96 Questions
What term is used to describe fixed beliefs that are not amenable to change in light of conflicting evidence?
Delusions
Which of the following is NOT a type of delusion mentioned in the text?
Dissociative
What are perception-like experiences that occur without an external stimulus known as?
Hallucinations
Which symptom in psychosis refers to the absence of behaviors that are normally present?
Affective flattening
What term refers to a marked decrease in reactivity to the environment, often involving actions like laughing or crying at inappropriate times?
Catatonic behavior
Which of the following types of delusions involves believing that one is being followed, harmed, or plotted against?
Persecutory
What distinguishes schizoaffective disorder from schizophrenia according to the text?
Presence of major depressive or manic episodes concurrently with active-phase symptoms
What specifier related to schizophrenia was the only one to remain in DSM-5 after the removal of diagnostic subtypes?
Catatonia
What symptoms characterize catatonia, as mentioned in the text?
Peculiar movements such as posturing
What are some signs of the prodromal phase of schizophrenia, as described in the text?
Subthreshold positive psychotic symptoms
When do functional impairments become noted in individuals with schizophrenia, based on the text?
In the residual phase
What is the typical age range for the onset of schizophrenia in males, as mentioned in the text?
Early to mid-20's
What is the minimum duration required for a delusion to be considered in the context of Schizophrenia?
1 month or longer
Which of the following is NOT part of Criterion A for Schizophrenia?
Inability to focus
What must be present for a diagnosis of Schizophrenia according to the text?
Two Delusions
How long do continuous signs of disturbance need to persist for in order to meet the diagnostic criteria for Schizophrenia?
6 months
In terms of functioning and behavior, what distinguishes a delusional disorder from Schizophrenia?
No impact on functioning and no bizarre behavior
Which symptom is NOT part of the diagnostic criteria for Schizophrenia in terms of positive symptoms?
Negative symptoms
What differentiates Schizoaffective disorder from Schizophrenia according to the text?
Presence of mood episodes concurrent with active-phase symptoms
What was the impact on diagnostic subtypes in DSM-5 according to the text?
They were removed due to lack of empirical support
What is a characteristic of catatonia as described in the text?
Extreme negativism or mutism
What defines the prodromal phase of Schizophrenia?
Subthreshold positive psychotic symptoms
Which symptom is typical during the First Episode of Schizophrenia?
Full threshold psychotic symptoms
When do functional impairments become noted in the course of Schizophrenia?
In the residual phase
Which of the following distinguishes Schizophreniform Disorder from Schizophrenia?
Absence of functional impairment
In the context of differential diagnosis, what is an important consideration when distinguishing Schizophrenia from Brief Psychotic Disorder?
Duration of symptoms
What is a significant difference between Antipsychotics and typical mood stabilizers in terms of treatment strategies for schizophrenia?
Effect on negative symptoms
Which factor is crucial in the diagnosis of Schizophrenia as opposed to Delusional Disorder?
Extent of functional impairment
What differentiates Brief Psychotic Disorder from Schizophrenia in terms of symptom presentation?
Duration of symptoms
When assessing treatment options for schizophreniform disorders, which aspect plays a critical role in determining the appropriate intervention?
Reaction to previous medication trials
What distinguishes brief psychotic disorder from schizophreniform disorder?
Duration of symptoms
Which neurotransmitter is suggested to be involved in the excessive activity within neural circuits associated with positive symptoms of psychosis?
Dopamine
In the context of psychosis, what term describes speech with disorganized thinking inferred from it, where ideas shift from one unrelated topic to another?
Loose associations
What is the characteristic perceptual experience that occurs without an external stimulus and is most commonly associated with psychosis?
Auditory hallucinations
'Avolition' is a negative symptom of psychosis characterized by what?
Lack of motivation or desire to perform activities
Which term refers to fixed beliefs that are resistant to change despite conflicting evidence and may include themes like being followed or plotted against?
Bizarre delusions
What is the primary reason why diagnostic subtypes of Schizophrenia were removed in DSM-5?
Empirical support for the subtypes was lacking
Which of the following symptoms characterizes catatonia as described in the text?
Extreme negativism or mutism
What differentiates the prodromal phase of Schizophrenia from the first episode?
Presence of subthreshold positive psychotic symptoms
In what phase of Schizophrenia do full threshold psychotic symptoms become evident?
First episode
What marks the course of Schizophrenia as different for males compared to females, according to the text?
Onset occurs earlier in males
What is a characteristic symptom that may be noted in the premorbid phase of Schizophrenia?
Cognitive, emotional, and behavioral signs
What is a key difference between Schizophrenia and Delusional Disorder, based on the text?
Impact on functioning
Which symptom is crucial for diagnosing Schizophrenia, according to the text?
Negative symptoms
What differentiates Brief Psychotic Disorder from Schizophreniform Disorder?
Duration of symptoms
In the context of Schizophrenia, what is the significance of brief manic or major depressive episodes relative to delusional periods?
They emphasize the chronicity of delusional episodes
Which specifier related to schizophrenia was retained in DSM-5 after removing diagnostic subtypes?
Paranoid Type
What is a characteristic of catatonia as described in the text?
Marked decrease in reactivity to the environment
What does the evidence regarding neuron loss in schizophrenia suggest?
Neuron loss remains stable regardless of illness duration
What does the heritability of schizophrenia suggest?
It supports a biological basis for schizophrenia
How does late-life cognitive decline in a subgroup of individuals with schizophrenia differ from the general trend?
It shows unusually rapid decline compared to others with schizophrenia
According to the Diathesis-Stress Model, how does genetic vulnerability contribute to the probability of developing schizophrenia?
It increases the probability proportional to shared genes with affected individuals
What do adoption studies reveal about adult schizophrenics that were adopted as children?
They are more likely to have biological relatives with schizophrenia
What does the progressive decline in schizophrenia support about its nature as a neurodevelopmental disorder?
Neuron loss is not linked to initial clinical presentation
Which cognitive abilities are more impaired following the resolution of the first episode of psychosis?
Working memory
What is one of the most significant deficits in individuals with psychosis in terms of effect size, according to the text?
Processing speed
Which type of memory shows among the most severe impairments in individuals with psychosis, as per the text?
Declarative memory
What fundamental feature is associated with deficits in attention/concentration in individuals with psychosis?
Easily overloaded by processing demands
Which aspect of language processing can be affected in individuals with psychosis?
Speech rate
What is a common characteristic of deficits in processing speed observed in individuals with psychosis?
Consistent reduction in speed
What is a common complicating factor in schizophrenia that leads to a 20% reduction in lifespan?
Malnutrition
What risk factor is associated with poor prognosis in schizophrenia?
Family history of psychosis
Which of the following medical conditions is NOT associated with schizophrenia according to the text?
Osteoporosis
What is suggested by the widening mortality gap between schizophrenia and the general population?
Improved health outcomes for people with schizophrenia
Which factor increases the risk of heart attack and cerebrovascular accidents in individuals with schizophrenia?
Antipsychotic medication
What percentage of patients demonstrate intact performance in neuropsychological assessments according to the text?
60%
Which factor is a common complicating factor in schizophrenia that leads to a 20% reduction in lifespan?
Increased cigarette smoking
What medical condition is NOT associated with schizophrenia according to the text?
Hypothyroidism
Which cognitive ability is significantly lower in individuals with schizophrenia, indicating more diffuse impairments?
Verbal intelligence
What is suggested by the widening mortality gap between schizophrenia and the general population?
Existence of high-risk behaviors in individuals with schizophrenia
Which frontal lobe dysfunction pattern is consistent with impairments in spontaneous use of strategies in patients with schizophrenia?
Frontal-Subcortical Pattern
What is a confounding factor to interpreting neuropsychological findings in schizophrenia?
Stroke or Lesion Data
What environmental factor is associated with an increased incidence of schizophrenia related to the relative number of schizophrenic births?
Season of birth
In which type of area does the seasonality effect related to schizophrenia primarily occur?
Cities
What is a likely cause of the increased incidence of schizophrenia found in babies born after an influenza epidemic?
Viral pathology
Which factor is associated with an increased risk of schizophrenia based on the distance from the equator?
Latitude
Which environmental factor is more readily transmitted in regions with high population densities, potentially impacting schizophrenia rates?
Viruses
What environmental factor associated with increased incidence of schizophrenia has a seasonality effect primarily observed in cities rather than rural areas?
Population density
What is one of the primary differences between First Generation Antipsychotics (FGAs) and Second Generation Antipsychotics (SGAs) based on the text?
FGAs block serotonin 2A receptors while SGAs block D2 receptors
Which pathway is affected by First Generation Antipsychotics (FGAs) according to the text?
Nigrostriatal pathway
What aspect of cognition is most severely impacted in individuals with psychosis according to the text?
Memory
What is suggested as a potential cause of the increased release of dopamine in persons with schizophrenia?
Increased density of D2 receptors
Which receptor type do Second Generation Antipsychotics (SGAs) have more potency at blocking compared to First Generation Antipsychotics (FGAs)?
Serotonin 2A receptors
What is a distinguishing feature of SGAs compared to FGAs in terms of their effects on schizophrenia symptoms?
SGAs are more potent at reducing negative symptoms compared to FGAs
What is the characteristic duration of symptoms in Brief Psychotic Disorder?
At least 1 day but less than 1 month
In Schizophreniform Disorder, how long should symptoms persist to differentiate it from Schizophrenia?
At least 1 month but not yet 6 months
What type of symptoms do antipsychotic medications primarily ameliorate in psychosis?
Positive
Which medication type used in psychosis management may have adverse effects on cognition, especially at high doses?
Stimulants
Why is reducing the gap between psychosis onset and treatment initiation crucial?
To reduce psychotic breaks
What is a common adjunct medication prescribed alongside antipsychotics in psychosis management?
Anxiolytics
Which gender is more likely to have worse premorbid adjustment in early-onset schizophrenia?
Males
What is a characteristic difference in the presentation of visual hallucinations in pediatric schizophrenia compared to other age groups?
They tend to be more complex and detailed in pediatric schizophrenia
What is a distinguishing feature of late-onset schizophrenia compared to typical onset schizophrenia?
Less paranoia and disorganization in late-onset schizophrenia
Which age group experiences more susceptibility to side-effects of antipsychotic medication according to the text?
Elderly individuals
What is a possible explanation provided in the text for the geriatric population's different etiology of late-onset schizophrenia?
Impact of aging on neurodevelopmental factors
In what aspect do individuals with late-onset schizophrenia differ from those with earlier onset, based on the text?
Identical course and symptoms between early and late-onset schizophrenia
Study Notes
Schizophrenia Spectrum and Other Psychotic Disorders
Important Terms in Psychosis
- Positive Symptoms: symptoms evident by their presence, referring to distorted reality, involving excessive activity in neural circuits that include dopamine as a neurotransmitter
- Delusions: fixed beliefs not amenable to change in light of conflicting evidence, may include various themes (bizarre, persecutory, referential, grandiose, somatic, religious, erotomania, jealous)
- Hallucinations: perception-like experiences without an external stimulus, may occur in any sensory modality (auditory, visual, tactile, gustatory, olfactory)
- Disorganized Symptoms: include speech, behavior, affect, and thoughts, may be manifested by loose associations, tangentiality, incoherent speech, and disorganized thinking
- Negative Symptoms: characterized by the absence of behaviors normally present, in areas such as speech, affect, and motivation, associated with poorer prognosis
Delusional Disorder
- Presence of one or more delusions with a duration of at least 1 month
- Criterion A for Schizophrenia has never been met
- Functioning is not markedly impaired, and behavior is not obviously bizarre or odd
- If manic or major depressive episodes have occurred, they have been brief relative to the duration of the delusional periods
Schizophrenia
- A. Two or more of the following, each present for a significant period of time during a 1-month period:
- Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganized or catatonic behavior
- Negative symptoms
- B. For a significant portion of time since onset, level of functioning in one or more major areas is markedly below the level achieved prior to onset
- C. Continuous signs of the disturbance persist for at least 6 months
- D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out
Course of Schizophrenia
- Premorbid: evidence of cognitive, emotional, and behavioral signs prior to prodromal phase of illness
- Prodromal: often experiencing subthreshold positive psychotic symptoms or brief intermittent symptoms
- First Episode: full threshold psychotic symptoms, acute, and residual
- Course: onset earlier for males than females, early to mid-20's
Other Topics
- Progressive Decline: suggests that schizophrenia is a neurodevelopmental disorder, but inconclusive evidence for neurodegenerative condition
- Diathesis-Stress Model: diathesis refers to genetic vulnerability, increased probability for the disorder proportional to the percentage of genes shared with an affected individual
- Heritability of Schizophrenia: ranges from 80 to 85%
- Adoption studies: adult schizophrenics that were adopted as children are likely to have schizophrenic biological relatives
- Cognitive Impairments: attention, concentration, processing speed, and declarative memory are significantly impaired
- Medical Comorbidities: common complicating factor, increased risk of metabolic syndrome, cardiovascular morbidity, and mortality
- Mortality Rate: 2-3 fold increased mortality rate, increased risk of suicide, and high-risk behaviors
- Prognosis: risk factors for poor prognosis include cognitive impairment, negative symptoms, younger age of onset, insidious onset with poor premorbid functioning, family history, and increased number of relapses### Genetics of Schizophrenia
- Complex genes with small effects contribute to the disorder
- Rare mutations with larger effects also play a role
- Interactions between genes and the environment are significant
Premorbid Intelligence and Pervasive Developmental Disorders
- Considered risk factors, may co-occur due to shared biological risk
- Retrospective studies show increased rates of:
- Intellectual disabilities (IDs) and autism spectrum disorders (ASDs) in childhood
- Language, motor, and social abnormalities
Environmental Factors Associated with Increased Incidence
- Season of birth: late winter and early spring births associated with higher risk of schizophrenia
- Population density: seasonality effect occurs primarily in cities, viruses transmitted more readily in high-density areas
- Viral epidemics: increased incidence of schizophrenia after influenza epidemics
- Latitude: people born farther from the equator are more likely to develop schizophrenia
- Socioeconomic status: associated with increased incidence
- Obstetric complications: associated with increased incidence
- Substance abuse: associated with increased incidence
Dopamine and Antipsychotics
- Excessive dopamine in schizophrenia
- FGAs block D2 receptors, mimicking Parkinson's Disease
- SGAs have more potency at blocking serotonin 2A receptors
- Antipsychotics reduce positive symptoms, but not negative symptoms
- Disturbance in dopamine may be a secondary effect in the disorder
Neuropsychological Assessment Results
- Moderate to severe deficits in memory, attention, and executive functions
- Global premorbid cognitive deficits and cognitive decline accompany onset of frank illness
Psychotic Disorders
- Schizophreniform disorder: same symptoms as schizophrenia, but lasting less than 6 months
- Brief psychotic disorder: criterion A symptoms of schizophrenia, lasting at least 1 day but less than 1 month
- Assessment: observation, interview, collateral, MMPI-2, PAI, Scale 6 and 8, SCZ and PAR scales, PANSS
Differential Diagnosis
- Comorbid illness is common, with syndromal overlap including depression, OCD, and anxiety
- Difficult to distinguish from schizoaffective disorder and mood disorders with psychotic features
- Primary basis is interview and history taking
Treatment
- Acute phase: mainly medical intervention
- Conventional antipsychotics: serious side-effects, extrapyramidal or Parkinsonian symptoms
- Atypical antipsychotics: alleviate positive symptoms, but do not help with cognitive or negative symptoms
- Medications for neuropsychological deficits: inconsistent results
- Polypharmacy is common, with adjunct medications for mood stabilizers, antidepressants, sedatives, and anticholinergics
Course and Outcome
- Reducing the gap between onset of psychosis and treatment initiation improves outcomes
- Early treatment initiation improves outcomes
- Late onset is associated with better premorbid functioning and less cognitive impairment
- Women tend to have a later illness onset, lower negative symptom severity, and better social, cognitive, and premorbid functioning
Test your knowledge on important terms related to schizophrenia spectrum and other psychotic disorders. Learn about positive symptoms, delusions, and neural circuits involved in these disorders.
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