Week 1

Question 1

What are the main features of psychosis, and how do they affect perception, thought, and behavior?

Answer 1

Psychosis involves an altered experience of reality where perception, thinking, and emotions are distorted. The three core symptoms are:

Delusions – persistent, false beliefs not shared by others in one’s culture and resistant to evidence (e.g., persecution, reference, grandiosity).

Hallucinations – vivid, involuntary perceptual experiences without external stimuli, affecting any sense (most commonly auditory).

Disorganised thinking, speech, and behavior – incoherent or associative speech, erratic or rigid movements, and unpredictable behavior.

Question 2

What are the different types of delusions in psychosis, and how do they manifest?

Answer 2

Persecutory delusions – belief that one is being watched, targeted, or harmed.

Referential delusions – belief that neutral events (e.g., a news anchor’s speech) are directly related to oneself.

Grandiose delusions – belief that one has exceptional powers, talents, or a special role.

Question 3

Which type of hallucination is most common in psychosis?

Answer 3

Auditory hallucinations (e.g., hearing voices).

Question 4

What defines hallucinations, and in which sensory modalities can they occur?

Answer 4

Hallucinations are vivid, involuntary perceptual experiences without external stimuli. They can be:

Auditory (most common): hearing voices or sounds with no source.

Visual, tactile, olfactory, or gustatory: less common but possible.
People experience them as real and have no control over them.

Question 5

How does disorganised thinking, speech, and behavior present in psychosis?

Answer 5

Speech/thought: Incoherent, tangential, or associative language (derailment, word salad).

Behavior: Erratic movements, clumsiness, restlessness, or rigidity (e.g., catatonia – holding abnormal postures or becoming immobile).
Disorganisation reflects disrupted information processing.

Question 6

What are negative symptoms in psychosis and how do they impact functioning?

Answer 6

Negative symptoms are reductions in normal functions and include:

Emotional flattening – reduced affect and facial expression.

Apathy and anhedonia – lack of motivation or pleasure.

Speech impediment – minimal speech or reduced intonation.

Initiative loss and lethargy – diminished energy and interest.

Question 7

What cognitive and affective symptoms may accompany psychosis?

Answer 7

Cognitive symptoms: Impaired working memory, attention, planning, reasoning, and problem-solving.

Affective symptoms: Depression, anxiety, or manic states. These can co-occur with or independently of psychotic symptoms

Question 8

In which other conditions can psychotic symptoms appear, and what does this indicate?

Answer 8

Psychotic symptoms may appear in:

Mood disorders: Bipolar and depressive disorder.

Personality disorders.

Neurodegenerative disorders: Parkinson’s, Alzheimer’s, Lewy body dementia.
This overlap suggests shared underlying mechanisms across disorders.

Question 9

What is the dimensional approach to psychiatric disorders, and how does it differ from classical diagnosis?

Answer 9

The dimensional approach focuses on five symptom dimensions:

Psychotic, 2. Manic, 3. Depressive, 4. Negative, 5. Cognitive.
Unlike categorical models (e.g., schizophrenia vs. bipolar), it treats symptoms as existing on a continuum, with varying severity and impact.

Question 10

What does “staging” mean in the context of psychosis, and how is it useful?

Answer 10

Staging categorizes psychotic disorders into different clinical stages based on:

Severity of symptoms

Impact on functioning

Appropriate interventions
This model guides early intervention and personalized treatment planning.

Question 11

What was Kraepelin’s role in the early classification of psychotic disorders?

Answer 11

Kraepelin introduced the distinction between:

Dementia praecox: A chronic, deteriorating disorder (now schizophrenia) with poor prognosis.

Manic depression: A cyclic disorder with better prognosis (now bipolar disorder).
He viewed mental illness as biologically based and focused on illness course.

Question 12

How did Kraepelin differentiate dementia praecox and manic depression?

Answer 12

Dementia praecox: Progressive cognitive/social decline, with symptoms like delusions and apathy.

Manic depression: Episodic illness, better recovery, no long-term cognitive decline.

Question 13

How did Bleuler redefine schizophrenia, and what was his key insight?

Answer 13

Bleuler coined “schizophrenia” in 1911. He:

Emphasized variability in prognosis.

Proposed a dimensional view—continuum between normal and psychotic experience.

Described loss of integration between emotion and cognition.

Incorporated social and psychological factors into understanding and treatment.

Question 14

What is the biopsychosocial model, and how did Bleuler contribute to it?

Answer 14

The model integrates biological, psychological, and social factors in mental illness. Bleuler contributed by:

Recognizing biological bases

Also emphasizing cognitive-emotional disintegration and social environment

Advocating holistic treatment approaches

Question 15

What recent scientific evidence suggests a shared basis for psychiatric disorders?

Answer 15

Studies (e.g., Wu et al., 2020) show overlapping genetic risk factors across disorders like schizophrenia, bipolar disorder, and depression. This supports moving toward dimensional rather than categorical diagnostics (Van Os & Kapur, 2009).

Question 16

Why did clinical focus shift from negative to positive symptoms in the 1960s?

Answer 16

Because positive symptoms (hallucinations, delusions, disorganised thought) are:

More observable

More responsive to antipsychotic medications
This made them more practical for diagnosis and treatment, though negative symptoms remain crucial for functional outcomes.

Question 17

What treatment model did Bleuler help pioneer?

Answer 17

The biopsychosocial model, integrating biological, psychological, and social factors.

Question 18

What is catatonia?

Answer 18

A state of immobility or excessive motor activity, often with rigid postures or repetitive movements.

Question 19

What are the DSM-5 criteria for a schizophrenia diagnosis?

Answer 19

A person must have at least two of the following symptoms for at least 6 months, with at least one from the first three:

• Hallucinations
• Delusions
• Disorganised speech
• Disorganised or chaotic behaviour

Negative symptoms
Additionally, there must be a significant decline in social or occupational functioning.

Question 20

Why can clinical presentation vary greatly between individuals with schizophrenia?

Answer 20

Because the DSM-5 requires only 2 out of 5 possible symptoms, the combination of symptoms (e.g., hallucinations vs. disorganisation) can differ widely between individuals.

Question 21

What cognitive issues are common in schizophrenia, and are they part of diagnostic criteria?

Answer 21

Impairments in memory, attention, and executive function are common but not included in the formal DSM-5 criteria, despite recognition by Kraepelin and Bleuler.

Question 22

Are positive and negative symptoms unique to schizophrenia?

Answer 22

No. They also appear in bipolar disorder (especially during manic/depressive episodes) and psychotic depression.

Question 23

What are the hallmark symptoms of a manic episode?

Answer 23

Euphoric or irritable mood

Excessive activity (e.g., starting projects impulsively)

Grandiose delusions

Rapid speech, racing thoughts

Easily distracted

Possible irritability or angry tirades

Question 24

What characterises a depressive episode and when can psychosis occur?

Answer 24

Depressive episodes involve sadness, irritability, and loss of interest, often with cognitive and physical symptoms.
Psychotic symptoms (hallucinations/delusions) can occur during severe depression or bipolar episodes.

Question 25

When does schizophrenia typically start, and what life phase does it disrupt?

Answer 25

Between ages 15–30, during a critical time for education, social development, and career-building—leading to major social and functional disruptions.

Question 26

What are the recovery rates for schizophrenia after the first psychosis?

Answer 26

13% recover after 2 years 38% recover on average after 13 years Recovery is now viewed more broadly to include daily and social functioning, not just symptom reduction.

Question 27

Do people with schizophrenia continue to have impairments even after psychotic symptoms subside?

Answer 27

Yes. Negative symptoms and cognitive deficits often persist and especially affect social functioning.

Question 28

What are the incidence and prevalence of schizophrenia?

Answer 28

Incidence: ~15 per 100,000 per year Prevalence: ~3 per 1,000 people (Data from Saha et al., 2008)

Question 29

What populations are at higher risk of developing schizophrenia?

Answer 29

Men (4x more than women) Urban dwellers (2x more than rural) Migrants (3–5x more than non-migrants) People born in winter/spring Residents of high-income countries

Question 30

What is the incidence and recovery course of bipolar disorder?

Answer 30

Incidence: ~7 per 100,000 per year Prevalence: 1–4% (based on criteria) 81–100% reach a euthymic phase (symptom-free) 78% relapse within 8 years

Question 31

How common are psychotic episodes in bipolar and depressive disorders?

Answer 31

40–60% of people with bipolar disorder 15–25% of people with depression Psychotic symptoms worsen illness course and severity.

Question 32

What factors negatively affect the course of bipolar disorder?

Answer 32

Family history of bipolar disorder Substance use disorder Sexual abuse Suicidality Symptom severity

Question 33

Beyond symptoms, what problems are common in bipolar and psychotic depression?

Answer 33

Issues in social relationships, family dynamics, and employment are frequent and can persist between episodes.

Question 34

What is late-onset psychosis and how does it differ from primary psychotic disorders?

Answer 34

Occurs after age 40 Often due to other conditions (e.g., delirium, substance use, dementia) Requires careful differential diagnosis as causes and symptoms may differ from schizophrenia

Question 35

How does psychosis manifest differently in dementia compared to schizophrenia?

Answer 35

Dementia: more visual hallucinations, fewer relational/bizarre delusions Schizophrenia: more auditory hallucinations, common bizarre delusions

Question 36

How does age of onset affect prognosis in psychotic disorders?

Answer 36

The earlier the onset, the less favourable the long-term outcome and course of the illness.

Question 37

What is the incidence and prevalence of psychotic depression?

Answer 37

ncidence: 3–7 per 100,000 per year Prevalence: 0.35–0.6% Diagnosis and rates vary by criteria used

Question 38

When are people usually diagnosed with bipolar or psychotic depression?

Answer 38

Most diagnoses occur between ages 21–23 But adolescent depression may be the first sign, especially for bipolar disorder

Question 39

What are psychotic symptoms considered in terms of cognitive function?

Answer 39

Delusions and hallucinations are themselves considered cognitive disorders.

Question 40

What is the first factor in Van der Gaag's (2006) four-factor model of psychosis development?

Answer 40

Dysregulated dopamine increases (bottom-up/neurobiological factor) lead to intense perception of internal/external stimuli.

Question 41

What is the second factor in Van der Gaag's model?

Answer 41

Top-down cognitive evaluation through inductive/deductive reasoning to assign meaning to stimuli.

Question 42

What is the third factor in Van der Gaag’s model?

Answer 42

Cognitive tendencies like excessive attention to danger, jumping to conclusions, expectancy bias, and Theory of Mind disruptions.

Question 43

What is the fourth factor in Van der Gaag’s model?

Answer 43

Consolidation—reinforcement of delusions via selective attention, memory bias, and avoidance behavior.

Question 44

How has the understanding of cognitive symptoms changed over time in schizophrenia research?

Answer 44

Previously overlooked, cognitive impairments are now considered core symptoms, especially post-20th century.

Question 45

Are cognitive symptoms included in DSM-5 criteria for schizophrenia?

Answer 45

No, though many researchers advocate for their inclusion.

Question 46

Can cognitive symptoms appear before full onset of psychosis?

Answer 46

Yes, especially in schizophrenia; sometimes even in high-risk individuals.

Question 47

Who else often shows cognitive impairment aside from patients?

Answer 47

First-degree relatives of people with schizophrenia and bipolar disorder.

Question 48

Which disorders show the highest levels of cognitive impairment according to Abramovitch et al. (2021)?

Answer 48

Schizophrenia and bipolar disorder with psychotic feature

Question 49

Which cognitive domains are most impaired in schizophrenia?

Answer 49

Attention, executive functioning, memory, and processing speed.

Question 50

How does long-term medication use affect cognition in schizophrenia?

Answer 50

Especially impacts the speed of information processing.

Question 51

Is cognitive decline in schizophrenia progressive?

Answer 51

No, it's relatively stable over time and comparable to normal aging.

Question 52

How do cognitive impairments in bipolar disorder compare to schizophrenia?

Answer 52

Present but generally milder and more variable based on mood episodes.

Question 53

How do mood episodes affect cognition in bipolar disorder?

Answer 53

Manic episodes impair verbal learning; depressive episodes impair verbal fluency.

Question 54

Which cognitive domains are especially impaired in bipolar patients with psychosis?

Answer 54

Verbal memory, executive function, working memory, and processing speed.

Question 55

What is social cognition, and which processes does it include?

Answer 55

Higher-order neuropsychological processes for social interaction, including emotion regulation, Theory of Mind, and attributional style.

Question 56

How is social cognition impaired in schizophrenia?

Answer 56

Problems in face recognition, speech prosody, Theory of Mind, and emotion regulation.

Question 57

How do cognitive impairments affect daily life in schizophrenia?

Answer 57

They hinder planning, memory, and attention, affecting independence, social life, and job performance.

Question 58

Is cognitive functioning or positive symptoms a better predictor of daily functioning in schizophrenia?

Answer 58

Cognitive functioning is a stronger predictor, especially for occupational functioning.

Question 59

What is the current dominant model for understanding the development of psychotic disorders?

Answer 59

The biopsychosocial model, which incorporates biological, psychological, and social factors.

Question 60

Which factors increase the risk of developing a psychotic disorder? (Multiple correct)

Answer 60

A) Growing up in a rural area B) Cannabis use ✅ C) Urban upbringing ✅ D) Having a first-degree relative with a psychotic disorder ✅ E) Being bilingual F) Perinatal complications ✅

Question 61

(True/False): People with family members who have psychotic disorders often perform worse on cognitive tests and may show subclinical symptoms.

Answer 61

True

Question 62

Name three environmental factors associated with increased risk of psychosis.

Answer 62

Urban upbringing, cannabis use, immigration status, perinatal factors (e.g., oxygen deprivation, infection), trauma in early childhood, season of birth, father's age.

Question 63

What structural brain changes are found in people with schizophrenia and bipolar disorder, according to ENIGMA meta-analyses?

Answer 63

Thinner cortex in both hemispheres and reduced grey matter, especially in frontal, temporal, and parietal areas.

Question 64

How does antipsychotic use relate to cortical thickness?

Answer 64

Antipsychotic use is associated with greater reductions in cortical thickness, though relapses also negatively affect brain structures.

Question 65

What pattern of white and grey matter development is seen in people at high risk of psychosis?

Answer 65

Less maturation of white matter and faster atrophy of grey matter, particularly in temporal, frontal cingulate, and parietal cortices.

Question 66

What does increased brain activation for equal performance in people with psychotic disorders suggest?

Answer 66

A compensatory mechanism—the brain works harder to achieve the same outcome.

Question 67

What brain areas show less activation in schizophrenia during executive functioning tasks?

Answer 67

Dorsolateral and ventrolateral prefrontal cortex, anterior cingulate cortex, thalamus.

Question 68

What is often seen in the right medial prefrontal cortex in people with schizophrenia and major depression during working memory tasks?

Answer 68

Increased activation compared to healthy controls.

Question 69

(True/False): People with schizophrenia show decreased amygdala activity in response to non-emotional stimuli.

Answer 69

False – they show increased amygdala activation.

Question 70

What brain areas show reduced connectivity in schizophrenia during social cognition tasks?

Answer 70

Insula, lateral postcentral cortex, striatum, and thalamus.

Question 71

What patterns are found in people at high risk for psychosis during social cognition tasks?

Answer 71

Increased activation in frontal, temporal, and cingulate cortices.

Question 72

What is the main mechanism of first-generation antipsychotics?

Answer 72

D2 dopamine receptor antagonism.

Question 73

What side effects are common with first-generation antipsychotics?

Answer 73

Extrapyramidal side effects, especially movement disorders.

Question 74

What characterizes second-generation (atypical) antipsychotics?

Answer 74

A) Target only dopamine receptors B) No extrapyramidal side effects ✅ C) High risk of metabolic syndrome ✅ D) Strong improvements in cognitive function E) Influence serotonin and glutamate receptors ✅

Question 75

What is the potential advantage of third-generation antipsychotics like aripiprazole?

Answer 75

Partial dopamine agonism, with potential to improve cognitive function (though evidence is inconclusive).

Question 76

What four components are essential in cognitive remediation for psychotic disorders?

Answer 76

1. Therapist-supported training 2. Cognitive training exercises 3. Developing problem-solving strategies 4. Transfer to everyday life

Question 77

Why is 'drill and practice' alone insufficient in cognitive rehabilitation?

Answer 77

It improves test performance but does not generalize to real-life functioning.

Question 78

What type of cognitive rehab shows best outcomes?

Answer 78

Therapist-supported programs (vs. unguided or computer-only exercises).

Question 79

What is the 'C-factor' in psychiatric disorders?

Answer 79

A transdiagnostic domain representing cognitive impairments across disorders.

Question 80

What is the Research Domain Criteria (RDoC) framework used for?

Answer 80

Studying psychiatric symptoms across six domains on a continuum from normal to pathological, incorporating biological and behavioral dimensions.

Question 81

(True/False): Cognitive impairments in psychotic disorders are mostly limited to memory and attention.

Answer 81

False – impairments span almost all cognitive domains and significantly impact daily functioning.

Question 82

Why is social cognition important in neuropsychological assessment for psychotic disorders?

Answer 82

Impairments in social cognition are common and significantly impact daily life and functioning.

Question 83

What three components are essential in making an effective treatment plan for psychotic disorders?

Answer 83

- Neuropsychological testing - Psychiatric evaluation - Clinical interview with patient and informants

Question 84

Van der Gaag Four Factor Model (verklaring psychose)

Answer 84

1. Dopamine dysregulatie Dopamine stijgt op willekeurige momenten → zintuiglijke prikkels worden sterker ervaren → prikkels krijgen een persoonlijke betekenis (salience). 2. Top-down processen Het brein probeert betekenis te geven aan deze prikkels via denken en verwachtingen. 3. Cognitieve neigingen Overmatige aandacht voor gevaar, negatieve interpretaties van prikkels, sterke verwachting van bedreiging. 4. Consolidatie Zelfversterking van wanen en vervormde waarnemingen, bv. het gevoel gedachten niet te kunnen controleren, negatieve herinneringen selectief onthouden, vermijden van situaties.