Schizophrenia Spectrum Disorders

Question 1

What core clinical phenomenon links all disorders on the schizophrenia spectrum?

Answer 1

Loss of contact with reality—’psychosis’—which manifests through delusions, hallucinations, disorganised thought or behaviour, and (in some cases) negative or cognitive symptoms.

Question 2

During what age range do schizophrenia-spectrum disorders most commonly emerge?

Answer 2

Late adolescence to early adulthood, roughly ages 16 – 30 (with men typically breaking a few years earlier than women).

Question 3

How does the ‘duration of untreated psychosis’ influence outcome?

Answer 3

A longer untreated period predicts poorer symptomatic and functional recovery, highlighting the value of early detection and intervention.

Question 4

What is the approximate lifetime prevalence of any psychotic experience?

Answer 4

≈ 3 % of the population.

Question 5

What is the lifetime prevalence of classic schizophrenia?

Answer 5

Approximately 0.3 – 0.7 %.

Question 6

Why is schizotypal personality disorder placed on the schizophrenia spectrum?

Answer 6

Its lifelong eccentric behaviour, odd beliefs, perceptual distortions, and social anxiety mirror attenuated positive psychotic phenomena and share genetic/neurobiological risk with schizophrenia.

Question 7

Do schizotypal individuals experience sustained hallucinations or delusions?

Answer 7

No—any psychotic-like experiences are transient or subthreshold.

Question 8

What percentage of people with schizotypal disorder eventually develop a full psychotic disorder?

Answer 8

Roughly 10 %.

Question 9

First-line management strategy for schizotypal personality disorder?

Answer 9

Psychotherapy focused on social-skills training and cognitive restructuring; low-dose atypical antipsychotics only when transient frank psychotic symptoms or severe anxiety intrude.

Question 10

Core diagnostic feature of delusional disorder?

Answer 10

Presence of one or more delusions lasting ≥ 1 month in an otherwise relatively intact psychosocial and cognitive context.

Question 11

How long must hallucinations last (if they occur) for delusional disorder still to be diagnosed?

Answer 11

Hallucinations must be brief, infrequent, and thematically related to the delusional content.

Question 12

Name the traditional DSM-5-TR delusional subtypes.

Answer 12

Persecutory, grandiose, erotomanic, jealous, somatic, and mixed.

Question 13

Typical age of onset for delusional disorder compared with schizophrenia?

Answer 13

Onset is often later—frequently after age 40.

Question 14

Mainstays of treatment in delusional disorder?

Answer 14

Second-generation antipsychotics plus cognitive-behavioural therapy aimed at dismantling belief rigidity; SSRIs when intrusive obsession-like doubts predominate.

Question 15

Minimum and maximum duration requirements for brief psychotic disorder?

Answer 15

≥ 1 day but < 1 month, followed by complete return to premorbid functioning.

Question 16

Essential symptom domains required for brief psychotic disorder?

Answer 16

At least one positive psychotic symptom: delusion, hallucination, disorganised speech, or grossly disorganised/catatonic behaviour.

Question 17

Common precipitants of brief psychotic disorder?

Answer 17

Marked psychosocial stressors, postpartum state, or cultural stress (‘brief reactive psychosis’).

Question 18

Long-term risk following an episode of brief psychotic disorder?

Answer 18

Roughly 10 – 20 % progress to schizophrenia or mood-related psychosis.

Question 19

Primary management principles for brief psychotic disorder?

Answer 19

Short-term antipsychotics, psycho-education, and relapse-warning-sign monitoring; involve family for support.

Question 20

How does schizophreniform disorder differ from schizophrenia in duration?

Answer 20

Total duration (prodrome + active + residual) is ≥ 1 month but < 6 months.

Question 21

List the four ‘good-prognosis’ specifiers in schizophreniform disorder.

Answer 21

Rapid onset (< 4 weeks), prominent confusion/perplexity, good premorbid social/occupational functioning, and absence of blunted/flat affect.

Question 22

What happens diagnostically if symptoms persist beyond six months?

Answer 22

The diagnosis converts to schizophrenia.

Question 23

Treatment approach for schizophreniform disorder?

Answer 23

Same as early schizophrenia—antipsychotics, psycho-education, family interventions—while monitoring for diagnostic conversion.

Question 24

DSM-5-TR Criterion A requirement for schizophrenia?

Answer 24

At least two of the following for ≥ 1 month, one of which must be 1, 2, or 3: 1. Delusions 2. Hallucinations 3. Disorganised speech 4. Grossly disorganised or catatonic behaviour 5. Negative symptoms.

Question 25

Minimum overall illness duration for schizophrenia (including prodrome/residual)?

Answer 25

Six months of continuous signs of disturbance.

Question 26

Which symptom domains does DSM-5-TR emphasise for severity rating?

Answer 26

Positive, negative, cognitive, mood/affective, and motor (catatonic) dimensions.

Question 27

Summarise current understanding of schizophrenia pathogenesis.

Answer 27

Polygenic risk interacting with neurodevelopmental factors—dopaminergic dysregulation, glutamatergic hypofunction, aberrant synaptic pruning, cortical thinning—plus environmental insults (perinatal complications, adolescent cannabis use).

Question 28

What fraction of individuals with schizophrenia achieve functional recovery?

Answer 28

Roughly one-third; another third have persistent but manageable symptoms; the final third experience chronic disability.

Question 29

Key components of optimal schizophrenia management.

Answer 29

Antipsychotic medication (long-acting injectables enhance adherence), CBT-p, social-skills training, supported employment, family psycho-education to reduce expressed emotion.

Question 30

Diagnostic rule that distinguishes schizoaffective disorder from mood disorder with psychotic features?

Answer 30

There must be ≥ 2 weeks of psychotic symptoms without prominent mood symptoms during the illness.

Question 31

What mood episodes can qualify in schizoaffective disorder?

Answer 31

Major depressive episode, manic episode, or both (bipolar type).

Question 32

Gender prevalence pattern in schizoaffective disorder?

Answer 32

Women are diagnosed more often, largely due to higher rates of depressive-type schizoaffective disorder.

Question 33

Evidence-based pharmacologic regimen for schizoaffective disorder.

Answer 33

Combination therapy: an antipsychotic (paliperidone ER has explicit approval) plus a mood stabiliser (lithium or valproate), adjusted per polar type; SSRIs/SNRIs for residual depression when needed.

Question 34

Why is suicide risk particularly high in schizoaffective disorder?

Answer 34

The disorder combines mood instability (as in major affective illness) with psychotic experiences, amplifying despair and impulsivity.

Question 35

Temporal relationship required between substance exposure and psychosis onset?

Answer 35

Symptoms emerge during or shortly after intoxication, withdrawal, or medication use of a known psychotogenic agent.

Question 36

Name three substances frequently implicated in substance-induced psychosis.

Answer 36

High-potency cannabis, methamphetamine (or other stimulants), hallucinogens; corticosteroids and L-dopa for medications.

Question 37

Prognosis after substance cessation?

Answer 37

Symptoms usually resolve within a month; however, persistent psychosis (especially after cannabis or stimulant use) predicts later primary psychotic disorders.

Question 38

Core therapeutic priorities for substance-induced psychosis.

Answer 38

Immediate discontinuation of the agent, short-term antipsychotic coverage, management of withdrawal, motivational interviewing, and relapse-prevention planning.

Question 39

Essential proof required for psychotic disorder due to another medical condition.

Answer 39

Evidence that the psychosis is a direct pathophysiological consequence of a specific medical illness.

Question 40

Medical conditions classically associated with secondary psychosis.

Answer 40

Temporal-lobe epilepsy, autoimmune encephalitis (e.g., anti-NMDA receptor), endocrine syndromes (Cushing disease, thyroid storm), metabolic disorders, HIV, neurosyphilis, neurodegenerative diseases.

Question 41

Characteristic sensory modality of hallucinations in medical-cause psychosis?

Answer 41

Visual or tactile hallucinations are more common than pure auditory forms.

Question 42

Mainstay of treatment for psychotic disorder due to a medical condition.

Answer 42

Aggressively treat the underlying illness; use antipsychotics symptomatically and with caution, especially when delirium risk is elevated.

Question 43

How many signs are required to diagnose catatonia according to DSM-5-TR?

Answer 43

Three or more out of twelve psychomotor features (stupor, catalepsy, waxy flexibility, mutism, negativism, posturing, mannerisms, stereotypy, agitation, grimacing, echolalia, echopraxia).

Question 44

Primary pharmacologic test-treatment for catatonia?

Answer 44

Intravenous lorazepam 1 – 2 mg, often producing dramatic response within hours.

Question 45

Definitive intervention when lorazepam fails in catatonia?

Answer 45

Electroconvulsive therapy (ECT).

Question 46

Serious medical complications that can result from untreated catatonia.

Answer 46

Malnutrition, dehydration, pressure ulcers, deep-vein thrombosis, aspiration pneumonia, and potentially lethal malignant catatonia.

Question 47

When should 'Other Specified Psychotic Disorder' be used?

Answer 47

When psychotic symptoms cause significant distress/impairment but do not meet full criteria for a named disorder, and the clinician wishes to state the specific reason (e.g., 'attenuated psychosis syndrome').

Question 48

When is 'Unspecified Psychotic Disorder' appropriate?

Answer 48

In acute care or insufficient-information settings where detailed justification is impossible or unnecessary.

Question 49

Why are these residual categories clinically important?

Answer 49

They remind clinicians to revisit diagnosis as longitudinal information emerges, avoiding premature or incorrect labelling.

Question 50

Which three temporal criteria are critical in differentiating primary psychotic diagnoses?

Answer 50

1 day to < 1 month → brief psychotic disorder; 1 month to < 6 months → schizophreniform disorder; ≥ 6 months → schizophrenia (if criteria met).

Question 51

How does schizoaffective disorder differ temporally from affective psychosis?

Answer 51

Psychotic symptoms must persist independently of mood symptoms for ≥ 2 weeks in schizoaffective disorder.

Question 52

Why must clinicians always screen for catatonia in psychosis evaluations?

Answer 52

Because catatonia can complicate any major mental or medical illness, is often life-threatening, and responds rapidly to benzodiazepines/ECT.

Question 53

What is the ultimate goal of management across the schizophrenia spectrum?

Answer 53

Functional recovery—employment, relationships, independent living—not merely symptomatic remission.