Schizophrenia Spectrum and Other Psychotic Disorders Quiz
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Questions and Answers

What term is used to describe fixed beliefs that are not amenable to change in light of conflicting evidence?

  • Hallucinations
  • Disorganized thinking
  • Delusions (correct)
  • Negative symptoms

    • Which of the following is NOT a type of delusion mentioned in the text?

  • Grandiose
  • Persecutory
  • Dissociative (correct)
  • Referential

    • What are perception-like experiences that occur without an external stimulus known as?

  • Delusions
  • Hallucinations (correct)
  • Disorganized symptoms
  • Negative symptoms

    • Which symptom in psychosis refers to the absence of behaviors that are normally present?

    <p>Affective flattening</p> Signup and view all the answers

    What term refers to a marked decrease in reactivity to the environment, often involving actions like laughing or crying at inappropriate times?

    <p>Catatonic behavior</p> Signup and view all the answers

    Which of the following types of delusions involves believing that one is being followed, harmed, or plotted against?

    <p>Persecutory</p> Signup and view all the answers

    What distinguishes schizoaffective disorder from schizophrenia according to the text?

    <p>Presence of major depressive or manic episodes concurrently with active-phase symptoms</p> Signup and view all the answers

    What specifier related to schizophrenia was the only one to remain in DSM-5 after the removal of diagnostic subtypes?

    <p>Catatonia</p> Signup and view all the answers

    What symptoms characterize catatonia, as mentioned in the text?

    <p>Peculiar movements such as posturing</p> Signup and view all the answers

    What are some signs of the prodromal phase of schizophrenia, as described in the text?

    <p>Subthreshold positive psychotic symptoms</p> Signup and view all the answers

    When do functional impairments become noted in individuals with schizophrenia, based on the text?

    <p>In the residual phase</p> Signup and view all the answers

    What is the typical age range for the onset of schizophrenia in males, as mentioned in the text?

    <p>Early to mid-20's</p> Signup and view all the answers

    What is the minimum duration required for a delusion to be considered in the context of Schizophrenia?

    <p>1 month or longer</p> Signup and view all the answers

    Which of the following is NOT part of Criterion A for Schizophrenia?

    <p>Inability to focus</p> Signup and view all the answers

    What must be present for a diagnosis of Schizophrenia according to the text?

    <p>Two Delusions</p> Signup and view all the answers

    How long do continuous signs of disturbance need to persist for in order to meet the diagnostic criteria for Schizophrenia?

    <p>6 months</p> Signup and view all the answers

    In terms of functioning and behavior, what distinguishes a delusional disorder from Schizophrenia?

    <p>No impact on functioning and no bizarre behavior</p> Signup and view all the answers

    Which symptom is NOT part of the diagnostic criteria for Schizophrenia in terms of positive symptoms?

    <p>Negative symptoms</p> Signup and view all the answers

    What differentiates Schizoaffective disorder from Schizophrenia according to the text?

    <p>Presence of mood episodes concurrent with active-phase symptoms</p> Signup and view all the answers

    What was the impact on diagnostic subtypes in DSM-5 according to the text?

    <p>They were removed due to lack of empirical support</p> Signup and view all the answers

    What is a characteristic of catatonia as described in the text?

    <p>Extreme negativism or mutism</p> Signup and view all the answers

    What defines the prodromal phase of Schizophrenia?

    <p>Subthreshold positive psychotic symptoms</p> Signup and view all the answers

    Which symptom is typical during the First Episode of Schizophrenia?

    <p>Full threshold psychotic symptoms</p> Signup and view all the answers

    When do functional impairments become noted in the course of Schizophrenia?

    <p>In the residual phase</p> Signup and view all the answers

    Which of the following distinguishes Schizophreniform Disorder from Schizophrenia?

    <p>Absence of functional impairment</p> Signup and view all the answers

    In the context of differential diagnosis, what is an important consideration when distinguishing Schizophrenia from Brief Psychotic Disorder?

    <p>Duration of symptoms</p> Signup and view all the answers

    What is a significant difference between Antipsychotics and typical mood stabilizers in terms of treatment strategies for schizophrenia?

    <p>Effect on negative symptoms</p> Signup and view all the answers

    Which factor is crucial in the diagnosis of Schizophrenia as opposed to Delusional Disorder?

    <p>Extent of functional impairment</p> Signup and view all the answers

    What differentiates Brief Psychotic Disorder from Schizophrenia in terms of symptom presentation?

    <p>Duration of symptoms</p> Signup and view all the answers

    When assessing treatment options for schizophreniform disorders, which aspect plays a critical role in determining the appropriate intervention?

    <p>Reaction to previous medication trials</p> Signup and view all the answers

    What distinguishes brief psychotic disorder from schizophreniform disorder?

    <p>Duration of symptoms</p> Signup and view all the answers

    Which neurotransmitter is suggested to be involved in the excessive activity within neural circuits associated with positive symptoms of psychosis?

    <p>Dopamine</p> Signup and view all the answers

    In the context of psychosis, what term describes speech with disorganized thinking inferred from it, where ideas shift from one unrelated topic to another?

    <p>Loose associations</p> Signup and view all the answers

    What is the characteristic perceptual experience that occurs without an external stimulus and is most commonly associated with psychosis?

    <p>Auditory hallucinations</p> Signup and view all the answers

    'Avolition' is a negative symptom of psychosis characterized by what?

    <p>Lack of motivation or desire to perform activities</p> Signup and view all the answers

    Which term refers to fixed beliefs that are resistant to change despite conflicting evidence and may include themes like being followed or plotted against?

    <p>Bizarre delusions</p> Signup and view all the answers

    What is the primary reason why diagnostic subtypes of Schizophrenia were removed in DSM-5?

    <p>Empirical support for the subtypes was lacking</p> Signup and view all the answers

    Which of the following symptoms characterizes catatonia as described in the text?

    <p>Extreme negativism or mutism</p> Signup and view all the answers

    What differentiates the prodromal phase of Schizophrenia from the first episode?

    <p>Presence of subthreshold positive psychotic symptoms</p> Signup and view all the answers

    In what phase of Schizophrenia do full threshold psychotic symptoms become evident?

    <p>First episode</p> Signup and view all the answers

    What marks the course of Schizophrenia as different for males compared to females, according to the text?

    <p>Onset occurs earlier in males</p> Signup and view all the answers

    What is a characteristic symptom that may be noted in the premorbid phase of Schizophrenia?

    <p>Cognitive, emotional, and behavioral signs</p> Signup and view all the answers

    What is a key difference between Schizophrenia and Delusional Disorder, based on the text?

    <p>Impact on functioning</p> Signup and view all the answers

    Which symptom is crucial for diagnosing Schizophrenia, according to the text?

    <p>Negative symptoms</p> Signup and view all the answers

    What differentiates Brief Psychotic Disorder from Schizophreniform Disorder?

    <p>Duration of symptoms</p> Signup and view all the answers

    In the context of Schizophrenia, what is the significance of brief manic or major depressive episodes relative to delusional periods?

    <p>They emphasize the chronicity of delusional episodes</p> Signup and view all the answers

    Which specifier related to schizophrenia was retained in DSM-5 after removing diagnostic subtypes?

    <p>Paranoid Type</p> Signup and view all the answers

    What is a characteristic of catatonia as described in the text?

    <p>Marked decrease in reactivity to the environment</p> Signup and view all the answers

    What does the evidence regarding neuron loss in schizophrenia suggest?

    <p>Neuron loss remains stable regardless of illness duration</p> Signup and view all the answers

    What does the heritability of schizophrenia suggest?

    <p>It supports a biological basis for schizophrenia</p> Signup and view all the answers

    How does late-life cognitive decline in a subgroup of individuals with schizophrenia differ from the general trend?

    <p>It shows unusually rapid decline compared to others with schizophrenia</p> Signup and view all the answers

    According to the Diathesis-Stress Model, how does genetic vulnerability contribute to the probability of developing schizophrenia?

    <p>It increases the probability proportional to shared genes with affected individuals</p> Signup and view all the answers

    What do adoption studies reveal about adult schizophrenics that were adopted as children?

    <p>They are more likely to have biological relatives with schizophrenia</p> Signup and view all the answers

    What does the progressive decline in schizophrenia support about its nature as a neurodevelopmental disorder?

    <p>Neuron loss is not linked to initial clinical presentation</p> Signup and view all the answers

    Which cognitive abilities are more impaired following the resolution of the first episode of psychosis?

    <p>Working memory</p> Signup and view all the answers

    What is one of the most significant deficits in individuals with psychosis in terms of effect size, according to the text?

    <p>Processing speed</p> Signup and view all the answers

    Which type of memory shows among the most severe impairments in individuals with psychosis, as per the text?

    <p>Declarative memory</p> Signup and view all the answers

    What fundamental feature is associated with deficits in attention/concentration in individuals with psychosis?

    <p>Easily overloaded by processing demands</p> Signup and view all the answers

    Which aspect of language processing can be affected in individuals with psychosis?

    <p>Speech rate</p> Signup and view all the answers

    What is a common characteristic of deficits in processing speed observed in individuals with psychosis?

    <p>Consistent reduction in speed</p> Signup and view all the answers

    What is a common complicating factor in schizophrenia that leads to a 20% reduction in lifespan?

    <p>Malnutrition</p> Signup and view all the answers

    What risk factor is associated with poor prognosis in schizophrenia?

    <p>Family history of psychosis</p> Signup and view all the answers

    Which of the following medical conditions is NOT associated with schizophrenia according to the text?

    <p>Osteoporosis</p> Signup and view all the answers

    What is suggested by the widening mortality gap between schizophrenia and the general population?

    <p>Improved health outcomes for people with schizophrenia</p> Signup and view all the answers

    Which factor increases the risk of heart attack and cerebrovascular accidents in individuals with schizophrenia?

    <p>Antipsychotic medication</p> Signup and view all the answers

    What percentage of patients demonstrate intact performance in neuropsychological assessments according to the text?

    <p>60%</p> Signup and view all the answers

    Which factor is a common complicating factor in schizophrenia that leads to a 20% reduction in lifespan?

    <p>Increased cigarette smoking</p> Signup and view all the answers

    What medical condition is NOT associated with schizophrenia according to the text?

    <p>Hypothyroidism</p> Signup and view all the answers

    Which cognitive ability is significantly lower in individuals with schizophrenia, indicating more diffuse impairments?

    <p>Verbal intelligence</p> Signup and view all the answers

    What is suggested by the widening mortality gap between schizophrenia and the general population?

    <p>Existence of high-risk behaviors in individuals with schizophrenia</p> Signup and view all the answers

    Which frontal lobe dysfunction pattern is consistent with impairments in spontaneous use of strategies in patients with schizophrenia?

    <p>Frontal-Subcortical Pattern</p> Signup and view all the answers

    What is a confounding factor to interpreting neuropsychological findings in schizophrenia?

    <p>Stroke or Lesion Data</p> Signup and view all the answers

    What environmental factor is associated with an increased incidence of schizophrenia related to the relative number of schizophrenic births?

    <p>Season of birth</p> Signup and view all the answers

    In which type of area does the seasonality effect related to schizophrenia primarily occur?

    <p>Cities</p> Signup and view all the answers

    What is a likely cause of the increased incidence of schizophrenia found in babies born after an influenza epidemic?

    <p>Viral pathology</p> Signup and view all the answers

    Which factor is associated with an increased risk of schizophrenia based on the distance from the equator?

    <p>Latitude</p> Signup and view all the answers

    Which environmental factor is more readily transmitted in regions with high population densities, potentially impacting schizophrenia rates?

    <p>Viruses</p> Signup and view all the answers

    What environmental factor associated with increased incidence of schizophrenia has a seasonality effect primarily observed in cities rather than rural areas?

    <p>Population density</p> Signup and view all the answers

    What is one of the primary differences between First Generation Antipsychotics (FGAs) and Second Generation Antipsychotics (SGAs) based on the text?

    <p>FGAs block serotonin 2A receptors while SGAs block D2 receptors</p> Signup and view all the answers

    Which pathway is affected by First Generation Antipsychotics (FGAs) according to the text?

    <p>Nigrostriatal pathway</p> Signup and view all the answers

    What aspect of cognition is most severely impacted in individuals with psychosis according to the text?

    <p>Memory</p> Signup and view all the answers

    What is suggested as a potential cause of the increased release of dopamine in persons with schizophrenia?

    <p>Increased density of D2 receptors</p> Signup and view all the answers

    Which receptor type do Second Generation Antipsychotics (SGAs) have more potency at blocking compared to First Generation Antipsychotics (FGAs)?

    <p>Serotonin 2A receptors</p> Signup and view all the answers

    What is a distinguishing feature of SGAs compared to FGAs in terms of their effects on schizophrenia symptoms?

    <p>SGAs are more potent at reducing negative symptoms compared to FGAs</p> Signup and view all the answers

    What is the characteristic duration of symptoms in Brief Psychotic Disorder?

    <p>At least 1 day but less than 1 month</p> Signup and view all the answers

    In Schizophreniform Disorder, how long should symptoms persist to differentiate it from Schizophrenia?

    <p>At least 1 month but not yet 6 months</p> Signup and view all the answers

    What type of symptoms do antipsychotic medications primarily ameliorate in psychosis?

    <p>Positive</p> Signup and view all the answers

    Which medication type used in psychosis management may have adverse effects on cognition, especially at high doses?

    <p>Stimulants</p> Signup and view all the answers

    Why is reducing the gap between psychosis onset and treatment initiation crucial?

    <p>To reduce psychotic breaks</p> Signup and view all the answers

    What is a common adjunct medication prescribed alongside antipsychotics in psychosis management?

    <p>Anxiolytics</p> Signup and view all the answers

    Which gender is more likely to have worse premorbid adjustment in early-onset schizophrenia?

    <p>Males</p> Signup and view all the answers

    What is a characteristic difference in the presentation of visual hallucinations in pediatric schizophrenia compared to other age groups?

    <p>They tend to be more complex and detailed in pediatric schizophrenia</p> Signup and view all the answers

    What is a distinguishing feature of late-onset schizophrenia compared to typical onset schizophrenia?

    <p>Less paranoia and disorganization in late-onset schizophrenia</p> Signup and view all the answers

    Which age group experiences more susceptibility to side-effects of antipsychotic medication according to the text?

    <p>Elderly individuals</p> Signup and view all the answers

    What is a possible explanation provided in the text for the geriatric population's different etiology of late-onset schizophrenia?

    <p>Impact of aging on neurodevelopmental factors</p> Signup and view all the answers

    In what aspect do individuals with late-onset schizophrenia differ from those with earlier onset, based on the text?

    <p>Identical course and symptoms between early and late-onset schizophrenia</p> Signup and view all the answers

    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

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    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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