Module Three

Question 1

1. What are the five key domains of psychotic disorders, according to the DSM-5?

Answer 1

Delusions, hallucinations, disorganized thinking (speech), grossly disorganized or abnormal motor behavior (including catatonia), and negative symptoms.

Question 2

2. Define ‘delusions’ in the context of schizophrenia spectrum disorders.

Answer 2

They are fixed beliefs that are not amenable to change in light of conflicting evidence, often characterized by themes like persecution, grandiosity, or reference.

Question 3

3. What is the difference between bizarre and nonbizarre delusions?

Answer 3

Bizarre delusions are implausible and not understandable to peers (e.g., organs replaced without scars), whereas nonbizarre delusions could occur in real life (e.g., being under constant police surveillance without evidence).

Question 4

4. How do persecutory delusions manifest?

Answer 4

They involve the belief that one is being harassed, conspired against, spied on, or harmed by others, typically with no factual basis.

Question 5

5. Describe a hallmark characteristic of hallucinations in psychotic disorders.

Answer 5

They are perception-like experiences that occur without an external stimulus, are vivid, and not under the individual’s voluntary control.

Question 6

6. Which modality of hallucination is most common in schizophrenia?

Answer 6

Auditory hallucinations, such as hearing voices, are the most prevalent.

Question 7

7. What is meant by ‘disorganized thinking’ in DSM-5?

Answer 7

It refers to disorganized speech, inferred from derailment (shifting topics abruptly), tangentiality (answers unrelated to questions), or incoherence (word salad).

Question 8

8. Give an example of grossly disorganized behavior in schizophrenia.

Answer 8

Severe disruptions in goal-directed behavior, such as random, purposeless agitation or childlike silliness that interferes with daily activities.

Question 9

9. What are negative symptoms, and why are they significant in schizophrenia?

Answer 9

They are deficits in normal functioning (e.g., avolition, alogia, anhedonia, asociality), significantly contributing to morbidity and functional impairment.
Avolition
Avolition
A marked decrease in initiating or persisting with goal-directed behavior (e.g., difficulty getting out of bed, neglect of personal hygiene).

Alogia
Poverty of speech or content of speech. Individuals may give brief, empty replies or have difficulty elaborating thoughts.

Anhedonia
Reduced ability to experience pleasure or loss of interest in previously enjoyable activities.

Asociality
Lack of interest in social interactions or difficulty forming close relationships.

Affective Flattening / Blunted Affect
Reduced expression of emotions through facial expressions, voice tone, or body language

Question 10

10. Name two negative symptoms commonly seen in schizophrenia.

Answer 10

(1) Avolition (lack of motivation) and (2) diminished emotional expression (flat affect).

Question 11

11. How does the DSM-5 gradient organize schizophrenia spectrum disorders?

Answer 11

From conditions with lesser psychotic features or duration (e.g., brief psychotic disorder) to more persistent and functionally impairing disorders (e.g., schizophrenia).

Question 12

12. Briefly describe Schizotypal Personality Disorder in relation to psychosis.

Answer 12

It involves social/interpersonal deficits and perceptual distortions but typically falls below the threshold for a full-blown psychotic disorder.

Question 13

13. What defines Delusional Disorder (DSM-5 code 297.1)?

Answer 13

One or more delusions for 1 month or longer, absence of other Criterion A symptoms for schizophrenia, no significant functional impairment beyond the delusions, and if mood episodes occur, they’re brief relative to delusional periods.

Question 14

14. Name a subtype of Delusional Disorder and give an example.

Answer 14

The persecutory type—an individual may believe neighbors are plotting to harm them, despite lack of evidence.

Question 15

15. What is the duration criterion for Brief Psychotic Disorder?

Answer 15

It lasts more than 1 day but remits by 1 month.

Question 16

16. How does Schizophreniform Disorder differ from Schizophrenia in terms of duration?

Answer 16

Schizophreniform lasts less than 6 months, whereas Schizophrenia requires symptoms to persist for at least 6 months.

Question 17

17. What are the core criteria for diagnosing Schizophrenia?

Answer 17

(1) Two or more major psychotic symptoms for a significant portion of 1 month (active phase), (2) social/occupational dysfunction, (3) continuous signs for at least 6 months, excluding other disorders or substances as causes.

Question 18

18. What distinguishes Schizoaffective Disorder from Schizophrenia?

Answer 18

Schizoaffective Disorder involves a mood episode concurrent with schizophrenia symptoms, plus at least 2 weeks of delusions or hallucinations without prominent mood symptoms.

Question 19

19. Define ‘substance/medication-induced psychotic disorder.’

Answer 19

Psychosis arising directly from substance intoxication or withdrawal, where symptoms persist beyond typical intoxication or withdrawal periods.

Question 20

20. What is ‘catatonia,’ and which disorders can it occur in?

Answer 20

A marked decrease in reactivity to the environment, presenting with stupor, negativism, or rigid postures; it may occur in schizophrenia, mood disorders, or medical conditions.

Question 21

21. Describe the difference between ‘Other Specified’ and ‘Unspecified’ psychotic disorders in DSM-5.

Answer 21

‘Other Specified’ is used when a presentation does not meet criteria but the clinician specifies the reason. ‘Unspecified’ is when information is insufficient or the clinician opts not to specify a reason.

Question 22

22. How does the DSM-5 recommend assessing severity in psychotic disorders?

Answer 22

Using dimensional ratings for each primary symptom (delusions, hallucinations, disorganized speech, abnormal motor behavior, negative symptoms) on a scale (0-4) to inform clinical decisions.

Question 23

23. According to the DSM-5, name three negative symptoms associated with schizophrenia.

Answer 23

Avolition, anhedonia, and diminished emotional expression (flat affect) are examples of negative symptoms.

Question 24

24. What does ‘Criterion A’ for Schizophrenia specify?

Answer 24

At least two psychotic symptoms (e.g., delusions, hallucinations, disorganized speech, catatonic behavior, negative symptoms) for a significant portion of 1 month.

Question 25

25. Why is functional decline (Criterion B) a key component in diagnosing Schizophrenia?

Answer 25

Because it shows the impact of symptoms on daily life, demonstrating marked decline in work, interpersonal relations, or self-care compared to prior functioning.

Question 26

26. What is the significance of 'prodromal' and 'residual' phases in Schizophrenia?

Answer 26

They mark periods before or after active episodes, often characterized by subthreshold or attenuated symptoms, particularly negative symptoms.

Question 27

27. How does DSM-5 differentiate Schizophrenia from a Major Depressive or Bipolar Disorder with psychotic features?

Answer 27

In Schizophrenia, psychotic symptoms persist even outside mood episodes; in mood disorders, psychosis only occurs during mood episodes.

Question 28

28. What are common comorbid conditions with Schizophrenia?

Answer 28

Substance use disorders, depression, anxiety disorders, and increased risk of medical conditions (e.g., metabolic syndrome).

Question 29

29. How does the DSM-5 categorize Schizophrenia based on course specifiers?

Answer 29

As first episode (acute, partial, or full remission), multiple episodes (acute, partial, or full remission), continuous, or unspecified, depending on symptom course.

Question 30

30. Why is it important to exclude substance effects or medical conditions before diagnosing Schizophrenia?

Answer 30

To ensure psychotic symptoms aren’t due to intoxication, withdrawal, or a medical disorder (e.g., temporal lobe epilepsy) which can mimic schizophrenia.

Question 31

31. According to Tandon et al. (2024), name two major genetic factors implicated in schizophrenia risk.

Answer 31

Common polygenic variants (each with small effect) and rare high-impact mutations or CNVs (Copy Number Variants).

Question 32

32. How do structural brain changes often manifest in individuals with Schizophrenia?

Answer 32

Common findings include reduced gray matter volume, enlarged ventricles, and abnormalities in frontal/temporal regions.

Question 33

33. Which neurotransmitter system is most classically associated with psychosis in Schizophrenia?

Answer 33

The dopaminergic system—specifically hyperactivity in the mesolimbic pathway linked to positive symptoms and potential hypoactivity in the mesocortical pathway for negative symptoms.

Question 34

34. Name two environmental risk factors that Tandon et al. (2024) associate with Schizophrenia.

Answer 34

Early urban upbringing and cannabis use are among the factors cited.

Question 35

35. What is the typical age of onset for Schizophrenia in males versus females?

Answer 35

Males typically present in their early to mid-20s; females often show symptoms in their late 20s, with a second smaller peak after 40.

Question 36

36. Summarize the 'multifactorial etiology' concept of Schizophrenia presented by Tandon et al. (2024).

Answer 36

They emphasize an interplay of genetic predispositions, neurobiological changes (dopaminergic, glutamatergic), and environmental factors (urban living, infections, trauma), collectively contributing to the disorder.

Question 37

37. Describe how negative symptoms might lead to long-term functional impairment in Schizophrenia.

Answer 37

Negative symptoms (e.g., avolition, anhedonia) reduce motivation, social engagement, and emotional expressiveness, hindering occupational success, interpersonal relationships, and everyday functioning.

Question 38

38. How do catatonic features present in someone with Schizophrenia?

Answer 38

They can manifest as stupor, negativism, posturing, mutism, or excessive motor activity that lacks purpose, reflecting a marked psychomotor disturbance.

Question 39

39. Give one reason for the higher mortality rate in individuals with Schizophrenia.

Answer 39

Cardiovascular disease is notably higher due to lifestyle factors (smoking, sedentary behavior), antipsychotic side effects (metabolic syndrome), and possible inadequate healthcare access.

Question 40

40. Which form of antipsychotic medication is often reserved for treatment-resistant Schizophrenia?

Answer 40

Clozapine is typically used for patients unresponsive to other antipsychotics, particularly those with persistent positive symptoms.

Question 41

41. What are 'first-generation antipsychotics' known for in terms of side effects?

Answer 41

They often cause extrapyramidal symptoms (EPS), tardive dyskinesia, and other movement-related adverse effects due to strong D2 blockade.

Question 42

42. Name two second-generation (atypical) antipsychotics commonly used for Schizophrenia.

Answer 42

Examples include risperidone and quetiapine (others are aripiprazole, olanzapine, ziprasidone, etc.).

Question 43

43. Why is metabolic syndrome a concern with second-generation antipsychotics?

Answer 43

Because these medications can cause weight gain, dyslipidemia, and insulin resistance, increasing risk of obesity, diabetes, and cardiovascular disease.

Question 44

44. Apart from pharmacotherapy, which psychosocial intervention is recommended by the DSM-5 for Schizophrenia?

Answer 44

Cognitive Behavioral Therapy (CBT) is recommended to help reduce symptom severity and improve coping and adherence.

Question 45

45. How does family-based intervention help individuals with Schizophrenia?

Answer 45

It provides psychoeducation, support, and skills training to families, reducing relapse rates and improving patient outcomes.

Question 46

46. Describe 'coordinated specialty care' for first-episode psychosis.

Answer 46

It’s a multidisciplinary approach combining medication, therapy (including CBT), family support, and case management designed to treat early-stage psychosis effectively.

Question 47

47. What is 'treatment-resistant Schizophrenia'?

Answer 47

A condition where patients do not respond adequately to standard antipsychotic regimens, typically defined by persistent positive symptoms despite trials of at least two different antipsychotics.

Question 48

48. Why is early intervention crucial in Schizophrenia management?

Answer 48

Early intervention can mitigate progression of symptoms, preserve functioning, and potentially improve long-term outcomes by addressing acute psychotic symptoms quickly.

Question 49

49. What are 'positive symptoms' in Schizophrenia?

Answer 49

They are additions to normal functioning, such as hallucinations, delusions, and disorganized thinking/speech.

Question 50

50. Can Schizophrenia be diagnosed if psychotic symptoms only occur during depressive or manic episodes?

Answer 50

No. In that case, a mood disorder with psychotic features or schizoaffective disorder might be more appropriate, as Schizophrenia requires psychotic symptoms outside mood episodes.

Question 51

51. According to Tandon et al. (2024), what conceptual challenges exist regarding the definition of Schizophrenia?

Answer 51

They highlight that Schizophrenia may be a heterogeneous syndrome rather than a single disease entity, raising debates over whether it should be viewed as part of a broader psychosis spectrum.

Question 52

52. How do cultural factors influence the diagnosis of Schizophrenia?

Answer 52

Certain delusions or hallucinations may be culturally sanctioned (e.g., religious visions). Clinicians must differentiate pathological symptoms from culturally normative experiences.

Question 53

53. Summarize how childhood trauma might factor into later Schizophrenia risk.

Answer 53

Childhood adversity (abuse, neglect, or trauma) can alter stress responses and neurodevelopment, raising vulnerability to psychosis in genetically predisposed individuals.

Question 54

54. Why do Tandon et al. (2024) emphasize the importance of integrating genetic, neurobiological, and psychosocial research?

Answer 54

Because Schizophrenia arises from complex interactions among genetics, brain function, and environmental factors, a broader integrative approach may yield better diagnostic and treatment strategies.

Question 55

55. What is the role of 'thought disorder' in Schizophrenia?

Answer 55

It manifests as disorganized or incoherent speech and is a core positive symptom reflecting disrupted thought processes.

Question 56

56. Name one reason women might show a second peak of onset for Schizophrenia after age 40.

Answer 56

Late-onset Schizophrenia in women may relate to hormonal changes (e.g., post-menopausal shifts) or other protective mechanisms that wane later in life.

Question 57

57. How does suicidality factor into Schizophrenia outcomes?

Answer 57

5-6% complete suicide, and 20% make at least one suicide attempt; suicidality is influenced by depressive symptoms, social isolation, and perceived burden of illness.

Question 58

58. What are some strategies to reduce medication nonadherence in Schizophrenia?

Answer 58

Use of long-acting injectable antipsychotics, psychoeducation, motivational interviewing, and supportive psychosocial interventions can improve adherence.

Question 59

59. Why might you consider metabolic screenings in patients on antipsychotics?

Answer 59

To monitor for weight gain, glucose intolerance, and dyslipidemia, which are common side effects that heighten cardiovascular risk.

Question 60

60. What is the typical course of Schizophrenia if untreated?

Answer 60

Chronic and relapsing, with periods of active psychosis and partial remissions, leading to potential progressive functional decline.

Question 61

61. Define 'schizoaffective disorder' in a concise way.

Answer 61

A disorder characterized by an uninterrupted period of illness with both mood disorder symptoms and Criterion A schizophrenia symptoms, alongside at least 2 weeks of psychosis without prominent mood symptoms.

Question 62

62. How can catatonia present in someone without a mood or psychotic disorder?

Answer 62

They may exhibit catatonic features, such as stupor or mutism, as 'Unspecified Catatonia' or 'Catatonia Due to Another Medical Condition,' indicating no underlying primary psychiatric cause.

Question 63

63. What is the significance of cognition in Schizophrenia, as noted by Tandon et al. (2024)?

Answer 63

Cognitive deficits (in attention, memory, executive function) are central to Schizophrenia, impacting daily functioning and often persisting even during symptomatic remission.

Question 64

64. Based on Tandon et al. (2024), what future directions might improve our understanding of Schizophrenia?

Answer 64

Enhanced genetic studies, advanced neuroimaging techniques, integrative approaches combining biological and psychosocial data, and evolving diagnostic frameworks that incorporate dimensional assessments.