Questions and Answers
Schizophrenia is one of the easiest psychiatric syndromes to define and describe.
False
Delusions and hallucinations are classified as negative symptoms of schizophrenia.
False
Alogia, avolition, affective flattening, and anhedonia are examples of negative symptoms in schizophrenia.
True
Positive symptoms of schizophrenia are the most florid and well-known types of symptoms.
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The concept of schizophrenia has remained constant and undisputed over the past century.
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Formal thought disorder is considered a negative symptom of schizophrenia.
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Inappropriate affect and bizarre behaviour are features of behavioural disorganization in schizophrenia.
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First-rank symptoms of schizophrenia help distinguish it from other psychotic disorders.
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Kurt Schneider first described first-rank symptoms.
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First-rank symptoms are the primary symptoms of schizophrenia.
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Thought insertion is an example of a first-rank symptom.
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First-rank symptoms are included in the diagnostic criteria of DSM-5 and ICD-11.
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Schneider's first-rank symptoms include delusional perception.
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First-rank symptoms are often found in disorders other than schizophrenia.
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Patients with schizophrenia almost always have impaired insight.
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Mood alterations are uncommon in patients with schizophrenia.
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'Sluggish schizophrenia' is a commonly used subtype and its use is frequently recommended.
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Undifferentiated schizophrenia includes cases with equally prominent features of more than one subtype.
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Residual schizophrenia indicates a state when positive symptoms are still recurring regularly.
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Subsyndromes of schizophrenia are reliable and stable over time, showing clear differences in pathophysiology and prognosis.
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The most reproducible finding from Liddle et al. (1992) is the link between psychomotor poverty, impaired performance on frontal lobe tasks, and decreased frontal blood flow.
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Crow's Type I schizophrenia is characterized by an insidious onset, mainly negative symptoms, and poor response to antipsychotic drugs.
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Contemporary studies show that cognitive deficits in schizophrenia affect all domains of learning and memory, particularly semantic memory, working memory, and attention.
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Patients with chronic schizophrenia showing reality disturbance exhibit decreased blood flow in the frontal cortex.
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According to Table 11.1, the anterior cingulate and right ventral frontal cortex are associated with psychomotor poverty schizophrenia symptoms.
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Impaired psychological performance for disorganized schizophrenia symptoms includes impairments in tests of selective attention.
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Cognitive aspects are thought to be central to schizophrenia and underlying psychotic symptoms.
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Depressive symptoms in schizophrenia occur only during the acute phase of the illness.
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Neurological signs called 'soft signs' in schizophrenia localize pathology to a particular tract or nucleus.
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Patients with schizophrenia tend to have normal olfactory function when not on medication.
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About 25% of patients with schizophrenia exhibit persistent and significant depression.
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There is no relationship between low IQ and schizophrenia.
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Chronic schizophrenia is primarily characterized by positive symptoms such as hallucinations and delusions.
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One of the most striking features of the chronic syndrome of schizophrenia is diminished volition.
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Paranoid schizophrenia is characterized by prominent thought disorder and negative symptoms.
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Positive symptoms are more prevalent than negative symptoms in acute schizophrenia.
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Patients with hebephrenic schizophrenia often display a mood that appears silly and unpredictable.
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Simple schizophrenia is characterized by the development of odd behavior and social withdrawal without apparent positive symptoms.
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Negative symptoms are more common than cognitive deficits in acute schizophrenia.
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Hallucinations and delusions are universal in chronic schizophrenia.
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Formal thought disorder is a positive symptom of acute schizophrenia.
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In catatonic schizophrenia, motor symptoms and changes in activity are the most striking features.
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Hallucinations in acute schizophrenia are predominantly visual rather than auditory.
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Cognitive impairment in chronic schizophrenia is always apparent without detailed cognitive testing.
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In acute schizophrenia, patients often have difficulty dealing with abstract ideas.
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Speech in chronic schizophrenia often shows evidence of thought disorder of the kinds found in the acute syndrome.
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Patients with acute schizophrenia rarely experience thought withdrawal.
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The symptoms and signs of chronic schizophrenia are generally stable and do not vary over time.
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Patients with acute schizophrenia often exhibit unusual ways of using words, such as using neologisms.
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Social withdrawal is a common behavior in patients with acute schizophrenia.
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Patients with acute schizophrenia often describe the sensation of thought blocking.
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Visual hallucinations are more common in patients with acute schizophrenia than tactile hallucinations.
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Pain insensitivity in patients with schizophrenia can occasionally be extreme.
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Religious delusions are becoming more common in schizophrenia patients now compared to a century ago.
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Highly intelligent schizophrenia patients often exhibit simple clinical pictures.
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Understimulation is thought to increase positive symptoms of schizophrenia.
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The prodrome of schizophrenia is characterized by a clear and specific set of symptoms.
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Most people considered to be in the prodromal phase will progress to overt psychosis during a 2 to 3-year follow-up.
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In adolescents and young adults with schizophrenia, clinical features often include thought disorder and mood disturbance.
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A longer prodrome of schizophrenia is associated with better long-term outcomes.
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Untreated psychosis in schizophrenia is believed to be 'neurotoxic' and makes the illness less responsive to treatment.
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The Comprehensive Assessment of At Risk Mental State (CAARMS) is used to define, assess, and rate the prodrome of schizophrenia.
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Study Notes
Schizophrenia: Definition and Clinical Features
- Schizophrenia is a difficult to define and describe psychiatric syndrome with varying concepts held in different countries and by different people.
- The disorder is characterized by both positive and negative symptoms, which can be divided into three categories: reality disturbance, disorganization, and psychomotor poverty.
Positive Symptoms
- Delusions and hallucinations are the most florid and well-known types of symptoms.
- First-rank symptoms (FRS) are a set of symptoms that are characteristic of schizophrenia, including:
- Hearing thoughts spoken aloud
- Third-person hallucinations
- Auditory hallucinations in the form of a 'running commentary'
- Somatic hallucinations
- Thought withdrawal or insertion
- Thought broadcasting
- Delusional perception
- Feelings or actions experienced as made or influenced by external agents (passivity)
Negative Symptoms
- Loss of normal functioning, including:
- Alogia (decreased spontaneous speech)
- Avolition (decreased motivation)
- Affective flattening (lack of emotional expressivity, but not depression)
- Anhedonia
- Negative symptoms are often less responsive to treatment and more difficult to manage.
Behavioural Disorganization
- Formal thought disorder (abnormalities in the flow and sequence of thoughts)
- Inappropriate affect
- Bizarre behaviour
Schizophrenia Subtypes
- Undifferentiated Schizophrenia: cases that do not fit into any of the other subtypes.
- Residual Schizophrenia: chronic schizophrenia with persistent negative symptoms but no recurrence of positive symptoms.
Cognitive Features
- Deficits in learning and memory, including:
- Semantic memory
- Working memory
- Attention
- Executive function and attention may be the core deficits.
Three Clinical Subsyndromes (Liddle, 1987)
- Reality disturbance:
- Delusions
- Hallucinations
- Disorganization:
- Formal thought disorder
- Inappropriate affect
- Bizarre behavior
- Psychomotor poverty:
- Flat affect
- Poverty of speech
- Decreased spontaneous movement
Type I and Type II Schizophrenia (Crow, 1985)
- Type I: acute onset, mainly positive symptoms, preserved social functioning during remissions, good response to antipsychotic drugs.
- Type II: insidious onset, mainly negative symptoms, poor outcome and response to antipsychotic drugs.
Chronic Schizophrenia
- Characterized by negative symptoms, including:
- Lack of drive and initiative
- Social withdrawal
- Emotional apathy
- Poor self-care
- Abnormal speech
- Catatonic symptoms
- Cognitive impairment is common in chronic schizophrenia.
Subtypes of Schizophrenia
- Paranoid schizophrenia: characterized by persecutory delusions and auditory hallucinations.
- Hebephrenic schizophrenia: characterized by thought disorder, affective symptoms, and a variable mood.
- Catatonic schizophrenia: characterized by motor symptoms, including excitement and stupor.
- Simple schizophrenia: characterized by the insidious development of odd behavior, social withdrawal, and declining performance at work.
The Prodrome of Schizophrenia
- The period of time during which psychosis is 'brewing', before diagnosable criteria are met.
- Focus on the prodrome reflects the fact that in many patients, this period may last for several months or years, and the longer the duration of untreated psychosis, the worse the outcome.
Factors that Modify the Clinical Features
- Social and cultural background
- Age
- Intelligence
- Social stimulation
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Description
Explore the complexities of defining and describing schizophrenia, a psychiatric syndrome with diverse concepts and uncertainties. Learn about the ongoing debates and challenges in psychiatry.
