Week 8 - Schizophrenia and other psychotic disorders Flashcards
Schizophrenia is characterized by an array of diverse symptoms, including (6)
extreme oddities in perception, thinking, action, sense of self, and manner of relating to others, and the hallmark, psychosis.
In schizophrenia there is a split within/between….(3)
the intellect,
between the intellect and emotion,
and between the intellect and external reality
The risk of developing schizophrenia over the course of one’s lifetime is actually around X.X per-cent
0.7
Risk factors of Schizophrenia
Having a parent with schizophrenia,
People whose fathers were older (50+; 2-3x)
Having a parent who works as a dry cleaner
First and second generation immigrants (particularly those form black caribbean and black african countries who live in majority white communities)
The characteristic age of onset of schizophrenia differs in men and women….(peak and fall)
In men, there is a peak in new cases of schizophrenia between ages 20 and 24. After about 35 the number falls markedly.
The incidence of schizophrenia in women peaks during the same age period, but the peak is less marked and drops more slowly (intersecting at 30-34, and then again around 50). Further, there is a second rise in new cases that begins around age 40, as well as a third spike in onset that occurs when women are in their early sixties
Males tend to have a more severe form of schizophrenia, and schizophrenia-related anomalies of brain structure (discussed later) are more severe in male patients than they are in female patients (T/F)
T
The M:F ratio for schizophrenia is:
The male-to-female ratio is 1.4:1
When estrogen levels are low (as is true premenstrually) or are falling, psychotic symptoms in women with schizophrenia often get _______
worse
A delusion is essentially…
an erroneous belief that is fixed and firmly held despite clear contradictory evidence
delusions are common in schizophrenia, occurring in more than ___ percent of patients at some time during their illness. (6 common examples).g.
90
E.g. - beliefs that one’s thoughts, feelings or actions are being controlled by external agents.
- private thoughts are being broadcast
- thoughts are being inserted by an external agency
- thoughts have been robbed
- delusions of reference, where some neutral environmental event (such as a television program or a song on the radio) is believed to have special and personal meaning intended only for the person
- Other strange propositions, including delusions of bodily changes (e.g., bowels do not work) or removal of organs, are also not uncommon
DSM-5 Criteria for. . . Schizophrenia
A. Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3):
1. Delusions.
2. Hallucinations.
3. Disorganized speech (e.g., frequent derailment or incoherence).
4. Grossly disorganized or catatonic behavior. 5. Negative symptoms (i.e., diminished emotional expres-sion or avolition).
B. For a significant portion of the time since the onset of the dis-turbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning).
C. Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of pro-dromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be mani-fested by only negative symptoms or by two or more symp-toms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).
D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either (1) no major depressive or manic episodes have occurred con-currently with the active-phase symptoms, or (2) if mood epi-sodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.
E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
F. If there is a history of autism spectrum disorder or a communi-cation disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucina-tions, in addition to the other required symptoms of schizo-phrenia, are also present for at least 1 month (or less if successfully treated).
A hallucination is a sensory experience that
seems real to the person having it, but occurs in the absence of any external perceptual stimulus (any sensory modality, but auditory hallucinations are the most common)
In a sample recruited from seven different countries, auditory hallucinations were found in ____ percent of patients with schizophrenia (Bauer et al., 2011). In contrast, visual hallucinations were reported less frequently (___ percent of patients), and olfactory, tac-tile, and gustatory hallucinations were even more rare (__ - ___percent).
75
39
1–7
The majority of patients (___ percent) reported that their voices usually spoke at a normal conversational volume. Hallucinated voices were often those of ______, although sometimes unfamiliar voices or the voices of ____ and the ____ were heard
73
people known to the patient in real life
God or the Devil
Most patients reported that they heard (how many)____ _____ ____voice and that their hallucinations were worse when they were _____
more than one
alone
Neuroimaging studies that compare hallucinating patients with nonhallucinating patients suggest that patients with speech hallucinations have a reduction in brain (gray matter) volume in the left hemisphere auditory and speech perception areas (T/F)
T
neuroimaging studies reveal that hal-lucinating patients show increased activity in _____ area—an area of the frontal lobe that is involved in speech production.
Broca’s
Modern research approaches support the old idea that Auditory hallucinations are really a form of….
misperceived subvocal speech
Disorganized speech is…
the external manifestation of a disorder in thought form.
neologisms (df)
(literally, “new words”)
Formal thought disorder (df)
a term clinicians use to refer to problems in the way that disorganized thought is expressed in disorganized speech)
Catatonia (df)
The patient with catatonia may show a virtual absence of all movement and speech and be in what is called a catatonic stupor. At other times, the patient may hold an unusual posture for an extended period of time without any seeming discomfort
Positive symptoms are those that reflect…
an excess or distortion in a normal repertoire of behavior and experience, such as delusions and hallucinations. Disorganized thinking (as revealed by disorganized speech) is also thought of in this way.
Negative symptoms reflect…
an absence or deficit of behaviors that are normally present.
1) reduced expressive behavior—either in voice, facial expression, gestures, or speech (blunted or flat affect, or alogia (very little speech))
2) reductions in motivation or in the experience of pleasure (avolition or anhedonia).
The inability to initiate or persist in goal-directed activity is called _____.
avolition
For example, the patient may sit for long periods of time staring into space or watching TV with lit-tle interest in any outside work or social activities
the presence of negative symptoms in the clinical picture is a good sign for the patient’s future outcome (T/F)
F
List four different types of psychotic disorders and state one way in which each is different from schizophrenia.
schizoaffective disorder (hybrid between Schizophrenia and Mood disorder)
schizophreniform disorder (schizophrenia-like psychoses that last at least a month but do not last for 6 months and so do not warrant a diagnosis of schizophrenia)
delusional disorder (delusional beliefs (e.g. erotomania [great love for a person, usually of higher status], but no gross disorganisation and performance deficiencies, and general behavioural deterioration is rare)
and brief psychotic disorder.
DSM-5 Criteria for. . . Schizoaffective Disorder
A. An uninterrupted period of illness during which there is a major mood episode (major depressive or manic) concurrent with Criterion A of schizophrenia. Note: The major depressive episode must include Criterion A1: Depressed mood.
B. Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode (depressive or manic) during the lifetime duration of the illness.
C. Symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the active and residual portions of the illness.
D. The disturbance is not attributable to the effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
DSM-5 Criteria for. . .Schizophreniform Disorder
A. Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if success-fully treated). At least one of these must be (1), (2), or (3):
- Delusions.
- Hallucinations.
- Disorganized speech (e.g., frequent derailment or incoherence).
- Grossly disorganized or catatonic behavior.
- Negative symptoms (i.e., diminished emotional expression or avolition).
B. An episode of the disorder lasts at least 1 month but less than 6 months. When the diagnosis must be made without waiting for recovery, it should be qualified as “provisional.”
C. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either (1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or (2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.
D. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
DSM-5 Criteria for. . . Delusional Disorder
A. The presence of one (or more) delusions with a duration of 1 month or longer.
B. Criterion A for schizophrenia has never been met. Note: Hallucinations, if present, are not prominent and are related to the delusional theme (e.g., the sensation of being infested with insects associated with delusions of infestation).
C. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and behavior is not obviously bizarre or odd.
D. If manic or major depressive episodes have occurred, these have been brief relative to the duration of the delusional periods.
E. The disturbance is not attributable to the physiological effects of a substance or another medical condition and is not better explained by another mental disorder, such as body dysmorphic disorder or obsessive-compulsive disorder.
Temporal versions of Schizophrenia (in chrono order)
Brief Psychotic Disorder (<1 month)
Schizophreniform Disorder (1-6 months)
Schizophrenia (6+ months)
DSM-5 Criteria for. . . Brief Psychotic Disorder
A. Presence of one (or more) of the following symptoms. At least one of these must be (1), (2), or (3):
1. Delusions.
2. Hallucinations.
3. Disorganized speech (e.g., frequent derailment or incoherence).
4. Grossly disorganized or catatonic behavior.
Note: Do not include a symptom if it is a culturally sanctioned response.
B. Duration of an episode of the disturbance is at least 1 day but less than 1 month, with eventual full return to premorbid level of functioning.
C. The disturbance is not better explained by major depressive or bipolar disorder with psychotic features or another psychotic disorder such as schizophrenia or catatonia and is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
Index cases (i.e. Proband)
the diagnosed group of people who provide the starting point for inquiry
The prevalence of schizophrenia in the first-degree relatives (parents, siblings, and offspring) of a proband with schizophrenia is about ___ percent. While only ____ for second-degree relatives.
10
3
As with the mood disorders, schizophrenia concordance rates for identical twins are routinely and consistently found to be significantly higher than those for fraternal twins or ordinary siblings (T/F)
T (45-50% vs 15-20%)
