schizophrenia and psychosis

Question 1

how were schizophrenia/psychotic disorders first conceptualized? by whom?

Answer 1

• Emile Kraeplin first proposed groupings of psychotic symptoms
• dementia praecox: a disorder with progressive deterioration beginning at an early age, characterized by disorganized thinking
• encompassed what later became divided into bipolar and schz

Question 2

who first introduced the term “schizophrenia”? how was it defined at the time?

Answer 2

• Eugen Bleuler c. 1911
• challenged Kraepelin’s ideas that dementia praecox was necessarily characterized by deterioration and always appeared at an early age
• considered schz to be a group of disorders characterized by disorganization of thought and a split from reality

Question 3

what are the 6 major symptoms of schizophrenia?

Answer 3

1. disturbances in perceptions
2. disturbances in content of thought
3. disturbances in form of thought
4. psychomotor disturbances
5. disordered relating

Question 4

what is the difference between illusions and hallucinations?

Answer 4

• illusion: stimulus is present but misperceived
• hallucination: stimulus is not present but perceived, or present but not perceived

Question 5

what is a delusion?

Answer 5

a firmly held false belief based on incorrect inference, which is maintained despite contradictory evidence

Question 6

what are the 13 types of delusions?

Answer 6

1. control by outside force
2. grandiosity
3. nihilistic
4. persecutory
5. jealousy
6. somatic
7. delusions of reference
8. thought withdrawal
9. thought insertion
10. thought diffusion/broadcasting
11. made impulses
12. made feelings
13. made volitional acts

Question 7

what are the 6 forms of disturbances in thought in people with schz?

Answer 7

1. derailment
2. word salad
3. alogia (saying little)
4. neologisms (new word or new meaning)
5. blocking (stopping abruptly)
6. illogical thinking

Question 8

what are the 3 forms of disturbances in affect in people with schz?

Answer 8

1. blunted/flat affect
2. context-inappropriate affect
3. problems perceiving others’ emotions

Question 9

what are the symptoms of catatonia?

Answer 9

1. catalepsy/waxy flexibility (doll-like)
2. stupor (immobile, unresponsive)
3. posturing
4. mutism
5. catatonic excitement
6. catatonic negativism (immobile, resists efforts to be moved)
7. echolalia (repeating words)
8. echopraxia (repeating movement)

Question 10

what are the 4 different forms of disordered relating in people with schz?

Answer 10

1. socially withdrawn
2. preoccupied with fantasy world
3. disordered volition (acting without purpose)
4. anhedonia

Question 11

what is the diagnostic criteria for schizophrenia? (criterion A, how many other symptoms, time period, what needs to be ruled out)

Answer 11

• criterion A: at least one of delusions, hallucinations, or disorganized speech/behaivour; markedly lower level of functioning prior to onset
• (if only meet 1 of criterion A) + at least one of abnormal motor activity or negative symptoms
• 6+ months, with at least 1 month of active symptoms
• cannot be attributed to substance use, unipolar or bipolar depression, or schizoaffective disorder

Question 12

what is the diagnostic criteria for schizoaffective disorder?

Answer 12

1. must currently meet criteria for depressed mood
2. must experience delusions or hallucinations for 2+ weeks in the absence of a mood episode

Question 13

what is the prevalence of schizophrenia?

Answer 13

0.7-1%

Question 14

what is the gender difference in the prevalence of schizophrenia? why does it exist?

Answer 14

• slightly more common in men, childhood onset is far more common in boys
• possible diagnostic bias: women present with more symptoms of depression and are more likely to be misdiagnosed
• possible that female sex hormones are protective, which is why we see late onset schizophrenia

Question 15

how does childhood schizophrenia usually present?

Answer 15

• insidious onset
• early speech and language problems
• delayed motor development, poor coordination

Question 16

how common is it for people with schz to live independently?

Answer 16

only 20-30% live alone or have a job

Question 17

according to a 15-year study, how common is recovery in people with schizophrenia, even if only periodic?

Answer 17

• only 40% had one or more periods of recovery
• this percentage is higher in developing countries, though it’s not clear why

Question 18

what is the avg life span of people which schz? why?

Answer 18

• 20 yrs less than gen pop
• suicide is main contributor, followed by cardiovascular disease (due to stress, substance use, pharmacological side effects)

Question 19

what prognostic indicators may predict a better outcome in people with schz

Answer 19

1. good premorbid adjustment
2. acute onset
3. manic and depressive symptoms
4. confusion or disorientation during psychosis
5. family history of mood disorder

Question 20

what prognostic indicators may predict a worse outcome in people with schz?

Answer 20

1. poor premorbid adjustment
2. insidious, gradual onset
3. negative symptoms, especially blunted affect
4. family history of schz
5. lower IQ (according to some studies)

Question 21

what % of people with schz attempt suicide? how many die by suicide?

Answer 21

20% attempt, 5% die

Question 22

what is the relationship between schz and aggression?

Answer 22

• slight increase in risk of violent aggression for people with schz
• aggression is most common in younger male patients with a history of violence or substance abuse
• majority of schz patients are more likely to be victims than perpetrators of violence

Question 23

what are the 8 main risk factors for schz?

Answer 23

1. low SES/social status
2. advanced paternal age at conception
3. birth complications, especially those leading to anoxia
4. prenatal exposure to viral infections, especially during 2nd trimester
5. born during late winter/early spring (more pronounced further from the equator)
6. malnutrition during pregnancy
7. disruptions in neural migration during 2nd trimester
8. decreased brain volume/grey matter deficits

Question 24

what is the dopamine hypothesis of schizophrenia?

Answer 24

• dopamine hypersensitivity can be caused by birth complications, which may increase risk of schizophrenia
• positive relationship between dopamine levels and psychotic tendencies
• high dopamine levels associated with aberrant salience, failure to respond to meaningful reward cues, abnormal oral-facial movements and upper-limb dyskinesias, and working memory deficits

Question 25

what is the proposed relationship between cannabis and schz?

Answer 25

- causal relationship is unclear - THC increases dopamine synthesis - cannabis can exacerbate symptoms in people with the disorder

Question 26

what is the relationship between expressed emotion in families and schz

Answer 26

- families high on EE (criticism, hostility, emotional over-involvement) may worsen outcomes for children with schz - high EE families are most likely to see schizophrenic children with odd and disruptive behaviour (while both high and low EE families had children with negative symptoms) - high EE is non-specific, as it also predicts worse outcomes in children with bipolar and depression, but seems to be protective for BPD

Question 27

what is the multiple hit model of schz development?

Answer 27

1. genetic factors + prenatal and perinatal effects -> brain vulnerability 2. brain vulnerability + stress + developmental maturation process -> psychosis

Question 28

what type of treatment sees the most promising effects in schz patients?

Answer 28

- biobehavioural therapy: combines antipsychotic meds with psychosocial treatment - medication lessens biological vulnerability, while training in social and independent living skills can reduce behavioural vulnerability - family counselling and support services can reduce degree of life stress

Question 29

how do we differentiate between schz and bipolar I?

Answer 29

- schz has no manic episode - psychotic symptoms in bipolar respond to lithium, while those in schz do not

Question 30

how do we differentiate between schz and schizoaffective disorder

Answer 30

schizoaffective has more prominent mood episodes that occur for the majority of the illness

Question 31

how do we differentiate between schz and cluster A PDs

Answer 31

- cluster A PDs tend to not have as severe positive symptoms; less likely to have full blown delusions or hallucinations - cluster A PDs are associated with lower levels of impairment in daily functioning

Question 32

how do we differentiate between schz and delusional disorder?

Answer 32

- delusional disorder's psychotic symptoms are usually restricted to one or few delusions, in contrast with multiple psychotic symptoms that occur in schz - delusional disorder's delusions are only sometimes accompanied by hallucinations, which are non-prominent, and directly relevant to the delusion

Question 33

how do we differentiate between schz and brief psychotic disorder

Answer 33

brief psychotic disorder symptoms occur for <1 month and resolve on their own, returning to a normal level of functioning

Question 34

how do we differentiate between schz and schizophrenoform disorder

Answer 34

- schizophrenoform is diagnosed when a person has schz symptoms for between 1 and 6 months - has a better prognosis than schz