of behavior to impairment is attributed to the functioning of this part of the brain

Question 34

Positive symptoms

Answer 34

those that add to the experience and behavior; the symptoms that distort reality

Question 35

Symptoms under positive symptoms

Answer 35

1. Delusions
2. Hallucinations

Question 36

Negative symptoms

Answer 36

the symptoms that take away a person’s ability to live normally; refers to deficits in normal behavior such as in areas of speech, blunted affect, and motivation

Question 37

Two domains of negative symptoms

Answer 37

1. Reduced expressive behavior (voice, facial expression, gestures of speech)
2. Reduced motivation or experience of pleasure

Question 38

Symptoms under Negative Symptoms

Answer 38

1. Alogia
2. Affect flattening
3. Avolition
4. Anhedonia

Question 39

What is more damaging for the future outcome of a patient? Positive or negative symptoms?

Answer 39

Negative symptoms.

Most patients exhibit positive and negative symptoms during the course of their disorder, but the presence of negative symptoms in the clinical picture is not a good sign for the patient’s future outcome

Question 40

True or false. Patients with negative symptoms cannot feel things at all.

Answer 40

FALSE. Although patients with negative symptoms may seem emotionally unexpressive, how they appear and how they are feeling are two different things.

Studies suggest that even though patients with schizophrenia may sometimes appear emotionally unexpressive, they are nonetheless experiencing plenty of emotion

Question 41

What are the active-phase symptoms of schizophrenia?

Answer 41

1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
5. Negative symptoms

Question 42

What are active-phase symptoms?

Answer 42

These are the symptoms referred to in the Diagnostic Criterion A of schizophrenia.

Question 43

How many active-phase symptoms should be present before a person is diagnosed with schizophrenia?

Answer 43

Two or more. In addition to that, one of the symptoms should be delusions, hallucinations, and disorganized speech.

Question 44

For how long should the active-phase symptoms be present before a person is diagnosed?

Answer 44

It should be for one month or less if schizophrenia has been successfully treated.

Question 45

What are the other criteria for schizophrenia?

Answer 45

1. The person must have below their usual functioning in their work, relationships with others, or in their self-care. If they are a child or adolescent, they must be able to fail to achieve the expected level of work, academic, and interpersonal functions (or how they treat others)
2. The continuous signs of the disturbance should continue for at least 6 months (including the 1 month period of active-phase symptoms) which may include prodromal or residual periods. During prodromal or residual periods, the disturbance may be manifested by only negative symptoms or by two or more active-phase symptoms in a reduced way.
3. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because (1) no major depressive or manic episodes have happened with the active-phase symptoms or (2) the mood episodes were only experienced for a super small period during the experience of active-phase symptoms.
4. The symptoms are not because of medicine or drugs.
5. If the person has autism or communication disorder during childhood, schizophrenia is only made if the delusions and hallucinations are incredibly prominent in addition to the other symptoms of schizophrenia.