Psychotic Disorders

Front 1

In what main way are the psychotic disorders different from the neurotic disorders?

Back 1

Psychosis broadly refers to mental illness characterized by a loss of touch with reality; those with neurosis generally tend to know their beliefs are unusual and that they are ill.

Front 2

What two disorders mentioned in the notes may be considered borderline since delusions may accompany?

Also, what two personality disorders may include psychotic characteristics?

Back 2

OCD is considered by some to be a 'borderline' diagnosis, since some obsessions can be founded in beliefs that are delusional.

Also, bipolar disorder can also be characterized by genuine delusions.

Some Cluster A PDs (paranoid & schizotypal) may include psychotic characteristics.

Front 3

What are the five characteristic symptoms of schizophrenia and how many are required for diagnosis? what is the exception to this number?

Back 3

1. Delusions
2. Hallucinations
3. Disorganized speech (e.g., frequent derailment or incoherence)
4. Grossly disorganized or catatonic behaviour
5. Negative symptoms, i.e., affective flattening, alogia, or avolition

The minimum number required for diagnosis of schizophrenia is two of these, or only one if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person's behavior or thoughts, or two or more voices conversing with each other.

Front 4

What is the minimum length of time one must experience schizophrenic symptom(s) in order to be diagnosed? (During this time symptoms must be present for a SIGNIFICANT portion of time.)

How long must continuous signs of the disturbance persist?

Back 4

Symptoms must EACH be present for a signficant portion of time during a ONE MONTH period (or less if successfully treated).

Continuous signs of the disturbance persist for at least 6 months. (This 6-month period must include at least 1 month of symptoms that meet Criterion A and may include periods of prodromal or residual symptoms.)

Front 5

After what time period can a particular classification of longitudinal course of schizophrenia be assigned?

Back 5

Classifications can be applied only after at least one year has elapsed since the initial onset of active-phase symptoms.

Front 6

When was schizophrenia first categorized scientifically, and by whom? and what was it called?

Back 6

1899 by Emil Kraepelin who combined three previously distinct symptoms under the single label 'dementia praecox'.

Front 7

What three previously distinct symptoms were combined under the single label 'dementia praecox'?

Back 7

Catatonia: Immobility alternating with agitation

Hebephrenia: Silly, immature emotionality

Paranoia: Delusions of grandeur or persecution

... Kraepalin suggested that all three symptoms could be considered signs of 'mental weakness'

Front 8

Kraepalin was the first to differentiate schizophrenia from manic depression. What are the differences in terms of time of onset and outcome?

Back 8

Schizophrenia is characterized by early onset and poor outcome.

Manic depression is characterized by a later onset, and better outcome.

Front 9

Who was the first to introduce the actually term 'schizophrenia'? Why was the term misleading?

Back 9

Eugen Bleuler introduced the term 'schizophrenia', from 'split' and 'mind' ... misleading the general public into thinking that schizophrenia is characterized by multiple personalities, which it is not.

Front 10

Capgras Syndrome and Cotard's Syndrome are symptoms that are associated with neurological damage and are sometimes seen in schizophrenia.

Are they examples of positive, negative, or disorganized symptoms.

[check txtbook: it may be that these symptoms are not neurologically caused in the case of schizophrenia.. thats what the notes seem to say)

Back 10

They are examples of positive symptoms (which are Positive symptoms: Active manifestations of abnormal behavior such as hallucinations and delusions).

Disorganized symptoms are symptoms of incoherent behavior such as rambling speech, erratic behavior, and inappropriate affect.

Front 11

What is 'negation delirium'?

Back 11

It is another name for Cotard's Syndrome, which is a belief that one is dead, or does not really exist. (The textbook characterizes it more generally as "a belief that some part of the body (often the brain) has been altered in some way."

Front 12

What is a possible neurological explanation of why some people may maintain delusions? What's wrong with this "explanation"?

Back 12

It may be due to inadequate integration of new information; N400 (a measure of semantic inconsistency) is smaller in schizophrenics.

But this may just be a description of the problem in other terms?

Front 13

What were the two possibilities given in the textbook for why some people maintain delusions?

Back 13

1. Inadequate integration of new information

2. Delusions may impart a sense of purpose and meaning to otherwise meaningless and bewildering experience. They may also help the patient avoid discomfort of some kind (e.g., damage to self-esteem).

Front 14

What is meant by this possible explanation of why some people maintain delusions:

"mental contents are mis-identified falsehoods, not truths"

Back 14

It means that patients may mis-identify the contents of imagination with the contents of real life.

Front 15

Explain what is meant by these two possible explanations for why some people maintain delusions:

1. Perceptual experience underlying the delusion is unusual.

2. Threshold for accepting anomalous experience is low.

Back 15

1. Patients may be doing their best to make sense of anomalous perceptual activity (e.g. no limbic input on seeing a loved one, as in Capgras syndrome) and their delusion is ‘the best fit’

2. E.g. ‘It seems odd to think that the government has implanted a tarker in my brain…but not that odd.’

Front 16

Two main theories about hallucinations are:
That the hallucinator cannot tell the difference between his/her own thought and an external voice
That abnormal activity in the auditory cortex is being interpreted.

Which is supported by fMRI evidence? Activity shown in which area of LH and in which area of RH?

Back 16

fMRI evidence is consistent with both: it has shown activity in left primary auditory cortex and right middle temporal cortex in actively-hallucinating schizophrenics.

[how does this prove first one? and check txtbook for differences between delusions and hallucinations]

Front 17

What does fMRI overlap between brain activation during movements and activation during action words (e.g. foot movements and leg words) suggest about the distinction between thought and perception?

Back 17

Co-activation of sensory-motor regions in normal individuals suggests that the distinction between thought and perception may be smaller than was once believed.

Front 18

What are some negative symptoms of schizophrenia? (Name 5) The presence of which symptom is associated with poor outcome (as indicated in the notes)?

Back 18

avolition: the inability to initiate and persist in actions (independent of all negative & positive symptoms except emotional withdrawl)

Alogia: decreased speech (difficulty finding words, or delay in replying or contributing to conversation)

anhedonia

affective flattening: (it is not clear if this is due to decreased experience of emotion in schizophrenics, or to decreased ability to express emotion)

asociality: deficits in forming, maintaining, or participating in social relationships

The presence of AVOLITION is associated with poor outcome.

Front 19

What is the best known predictor of asociality in schizophrenics?

Back 19

The best known predictor is COGNITIVE IMPAIRMENT, suggesting that information processing problems may underlie the symptoms.

Front 20

What is "cognitive slippage" as it presents in schizophrenics? What type of symptom is it?

Back 20

Cognitive slippage is an example of a disorganized symptom of schizophrenia. An example of cognitive slippage is weak or illogical reasoning underlying ideas.

Front 21

What are the four subtypes of schizophrenia (not including the undifferentiated type)?

Back 21

Paranoid Type: usu. have intact cognitive skills, behavior, and affect, with a preoccupation with delusions of persecution

Disorganized Type: demonstrate marked disruption to speech and behavior, flattened affect, and self-absorption

Catatonic Type: demonstrate immobility or catelepsy and or purposeless motor activity

Residual Type: schizophrenics who have shown symptoms previously but no longer do

Front 22

What is catelepsy and which subtype of schizophrenia may it characterize?

Back 22

Catelepsy is "waxy flexibility."

It (and/or immobility and/or purposeless motor activity) characterizes the CATATONIC type of schizophrenia.

Front 23

Which subtype of schizophrenia is characterized by flattened affect and self-absorption?

Back 23

Disorganized Type.
(also characterized by a disruption to speech and behavior)

Front 24

What is the lifetime prevalence of schizophrenia?

Back 24

1%

Front 25

Are males or females more likely to be diagnosed with schizophrenia? who is more likely to have a better outcome?

Back 25

Women are LESS likely to be diagnosed (especially under age 36) and have better outcomes.

Front 26

What is referred to by "schizophrenic burnout"? Does it imply something about the course of schizophrenia?

Back 26

"Schizophrenic burnout" refers to the fact that older schizophrenics tend to show FEWER POSITIVE symptoms.

Still, the course of the disease is chronic: most fluctuate between severe and moderate levels all their life.

Front 27

Do those who go on to develop schizophrenia that DO NOT have schizophrenic siblings tend to show more negative or positive symptoms?

Back 27

More negative. Less positive.

Front 28

Give the % of schizophrenics in each group after a five-year follow-up (or at least rank them in order of least common to most common)

Group 1: One episode only; no impairment.

Group 2: Several episodes with minimal or no impairment.

Group 3: Impairment after the first episode with subsequent exacerbation and no return to normality.

Group 4: Impairment INCREASING with each of several episodes and no return to normality.

Back 28

Group 1: 22%

Group 2: 35%

Group 3: 8%

Group 4: 35%

So b/w 1 & 2: it is more likely to have several episodes with little to no impairment.

b/w 3 & 4: it is more likely to have INCREASING impairment with no return to normality than to have one (single?) exacerbation after the first episode..

Front 29

What is the concordance rate for schizophrenia between monozygotic twins?

Back 29

~50%

Front 30

What is the likelihood of developing schizophrenia if both parents are schizophrenic?

Back 30

~45%

Front 31

What is the likelihood of developing schizophrenia if only one parent is schizophrenic?

Back 31

~15%

Front 32

Is there genetic underpinning to schizophrenia?

Back 32

As might be expected with such a complex disease with so many different manifestations, evidence suggests that many genes (on six chromosomes so far) may be implicated .

Front 33

What are the four main theories about what underlies the symptoms of schizophrenia?

Back 33

1. Dopamine system over-activity
2. NMDA over-activity
3. Brain structure anomalies
4. Viral infection

Front 34

Name four pieces of evidence that the theory of dopamine system over-activity rests on.

(hints:

1. what type of drugs work against schizophrenia?
2. side-effects of these drugs?
3. role of L-Dopa in Parkinson's?
4. role of amphetamines?)

Back 34

1. Effective antipsychotic drugs (such as haloperidol) are DOPAMINE ANTAGONISTS.

2. These drugs produce similar side-effects to those seen in Parkinson's, which is known to be due to insufficient dopamine. [I don't get how this is evidence]

3. L-DOPA (a dopamine agonist used against Parkinson's) sometimes produces schizophrenic-like symptoms as a side-effect.

4. Amphetamines (also dopamine agonists) can exacerbate symptoms in schizophrenics?

Front 35

How many subtypes of dopamine receptors are there (t least) and which type do the best schizophrenia medications block? (D1, or D2, etc.) Which receptor are there too few of?

Back 35

At least five.

The best medications mainly block D2 receptors.

In contrast, there may be too few D1 receptors in pre-frontal areas in schizophrenics

Front 36

What is NMDA and what is the NMDA over-activity theory? [shouldn't it be underactivity?]

Back 36

NMDA (N-methyl-d-aspartate) is an example of a glutamate, which is an excitatory neurotransmitter.

The NMDA theory suggests that the symptoms of schizophrenia may be due to glutamate deficits.

Front 37

What is the evidence for the NMDA over-activity theory? (hint: what is PCP(phencyclidine) and ketamine) [shouldn't it be underactivity?]

Back 37

evidence: PCP and ketamine are NMDA antagonists that are hallucinogenic and cause psychotic-like symptoms.

Front 38

What is ketamine and PCP (phencyclidine)?

Back 38

They are NMDA antagonists that cause hallucinogenic and psychotic-like symptoms.

Front 39

What are the brain structure anomalies of schizophrenics? What may be the problem with the brain structure anomalies theory of schizophrenia? What are two areas of the temporal lobe that have abnormalities?

Back 39

Enlarged VENTRICLES (leading to decreased brain volume)

Hypofrontality (FRONTAL LOBE dysfunction)

Reduced volume of the THALAMUS

Abnormalities in TEMPORAL lobe areas (such as the HIPPOCAMPUS and AMYGDALA.)

However, these abnormalities are not found in all patients.

Front 40

Where does the gray matter lost in early-onset schizophrenics begin (and where does it spread to)?

Back 40

The grey matter loss begins in the parietal cortex and spreads to temporal cortex and frontal cortex.

Front 41

What is "hypofrontality"? What % of schizophrenics show hypofrontality?

Back 41

Hypofrontality is diminished ACTIVITY in the DLPFC. About 50% of schizophrenics show hypofrontality.

[check txt: evidence for or against brain structure anomalies theory?]

Front 42

Is there evidence of brain damage implicated in schizophrenia?

Back 42

Some evidence suggests that general brain damage might be implicated in schizophrenia
Among identical twins, obstetrical complications (such as anoxia) are more often seen in the twin who has (or who has the worst case of) schizophrenia.

Front 43

What is the evidence for the viral infections theory of schizophrenia?

Back 43

There are more schizophrenics in urban than rural areas.

(Ambiguous) evidence suggests it is more common now that in the past.

Some (but not all) studies show that those whose mothers were exposed to flu in the second trimester are more likely to have schizophrenia.

Front 44

Schizophrenia is more common in low SES, what does this suggest about the cause of schizophrenia?

Back 44

The higher frequency of schizophrenia in low SES may be due to increased stress or possibly due to social selection.

Front 45

What is the evidence for the Double Bind theory of schizophrenia?

Back 45

Like the Cold Mother theory, the Double Bind theory has been repudiated and is no longer supported.

Front 46

What is "expressed emotion" in a family and how is it related to schizophrenic relapse rates (increases them by how much)?

Back 46

Expressed emotion - the amount of expressed disapproval, hostility, and intrusiveness in a family.

Schizophrenic relapse rates are 3.7x higher in families with high expressed emotion than in families with low expressed emotion.

Front 47

What is the percentage of families with high expressed emotion in:

Anglo-American culture?
British culture?
Mexican culture?
Indian culture?

Are schizophrenic rates higher in those countries with a higher % of families with high EE?

Back 47

Percentage of Families with High EE:

Anglo American : 70%
British: 50%
Mexican: 40%
Indian: 20%f

Cultural differences in EE are not reflected in differences in schizophrenia rates.. undermining the EE theory...?

Front 48

What neurotransmitter do antipsychotic drugs affect (and how)?

Back 48

Antipsychotics work by BLOCKING DOPAMINE receptors.

Front 49

What are the two types of antipsychotics used for schizophrenia?

What were two major side effects of the conventional antipsychotics? What are the benefits of the newer type?

Back 49

Conventional
-have bad side-effect profile, including extrapyramidal (motor abnormality) symptoms and sedation
-tardive dyskinesia = involuntary movements

Novel antipsychotics
-have fewer extrapyramidal side effects
-patients tend to do better overall

Front 50

What is an example of both a conventional antipsychotic and a novel antipsychotic and what are their commercial names?

Back 50

Haliperidol is an example of a conventional antipsychotic; Haldol is its commercial name.

Clozapine is an example of a novel antipsychotic; Clozaril is its commercial name

Front 51

What are some other psychotic disorders related to schizophrenia?

Back 51

1. [Schizotypal Personality Disorder]
2. Schizophreniform Disorder
3. Schizoaffective Disorder
4. Delusional Disorder
5. Brief Psychotic Disorder
6. Shared Psychotic Disorder
7. [Psychotic Disorder due to a medical condition]
8.[Substance-induced Psychotic Disorder]

Front 52

How is schizophreniform disorder the same as schizophrenia?

How is it different?

Back 52

Criteria A, D, and E are met (main symptoms + standard disclaimer), but not B (social/occupational dysfunction).

Front 53

How long is an episode of schizophreniform disorder (including prodromal, active, and residual phases)?

Back 53

An episode of the disorder (including prodromal, active, and residual phases) lasts at least ONE month but LESS THAN SIX months.

(If the diagnosis must be made before waiting for recovery, it should be qualified as "Provisional")

Front 54

What does prodromal mean?

Back 54

A prodrome is an early symptom indicating the onset of an attack or a disease.

Front 55

Schizophreniform Disorder may be diagnosed as "with Good Prognostic Features" if onset of prominent psychotic symptoms occurs within __ _____ of the first noticeable change in usual behavior or functioning.

Back 55

If within FOUR WEEKS of the first noticeable change.

(Note: This plus one other item is required for diagnoses with good prognostic features.)

Front 56

What does it mean is Schizophreniform Disorder is characterized "with Good Prognostic Features"?

(hint:
Onset within ... of first noticeable change in behavior/functioning

Confusion....
Premorbid...
Absence of...?)

Back 56

With Good Prognostic Features is evidenced by two (or more) of the following:

(1) ONSET of prominent psychotic symptoms WITHIN FOUR WEEKS of the first noticeable change in usual behavior or functioning

(2) CONFUSION or perplexity at the height of the psychotic episode

(3) good PREMORBID social and occupational FUNCTIONING

(4) ABSENCE of blunted or flat affect

Front 57

What is Schizoaffective Disorder?

Back 57

An uninterrupted period of illness during which at some time, there is either a

Major Depressive Episode (depressed mood)
Manic Episode, or
Mixed Episode

concurrent with symptoms that meet Criterion A for Schizophrenia.

Front 58

During the same period of illness under Schizoaffective Disorder, there must have been delusions or hallucinations for at least __ weeks in the absence of prominent mood symptoms.

Back 58

At least two weeks.

Front 59

In Schizoaffective Disorder, how long must symptoms that meet criteria for a mood episode be present for during the active and residual periods of the illness? (in terms of a PORTION of the time)

Back 59

Symptoms for a mood episode must be present for a SUBSTANTIAL portion of the total duration of the active and residual periods of the illness.

Front 60

What are the two types of Schizoaffective Disorder?

Back 60

Bipolar Type: if the disturbance includes a Manic or a Mixed Episode (or a Manic or a Mixed Episode AND Major Depressive Episodes)

Depressive Type: if the disturbance ONLY includes Major Depressive Episodes

Front 61

What type would this presentation of Schizoaffective Disorder be classified as?:

Major Depressive Episodes and a Manic or a Mixed Episode

Back 61

Bipolar Type.

Front 62

Is delusional disorder characterized by bizarre or nonbizarre delusions?

Back 62

Nonbizzare. (i.e., involving situations that occur in real life, such as being followed, poisoned, infected, loved at a distance, or deceived by spouse or love, or having a disease).

Front 63

What is the minimum duration of delusional disorder?

Back 63

Delusions must occur for at least ONE month's duration.

Front 64

Can delusional disorder co-occur with Schizophrenia?

Back 64

No. Criterion B says that "Criterion A for Schizophrenia has never been met."

(Indeed, if delusions were large enough, it would likely be diagnosed as Schizophrenia instead. Hence why delusions must be nonbizarre in Delusional Disorder.)

Front 65

Can tactile and olfactory hallucinations be present in Delusional Disorder?

Back 65

Yes, if they are related to the delusional theme. (Note how auditory hallucinations are not included.)

Front 66

How is functioning and behaviour affected in Delusional Disorder?

Back 66

Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired and behaviour is not obviously odd or bizarre.

Front 67

Can mood episodes occur concurrently with delusions in delusional disorder?

Back 67

Yes, but only if their total duration has been BRIEF relative to the duration of the delusional periods.

Front 68

What are the six types of Delusional Disorder (not including Unspecified Type)

Back 68

Erotomanic Type: Delusions that another person, usually of higher status, is in love with the individual

Grandiose Type: Delusions of inflated worth, power, knowledge, identity, or special relationship to a deity or famous person.

Jealous Type: Delusions that the individual's sexual partner is unfaithful

Persecutory Type: Delusions that the person (or someone to whom the person is close) is being malevolently treated in some way.

Somatic Type: Delusions that the person has some physical defect or general medical condition

Mixed Type: Delusions characteristic of more than one of the above types but no one theme predominates.

Front 69

How many symptoms are required for brief psychotic disorder (and what are the four possible symptoms)?

Back 69

Only one symptom is required, but more can be had. Possible symptoms are:

(1) delusions
(2) hallucinations
(3) disorganized speech
(4) grossly disorganized or catatonic behavior

Front 70

What is the (range of) duration of an episode of Brief Psychotic Disorder?

Back 70

At least ONE DAY, but less than one month.

Front 71

What does "brief reactive psychosis" refer to in regards to Brief Psychotic Disorder?

Back 71

It means that the disorder is specified "with Marked Stressor(s)": that is, if symptoms occur shortly after and apparently in response to events that, singly or together, would be markedly stressful to almost anyone in similar circumstances in the person's culture.

Front 72

Brief Psychotic Disorder may be specified "with Postpartum Onset" if within __ _____ postpartum.

Back 72

If within four weeks postpartum.

Front 73

Are stressors required for the onset of brief psychotic disorder?

Back 73

No, it can be specified "without Marked Stressor(s)".

Front 74

What is "Folie à deux"?

Back 74

Folie à deux is Shared Psychotic Disorder, characterized by a delusion that develops in an individual in the context of a close relationship with another person(s), who has an already-established delusion.

The delusion is SIMILAR IN CONTENT to that of the person who already has the established delusion.