Schizophrenia and Psychosis

Question 1

Psychosis

Answer 1

The inability to distinguish between reality and unreality

Question 2

Egen Bleuler’s take on Schizophrenia

Answer 2

Splitting of usually integrated psychic functions of mental associations, thoughts, emotions not splitting of personalities

Question 3

Psychotic symptoms

Answer 3

• Negative Symptoms
• Delusions
• Hallucinations
• Disorganized thought
• Disorganized behaviour

Question 4

Schizophrenia Spectrum

Answer 4

Number, severity and duration of symptoms can vary
- Distinguishes the psychotic disorders form one another
- cognitive deficits also common

Question 5

Delusions

Answer 5

• False, unshakable beliefs that are held with strong conviction despite contradictory evidence
• Inappropriately high meaning and attention to irrelevant events
• Different from self-deceptions (possible, attended to occasionally, acknowledged that could be incorrect)

Question 6

Hallucinations

Answer 6

• False or inaccurate perceptions that cause one to sense what others do not
• Auditory verbal hallucinations are most common (70-80% of people with schizophrenia)
• Visual hallucinations (24-72 with schizophrenia)

Question 7

Prevalence of types of hallucinations

Answer 7

MOST COMMON
Auditory
Visual
Somatic, Tactile
Olfactory, Gustatory
LEAST COMMON

Question 8

Neuroscience and Hallucinations

Answer 8

• Auditory hallucinations produce signals of sound - brain ‘hears’ them
• Activity in Broca’s area (production of sounds, including speech)
• Activity in areas that perceive sound
• Recognized as sounds coming from within

Question 9

Formal thought disorder

Answer 9

Disorganized thinking
- Not a disorder, thought is in disorder

Question 10

Loose associations

Answer 10

Slipping from one topic to seemingly unrelated topic

Question 11

Neologisms

Answer 11

Made-up words that mean something only to the speaker

Question 12

Clangs

Answer 12

Words associated by sound not content (rhyming)

Question 13

Disorganized thought and speech

Answer 13

• Formal Thought disorder
• Loose associations
• Neologisms
• Clangs
• Can be incoherent, speaking in ‘word salad’
• Men show more language deficits than women

Question 14

Disorganized Behavior

Answer 14

• Unpredictable, apparently untriggered agitation
• Difficulty organizing daily routines
• socially unacceptable behavior
• Catatonia

Question 15

Catatonia

Answer 15

Noticeable psychomotor dysfunction; decreased or excessive peculiar motor activity
- Negativism: lack of response to instructions
- Mutism: lack of verbal or motor responses
- Catatonic excitement: purposeless excessive motor movement

Question 16

Negative Symtpoms

Answer 16

Loss of certain qualities
- Restricted Affect
- Alogia
- Avolition
- Asociality
More strongly associated with poor outcomes than positive symptoms (more persistent, difficult to treat)

Question 17

Restricted Affect

Answer 17

Severe reduction or absence of emotional expression

Question 18

Alogia

Answer 18

Reduction of speech

Question 19

Avolition

Answer 19

Inability to initiate or persist at common goal-directed activities

Question 20

Asociality

Answer 20

Lack of desire to interact with people

Question 21

Cognitive Deficits

Answer 21

• Affecting attention, memory, and processing speed
• Difficulty paying attention to relevant information and suppressing unwanted or relevant information (poor filtering of stimulation and information) (may contribute to positive symptoms)
• Commonly experienced before disorder onset
• Family members commonly experience these symptoms, but to a lesser degree

Question 22

Chrobak et al. eye tracking study

Answer 22

• Participants asked to keep head still and track a moving object back and forth with eyes
• Patients with schizophrenia scored worse on smooth-pursuit eye movement (may be related to attention problems

Question 23

Diagnosing Schizophrenia

Answer 23

• Two psychotic symptoms must be consistently and acutely present at least 1 month
• at least one symptom should be hallucinations, delusions, or disorganized speech
• an acute phase
• Other symptoms that impair functioning must be present for at least 6 months

Question 24

Acute phase

Answer 24

period involving consistent and intense psychotic symptoms

Question 25

Schizophrenia prevalence

Answer 25

1% lifetime prevalence in Canada

Question 26

Stages of schizophrenia

Answer 26

Premorbid - no or few symptoms Prodromal - Attenuated symptoms (6 month period, mild psychotic symptoms causing functional decline) Syndromal - Psychotic symptoms (acute period - 1 month to 1 year) Chronic or Residual - Psychotic symptoms, negative symptoms, cognitive symptoms, functional disability (Mild symptoms)

Question 27

Schizophrenia onset

Answer 27

- Earlier onset = worse prognosis - Not common to emerge before 13 - onset usually after puberty - May see cognitive deficits or negative symptoms before - Rare to have onset after 40

Question 28

Schizoaffective

Answer 28

- Psychotic symptoms mixed with mood symptoms - Major depressive OR manic episodes - At least two weeks of hallucinations or delusions without mood symptoms

Question 29

What is the order of functionality impairment of schizophrenia related disorders?

Answer 29

MOST IMPAIRMENT - Schizophrenia - Schizoaffective - Brief Psychotic Disorder - Delusional Disorder - Schizotypal personality disorder

Question 30

Schizophreniform

Answer 30

Only 1-6 months of symptoms - 2/3/ go on to meet criteria for schizophrenia

Question 31

Brief Psychotic Disorder

Answer 31

Sudden onset of symptoms - Common after major stressor but doesn't have to happen Lasts 1-30 days followed by complete remission - Usually only positive symptoms - Relapse is common

Question 32

Delusional Disorder

Answer 32

- Delusions about real-life occurrences for at least one month - no other psychotic symptoms, no other changes in functioning - Not a psychotic disorder but puts people at higher risk

Question 33

Heritability of schizophrenia

Answer 33

41-87%

Question 34

Biological approach to theories of schizophrenia

Answer 34

- Reduction in gray matter across cortex - Reduction in white matter in areas associated with working memory (also seen in family members without schizophrenia - Abnormal activity in PFC - Enlarged ventricles - Prenatal exposures and birth complications - Excess dopamine in PFC and limbic system (increased HPA axis activity may cause changes in dopamine production, antipsychotic medication works to block dopamine receptors)

Question 35

Psychosocial Contributors to schizophrenia

Answer 35

- More likely to emerge in chronically stressful circumstances - living in populated areas - Childhood trauma linked with adulthood psychosis

Question 36

Goldberg and Morrison study on schizophrenia and SES

Answer 36

- Men with schizophrenia end up with lower SES than their fathers - Men without schizophrenia end up in similar or higher SES than fathers - Social drift as a reuslt