Schizophrenia Spectrum and Other Psychotic Disorders - Ch. 15

Question 1

4 phases of schizophrenia behavior

Answer 1

Phase 1 - Premorbid phase
Phase 2 - Prodromal phase
Phase 3 - Schizophrenia
Phase 4 - Residual phase

Question 2

Phase 1 - Premorbid phase

Answer 2

• Social maladjustment
• Antagonistic thoughts and behavior
• Shy and withdrawn
• Poor peer relationships
• Doing poorly in school
• Antisocial behavior

Question 3

Phase 2 - Prodromal phase

Answer 3

• Lasts from a few weeks to a few years
• Deterioration in role functioning and social withdrawal
• Substantial functional impairment
• Sleep disturbance, anxiety, irritability
• Depressed mood, poor concentration, fatigue
• Perceptual abnormalities, ideas of reference, and
  suspiciousness herald onset of psychosis

Question 4

Phase 3 - Schizophrenia

Answer 4

• In the active phase of the disorder, psychotic symptoms are prevalent
• Delusions
• Hallucinations
• Impairment in work, social relations, and self-care

Question 5

Phase 4 - Residual phase

Answer 5

Symptoms similar to prodromal phase.
Flat affect and impairment in role functioning are prominent.

Question 6

Prognosis of schizophrenia

Answer 6

A return to full premorbid functioning is not common.
Factors associated with a positive prognosis include:
 Good premorbid functioning
 Later age at onset
 Female gender
 Abrupt onset precipitated by a stressful event
 Associated mood disturbance
 Brief duration of active-phase symptoms
 Minimal residual symptoms
 Absence of structural brain abnormalities
 Normal neurological functioning
 Family history of mood disorder
 No family history of schizophrenia

Question 7

Predisposing factors of schizophrenia: Biological Influences

Answer 7

Biological influences:
- Genetics: genetics plays an important role in the development of schizophrenia.
- Biochemical influences: One theory suggests that schizophrenia may be caused by an excess of dopamine activity in the brain. Abnormalities in other neurotransmitters have also been suggested.
- Physiological influences: Viral infection, Anatomical abnormalities, Electrophysiology, Epilepsy, Huntington’s Disease, Birth trauma, Head injury in adulthood, Alcohol abuse, Cerebral tumor, Cerebrovascular accident, Systemic lupus erythematosus

Question 8

Predisposing factors of schizophrenia: Psychological Influences

Answer 8

NONE MOTHERFUCKER - These theories no longer hold credibility. Researchers now focus their studies of schizophrenia as a BRAIN DISORDER.
Psychosocial theories probably developed early on out of
a lack of information related to a biological connection.

Question 9

Predisposing factors of schizophrenia: Enviromental Influences

Answer 9

 Sociocultural factors: Poverty has been linked with the
development of schizophrenia.
 Downward drift hypothesis: Poor social conditions seen as consequence of, rather than a cause of schizophrenia.
 Stressful life events may be associated with
exacerbation of schizophrenic symptoms and increased
rates of relapse.
 Studies of genetic vulnerability for schizophrenia have
linked certain genes to increased risk for psychosis and
particularly for adolescents who use cannabinoids.

Question 10

Predisposing factors of schizophrenia: Theoretical integration

Answer 10

Schizophrenia is most likely a biologically based disease, the onset of which is influenced by factors in the internal or external environment.

Question 11

Delusion disorder: definition and types

Answer 11

The existence of prominent, nonbizarre delusions.
 Erotomanic type
 Grandiose type
 Jealous type
 Persecutory type
 Somatic type
 Mixed type

Question 12

Brief psychotic disorder: definition

Answer 12

 Sudden onset of symptoms
 May or may not be preceded by a severe
psychosocial stressor
 Lasts less than 1 month.
 Return to full premorbid level of functioning.

Question 13

Substance-induced psychotic disorder: definition

Answer 13

The presence of prominent hallucinations and
delusions that are judged to be directly attributable to
substance intoxication or withdrawal

Question 14

Psychotic disorder associated with another medical condition: definition

Answer 14

Prominent hallucinations and delusions are directly attributable to a general medical condition.

Question 15

The catatonic features specifier

Answer 15

Catatonic features may be associated with other psychotic disorders, such as brief psychotic disorder, schizophreniform disorder, schizophrenia, schizoaffective disorder, and substance-induced psychotic disorder.

Question 16

Symptoms of catatonic disorder

Answer 16

Stupor and muscle rigidity or excessive, purposeless motor activity, Waxy flexibility, negativism, echolalia, echopraxia

Question 17

Catatonic disorder associated with
another medical condition: define

Answer 17

This diagnosis is made when the catatonic symptoms
are directly attributable to the physiological
consequences of a general medical condition.

Question 18

Schizophreniform disorder: define

Answer 18

Same symptoms as schizophrenia with the exception
that the duration of the disorder has been at least 1 month but less than 6 months

Question 19

Schizoaffective disorder: define

Answer 19

Schizophrenic symptoms accompanied by a strong
element of symptomatology associated with the mood disorders either mania or depression

Question 20

Positive vs. negative symptoms in psychotic disorders

Answer 20

Positive sx: something added – hallucinations, delusions, cognitive distortions.

Negative sx: something taken away – flat affect (affect taken away), anhedonia (energy taken away), etc.
Negative sx will be the baseline for someone with schizophrenia that they will have to learn to live with once theyre are in the postdromal stage

Question 21

Content of though symptoms - delusions, religiosity, paranoia, and magical thinking (positive symptoms)

Answer 21

Delusions: False personal beliefs

Religiosity: Excessive demonstration of obsession with religious ideas and behavior

Paranoia: Extreme suspiciousness of others

Magical thinking: Ideas that one’s thoughts or behaviors have control over specific situations

Question 22

Form of thought symptoms - Associative looseness, neologisms, concrete thinking, clang associations (positive symptoms)

Answer 22

 Associative looseness (also called loose association): Shift
of ideas from one unrelated topic to another

 Neologisms: Made-up words that have meaning only to the
person who invents them

 Concrete thinking: Literal interpretations of
the environment

 Clang associations: Choice of words is governed by sound
(often rhyming)

Question 23

Form of thought symptoms - Word salad, circumstantiality, tangentiality, mutism, and perseveration (positive symptoms)

Answer 23

 Word salad: Group of words put together in a
random fashion

 Circumstantiality: Delay in reaching the point of a communication because of unnecessary and tedious details

 Tangentiality: Inability to get to the point of communication due to introduction of many new topics

 Mutism: Inability or refusal to speak

 Perseveration: Persistent repetition of the same word or idea in response to different questions

Question 24

Hallucinations: define & types (positive symptom)

Answer 24

Hallucinations: False sensory perceptions NOT associated with real external stimuli (something that is NOT there)
− Auditory
− Visual
− Tactile
− Gustatory
− Olfactory

Question 25

Illusions/Delusions: define (positive symptoms)

Answer 25

Illusions/Delusions: Misperceptions of real external stimuli

Question 26

Sense of self symptoms - echolalia, echopraxia, identification and imitation, and depersonalization (positive symptoms)

Answer 26

 Echolalia: Repeating words that are heard.

 Echopraxia: Repeating movements that are observed.

 Identification and imitation: Taking on the form of behavior one observes in another.

 Depersonalization: Feelings of unreality.

Question 27

Affect symptoms - inappropriate affect, bland, flat, apathy (negative symptoms)

Answer 27

 Inappropriate affect: Emotions are incongruent with the circumstances.

 Bland: Weak emotional tone

 Flat: Appears to be void of emotional tone.

 Apathy: Disinterest in the environment

Question 28

Avolition definition

Answer 28

Avolition: Impairment in the ability to initiate goal-directed activity.

Question 29

Avolition symptoms - emotional ambivalence and deterioration in appearance (negative symptoms)

Answer 29

Emotional ambivalence: Coexistence of opposite emotions toward same object, person, or situation.

Deterioration in appearance: Impaired personal grooming and self-care activities.

Question 30

Interpersonal symptoms - impaired social interaction and social isolation (negative symptoms)

Answer 30

Impaired social interaction: Clinging and intruding on
the personal space of others, exhibiting behaviors that.
are not culturally and socially acceptable.

Social isolation: A focus inward on the self to the
exclusion of the external environment.

Question 31

Lack of insight symptoms: anosognosia, anergia, anhedonia (negative symptoms)

Answer 31

Anosognosia: Lack of awareness of any illness or disorder.

Anergia: deficiency of energy.

Anhedonia: Inability to experience pleasure.

Question 32

Other negative symptoms - waxy flexibility, posturing, pacing and rocking, regression, and eye movement abnormalities.

Answer 32

Waxy flexibility: Passive yielding of all movable parts
of the body to any effort made at placing them in certain positions

Posturing: voluntary assumption of inappropriate or bizarre postures

Pacing and rocking: Pacing back and forth and rocking
the body

Regression: Retreat to an earlier level of development

Eye movement abnormalities

Question 33

Recovery after an initial schizophrenia episode (RAISE)

Answer 33

A program of case management that takes a team
approach in providing comprehensive, community-based psychiatric treatment, rehabilitation, and support to persons with serious and persistent mental illness

Question 34

Typical (first gen) antipsychotic action

Answer 34

Typicals: Dopaminergic blockers with
various affinity for cholinergic, α-adrenergic, and histaminic receptors.

Question 35

Atypical (second gen) antipsychotic action

Answer 35

Atypicals: Weak dopamine antagonists; potent 5HT2A antagonists; also exhibit antagonism for cholinergic, histaminic, and adrenergic receptors.