Psychology Case Study: Schizophrenia Diagnosis

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Questions and Answers

What is the primary characteristic of schizophrenia?

Periods of loss of touch with reality (correct)

Periods of elevated mood

Sudden onset of psychotic symptoms

Fluctuating levels of anxiety

What is the peak age of onset for schizophrenia in men?

25-35 years

10-15 years

15-25 years (correct)

35-45 years

Which of the following is a positive symptom of schizophrenia?

Poor grooming

Lack of motivation

Delusions (correct)

Flat affect

What is the best response to negative symptoms of schizophrenia?

Atypical antipsychotics Signup and view all the answers

Which of the following is NOT a characteristic of schizophrenia?

Sudden onset of symptoms Signup and view all the answers

What is the most appropriate diagnosis for a patient with a 20-year history of severe depressive and psychotic symptoms?

Schizophrenia Signup and view all the answers

What is the primary difference between positive and negative symptoms of schizophrenia?

Type of symptoms Signup and view all the answers

What is the prevalence of schizophrenia across different cultures and ethnic groups?

Equal in men and women, all cultures, and all ethnic groups Signup and view all the answers

What is the typical course of schizophrenia?

Chronic with periods of remission Signup and view all the answers

Which of the following is NOT a negative symptom of schizophrenia?

Delusions Signup and view all the answers

Which of the following neurotransmitters is implicated in schizophrenia due to its hyperactivity?

Serotonin Signup and view all the answers

Which of the following is a characteristic of schizotypal personality disorder?

Odd behavior and avoidance of social relationships Signup and view all the answers

Which of the following is a medical illness that can cause psychotic symptoms and mimic schizophrenia?

Temporal lobe epilepsy Signup and view all the answers

What is the primary advantage of atypical antipsychotic agents over traditional antipsychotics?

Better side effect profiles Signup and view all the answers

Which of the following is a type of psychotherapy that is useful for providing long-term support to patients with schizophrenia?

All of the above Signup and view all the answers

What is the term for the metabolite of dopamine that is elevated in the body fluids of patients with schizophrenia?

Homovanillic acid (HVA) Signup and view all the answers

Which of the following medications is useful in treating some of the neurodegenerative symptoms of schizophrenia?

Memantine Signup and view all the answers

What is the term for the scale used to rate the current symptom severity of schizophrenia in the DSM-5?

5-point scale Signup and view all the answers

Which of the following is a characteristic of delusional disorder in partner of individual with delusional disorder (IPDD)?

Delusional symptoms in the partner of an individual with delusional disorder Signup and view all the answers

Which of the following is a common issue in patients with schizophrenia that can further exacerbate their clinical condition?

All of the above Signup and view all the answers

What is the characteristic of patients with predominantly negative symptoms?

They have more neuroanatomic and metabolic abnormalities than those with predominantly positive symptoms. Signup and view all the answers

What is the prodromal phase of schizophrenia characterized by?

Avoidance of social activities, physical complaints, and new interest in religion Signup and view all the answers

What is the residual phase of schizophrenia characterized by?

Negative symptoms, intact memory capacity, and typical level of consciousness Signup and view all the answers

What is the duration of active phase symptoms required for the diagnosis of schizophrenia?

At least 1 month Signup and view all the answers

What is the common outcome of patients with schizophrenia?

Repeated psychotic episodes and a chronic, downhill course Signup and view all the answers

What is a factor that reduces the risk of suicide in patients with schizophrenia?

Having a good employment history Signup and view all the answers

What is a possible explanation for the seasonality of birth in schizophrenia?

Viral infection of the mother during pregnancy Signup and view all the answers

What is a characteristic of the brains of people with schizophrenia?

Decreased use of glucose in the frontal lobes Signup and view all the answers

What is the dopamine hypothesis of schizophrenia?

Positive symptoms result from excessive dopaminergic activity Signup and view all the answers

What is a characteristic of the residual phase of schizophrenia?

The patient is in touch with reality but has negative symptoms Signup and view all the answers

Study Notes

Schizophrenia

A chronic, debilitating mental disorder characterized by periods of loss of touch with reality (psychosis), persistent disturbances of thought, behavior, appearance, and speech, abnormal affect, and social withdrawal.
Peak age of onset: 15-25 years for men and 25-35 years for women.
Occurs equally in men and women, all cultures, and all ethnic groups studied.

Symptoms

Classified as positive or negative.
Positive symptoms: delusions, hallucinations, agitation, and talkativeness.
Negative symptoms: lack of motivation, social withdrawal, flattened affect, cognitive disturbances, poor grooming, and poor speech content.
Positive symptoms respond well to most traditional and atypical antipsychotic agents.
Negative symptoms respond better to atypical than to traditional antipsychotics.

Course

Three phases: prodromal, active (psychotic), and residual.
Prodromal phase: avoidance of social activities, physical complaints, and new interest in religion, the occult, or philosophy.
Active phase: disorders of perception, thought content, thought processes, and form of thought.
Residual phase: characterized by negative symptoms, intact memory capacity, and typical level of consciousness.

Prognosis

Involves repeated psychotic episodes and a chronic, downhill course over years.
Suicide is common: more than 50% attempt suicide, and 10% of those die in the attempt.
Better prognosis and lower suicide risk if the patient is older at onset, is married, has social relationships, is female, has a good employment history, has mood symptoms, and has few negative symptoms.

Etiology

Genetic factors: schizophrenia occurs in about 1% of the population, and persons with a close genetic relationship to a patient with schizophrenia are more likely to develop the disorder.
Other factors: season of birth (more people with schizophrenia are born during cold weather months), and possible viral infection of the mother during pregnancy.

Neural Pathology

Abnormalities of the frontal lobes, lateral and third ventricle enlargement, abnormal cerebral symmetry, and changes in brain density.
Decreased volume of limbic structures (e.g., amygdala, hippocampus).
Neurotransmitter abnormalities:
- Dopamine hypothesis: excessive dopaminergic activity in the limbic system causes positive symptoms.
- Serotonin hyperactivity: implicated in schizophrenia.
- Glutamate: implicated in schizophrenia, and NMDA antagonists are useful in treating neurodegenerative symptoms.

Severity

Rated on a 5-point scale using the DSM-5.

Differential Diagnosis

Medical illnesses that can cause psychotic symptoms (e.g., neurologic infection, neoplasm, trauma, disease).
Medications that can cause psychotic symptoms (e.g., analgesics, antibiotics, anticholinergics, antihistamines, antineoplastics, cardiac glycosides).
Psychiatric illnesses other than schizophrenia that may be associated with psychotic symptoms (e.g., bipolar I disorder, major depressive disorder, neurocognitive disorders, substance-related disorders).
Personality disorders (e.g., schizotypal, paranoid, borderline) that are not characterized by frank psychotic symptoms.

Management

Pharmacologic management: traditional antipsychotics and atypical antipsychotic agents.
Psychological management: individual, family, and group psychotherapy to provide long-term support and help patients adhere to the drug regimen.

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A 45-year-old man with a history of depressive and psychotic symptoms is treated for depression, but remains withdrawn and expresses a delusional belief. What is the most appropriate diagnosis?