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Schizophrenia and Other Psychotic Disorders

What some other psychotic disorders we have learned other than Schizophrenia?
Schizophreniform disorder
Schizoaffective disorder
Delusional disorder
Shared Psychotic disorder
Psychotic disorder NOS
Culture-Bound syndromes
What is the lifetime prevalence of Schizophrenia?
Approximately ____% of schizophrenics will not get treated
For schizophrenia, the male/female ratio is equal but ______ ____ __________ differs.
age of onset (more males are affected earlier in life)
If someone is born in the ________ season, they are more likely to become affected.
True or False: Schizophrenics are not likely to become drug users.
False: they are MORE likely to become drug users!
There is a likelihood of re-admittance to hospital within two years of first episode in ______% of schizophrenics.
_____% of psychiatric beds are occupied by schizophrenic patients.
_____% concordance with monozygotic twin of schizophrenic patient.
Dads over ____ are more likely to produce children with schizophrenia.
____% of schizophrenics attempt suicide.
Who called schizophrenia 'Dementia Precox'?
Emil Kraepalin (he also used the term 'paranoia' to identify a separate group 'characterized by persistent persecutory delusions
What does precox mean?
early onset
Who came up with 'schizophrenia'?
Eugene Bleuler ('Schizo' (schism) was used because he felt it represented the breaks between thought and reality)
What are some examples of Positive Symptoms?
hallucinations, delusions, racing thoughts
What are some examples of Negative Symptoms?
Apathy, lack of emotion, poor or non-existent social functioning
Cognitive Symptoms may be apparent in both the _________ and _________ categories.
positive and negative. Cognitive symptoms include disorganized thoughts, difficulty concentrating or following instructions, and memory problems.
What is a negative symptom?
traits/characteristics found in normal persons but lacking in schizophrenics--indicates a lack of something or something missing (i.e. blunted affect, loss of desire, lack of emotion, etc.)
What is a positive symptom?
symptoms apparent in schizophrenics but not in a 'normal' population (i.e. hallucinations)
What is a delusion?
a false belief not shared by culture (aliens are secretly running the USA)
What is an illusion?
the misperception of real stimuli (for a second there I thought that tree was an alien)
What is a hallucination?
a sensory impression or activation without actual stimuli (the aliens are talking to me all the time)
75% of hallucinations in schizophrenia are ______________.
What does anhedonia mean?
not taking pleasure in pleasurable things
What does avolution mean?
the lack of desire to pursue a meaninful goal
What does alogia mean?
not being able to speak?
What is the flattened affect?
also called the 'blunted affect'; it is the failure to express feelings either verbally or non-verbally; expressive gestures are rare and there is little animation in facial expression
What are the different criterias for diagnosing Schizophrenia?
Criterion A: Delusions, Hallucinations, Disorganized Speech, Grossly disorganized or Catatonic behavior, Negative symptoms
Criterion B: Social/occupational dysfunction
Criterion C: Duration must be of six months
Criterion D: No diagnosis of schizoaffective disorder or mood disorder (not better accounted for by some other condition)
Criterion E: Not due to drugs or medical condition
What are some of the Subtypes of Schizophrenia?
Paranoid Schizophrenia, Disorganized Schizophrenia, Catatonic Schizophrenia, Undifferentiated Schizophrenia, Residual Type Schizophrenia, Simple Schizophrenia, Deficit Schizophrenia
What subtype of Schizophrenia is characterized by delusions of persecution or grandeur?
Paranoid Schizophrenia
What subtype of Schizophrenia has an older age of onset than other subtypes?
Paranoid (this is why paranoid patients sometimes manage better because of more developed social skills/interactions)
What subtype of Schizophrenia is a marked regression to primitive, disinhibited, messy behavior?
Disorganized Schizophrenia (age of onset typically under 25; patients tend to be active but in an 'aimless' manner and 'act silly')
What subtype of Schizophrenia is described as having stupor, negativism, rigidity, posturing, excitement, and mutism?
Catatonic Schizophrenia
What subtype of Schizophrenia is a rare condition nowadays in industrialized countries?
Catatonic Schizophrenia
What subtype of Schizophrenia meets criterion A but is not easily classified as another subtype?
Undifferentiated Schizophrenia (it is kind of like the 'NOS' category)
What subtype of Schizophrenia involves the continuing presence of schizophrenic disturbance without 'a complete set of active symptoms'?
Residual type of Schizophrenia
What subtype of Schizophrenia involves a gradual loss of drive and ambition and social withdrawal? These individuals are not 'heavily psychotic, and hallucinations/delusions are not persistent.
Simple Deteriorative Disorder (Simple Schizophrenia)
What subtype of Schizophrenia has long lasting negative symptoms (blunted affect, poverty of speech, decreased social drive and interactions, etc.?
Deficit Schizophrenia
Most schizophrenics will end up showing __________ symptoms.
Patients with Simple Schizophrenia and Deficit Schizophrenia mainly display __________ symptoms.
What is the dopamine (DA) hypothesis?
over-activity of DA systems-->it states that drugs that increase DA activity (AMPH) can cause schizo-like symptoms, and anti-psychotic drugs are D2R antagonists.
Excess Dopamine activity correlates with __________ symptoms.
What is an example of a long time anti-psychotic D2 antagonist that blocks the effect of the endogenous transmitter?
Haldol (haloperidol) --> a 'typical' anti-psychotic
Dopamine intake will ___________ the likelihood of schizophrenia.
If a specific drug works on dopamine, it is a ___________ antipsychotic.
If a specific drug works on serotonin, it is a ___________ antipsychotic.
What are some examples of neurotransmitters that are correlated with schizophrenia?
serotonin (5-HT), GABA, Glutamate, Acetylcholine, and dopamine
What is 5-HT another name for?
What is DA?
Excess Serotonin levels are correlated with ___________ symptoms.
positive AND negative
GABA is an _______________ transmitter.
GABA interacts with both _________ and __________ systems.
5-HT (serotonin) and DA (dopamine) systems
What is the Glutamate antagonist that can induce a schizophrenia-like condition?
Decreased acetylcholine and decreased ____________ receptors has been correlated with hallucinations in Schizophrenics.
nicotinic (this is perhaps why schizophrenics self medicate by smoking)
Schizophrenics have deficits in following a moving finger and thus have deficits in __________ ___________ eye movements.
smooth pursuit
_____% of schizophrenics show saccadic eye movements (jumpy eye movements when asked to follow a moving finger).
When faced with a cognitive task, normal individuals show ____________ activity in the prefrontal cortex, whereas schizophrenics show ____________ activity.
increased (hyperfrontality), decreased (hypofrontality)
What does hypofrontality mean?
decreased activity in the frontal lobes
Schizophrenics show hypofrontality, __________ size of ventricles, and __________ size of limbic structures (emotional circuitry)
increased, decreased
True or False: it is easy to test for Schizophrenia
FALSE: it is very hard to test for Schizophrenia for many reasons (i.e. it is unethical to leave them unmedicated)
In chronic Schizophrenics, you see a progressive loss of cortical ________ matter.
True or false: All 'schizophrenic symptoms appear in other disorders'.
True! Thus, there is no single sign or symptom that is pathognomonic for schizophrenia, symptoms may also change over time. SO.... the patient history becomes very important!
What term means that a sign/symptom is unique to one disease?
What does it mean when something is premorbid?
It is preceding the disease
What does it mean when something is prodromal?
it is an early, nonspecific symptom(s) that may indicate the start of a disease
The mental status of schizophrenics is so __________ it can't be summarized in one or two sentences. However more specific areas can be discussed like hallucinations, illusions, and homicide/suicide/violence.
What are the most common type of hallucinations?
Auditory (visual come second); other sensory hallucinations may suggest a medical/neurological condition
What is the type of hallucination in which you have altered states of your body organs (i.e. your brain is on fire)?
Cenesthetic type
What are illusions?
distortions of real images or sensations (i.e. based on something real)
True or False: Violence is uncommon among untreated Schizophrenic patients.
False: Violence is very common among untreated Schizophrenic patients!
____________ is the leading cause of death among untreated schizophrenics.
Suicide. However, they are no more likely to commit homicide than your average student
True or False: In Schizophrenics, orientation and memory are frequently intact.
True or False: a typical Schizophrenic patient does not do well recognizing he/she has a condition.
True. Thus, poor compliance with treatment and medication is common.
What are some signs that indicate someone might have Schizophrenia?
1) motor disorders, tics, hypertonicity (rigidity), lack of coordination, fine motor skill problems
2) higher blinking rate than normal (^DA)
3) frequent lack of prosody (could involve non-dominant parietal lobe)
What are some conditions/diseases that may be associated with Schizophrenia? (conditions/diseases that have comorbidity)
1) Obesity: higher average BMI in patients
2) Diabetes, COPD, heart disease: much higher smoking rate in patients, etc.
3) HIV: due to increased risk behavior
What are some drugs that cause symptoms similar to Schizophrenia?
Cocaine or AMPH-induced psychosis, PCP, alcohol, or barbiturate withdrawal
What are some diseases that cause symptoms similar to Schizophrenia?
HIV, encephalitis, Huntington's, Wilson's disease (problems with copper accumulation), Wernicke-Korsakoff

If it causes brain damage or dysfunction, it could result in symptoms similar to Schizophrenia
What are some psychiatric disorders that cause symptoms similar to Schizophrenia?
Schizophreniform disorder, Brief psychotic disorder, Schizoaffective disorder, Delusional disorder, and malingering (pretending to have an illness to avoid work, etc.)
A schizophrenic will first be diagnose with _______________ then _______________ THEN Schizophrenia.
1) Brief Psychotic disorder then
2) Schizophreniform disorder THEN
3) Schizophrenia
What are some examples of mood disorders?
depression, mania, bipolar, anxiety
For someone to have Schizophreniform disorder, symptoms must be present for more than _______ but less than _________.
more than 1 month but less than 6 months
For someone to have Brief Psychotic disorder, symptoms must be present for more than ________ but less than _________.
more than a day but less than a month
For someone to have Schizoaffective disorder, they must have Schizophrenia PLUS a _________ or __________ syndrome.
manic or depressive
ex: bipolar, depression, anxiety, mania, etc.
For someone to have a delusional disorder, they must have delusions without ______________.
hallucinations (they must have delusions without the other symptoms of Schizophrenia)
Typically, Schizophrenic symptoms begin in _________________.
After the onset of symptoms in Schizophrenics, what phase follows?
Prodromal phase (often brought on by major changes like going to college, etc.)

Prodromal phase: a clear deterioration in function before the active phase of mental disturbance
After the Prodromal phase, what type of symptoms usually follow?
In general, Schizophrenic patients subsequently undergo a series of ___________ and ___________.
recoveries and relapses
What is the course of Schizophrenia? (what phase comes first, second, third?)
1) Prodromal Phase: may consist of decreased social activities, new/changing interests in religion, occult, philosophy (i.e. seeking answers because they are thinking differently)
2) Active Phase: the psychotic episode
3) Residual Phase: the period between psychotic episodes, usually negative symptoms (where the active symptoms aren't really present)
5-10 years after initial hospitalization, only _______ of patients are considered to have 'good outcomes'.
____% or more of patients remain significantly impaired for the remainder of their lives.
Only _____% of schizophrenics are considered to lead 'normal' lives.
What are the possible treatments for Schizophrenia?
antipsychotic drugs but also therapies/interventions/etc to help increase the degree of recovery
True or False: Pharmacotherapy (antipsychotic drugs like dopamine and serotonin) are sufficient to treat Schizophrenics.
False: they are good, but NOT sufficient
For treating Schizophrenia, single approaches do not generally work. Why is that?
because Schizophrenia is a complicated disorder and is multifaceted (to treat, you must attack it at every angle)
_________ drugs are used to treat the positive symptoms of Schizophrenia. What are some examples of these drugs?
Typical (dopamine) drugs
Chlorpromazine (Thorazine)
Haloperidol (Haldol)
Perphenazine (Etrafon, Trilafon)
Fluphenazine (prolixin)
__________ drugs are used to treat the negative symptoms of Schizophrenia or to treat people who have had Schizophrenia for a long duration of time. What are some examples of these drugs?
Atypical (serotonin) drugs
Clozapine (Clozaril)
Risperidone (Risperdal)
Olanzapine (Zyprexia)
True or False: Atypical drugs are generally preferred for initial treatment over typicals, but they are more expensive and have other issues (weight gain).
__________ can be very effective for treatment resistant schizophrenics, but has serious potential side effects for your heart (agranulocytosis and myocarditis)
Antipsychotic meds produce side effects. What are some examples of these side effects?
Extrapyramidal Side Effects (EPS) and movement disorders such as Tardive Dyskinesia (constant movements of tongue, lips, face, trunk, and extremities)
Schizophreniform Disorder is very similar to Schizophrenia except for 3 main differences. What are those differences??
1) Symptom duration must be more than one month, but less than 6 (symptoms for more than 4-6 months-->person has Schizophrenia)
2) Long term prognosis is generally good
3) Patients tend to have more affective symptoms (i.e. mania), so the condition may be more similar to mood disorder
A Schizoaffective person usually has a noticeably stronger mood component than a _________ but not a noticeably stronger mood component than a ___________.
Schizophrenic, Schizophreniform individual
Individuals with Schizophreniform may have more than one episode. Approximately _____% go on to develop Schizophrenia.
True or False: Treatment for Schizophreniform disorder is essentially the same for Schizophrenia.
What is the lifetime prevalence for Schizophreniform disorder?
Around 0.1%
________ disorder has features of both Schizophrenia and affective (mood) disorders.
What is the lifetime prevalence for Schizoaffective Disorder?
less than 1%
Schizophrenia has the highest prevalence, __________ has second highest, _____________ has 3rd highest.
Schizophreniform, Schizoaffective
A patient with Schizoaffective disorder must be in one of these categories....
1) Schizophrenic with mood symptoms
2) Having a mood disorder and also Schizophrenia
3) Both mood disorder and Schizophrenia
4) Having a 3rd psychosis unrelated Schizophrenia or mood disorders
5) Disorder in on a continuum between Schizophrenia and mood disorders
6) Some combination of the above
For someone to have delusional disorder, they must have 'non-bizarre' delusions for at least ___________.
one month
Usually people are diagnosed with Delusional Disorder when Criterion ___ for schizophrenia are not met.
Criterion A (Delusions, Hallucinations, Disorganized Speech, Grossly disorganized or Catatonic behavior, Negative symptoms)
What is considered a bizarre delusion?
a delusion that involves a totally implausible phenomenon (bizarre delusions are common in Schizophrenia)
T or F: In delusional disorder, functioning is impaired and behavior is obviously odd/bizarre.
False: functioning is not impaired and behavior is not obviously odd or bizarre.
T or F: Delusional disorders usually affect the quality of life.
False: Delusional disorders usually do not affect the quality of life
What is a delusion?
a belief not believed by most of society
What is considered a non-bizarre delusion?
a delusion that is 'believable' and could happen in real life
What are some types of Delusional Disorders?
1) Jealous
2) Erotomanic
3) Grandiose
In what type of delusional disorder does one believe that their partner is being unfaithful?
Jealous (delusional disorder); this disorder can have a very sudden onset with no prior psychiatric history--can potentially be dangerous; this is not normal jealousy, this is jealousy that is implausible (there is no reason for the person to be jealous)
In what type of delusional disorder does one fall in love with someone and start to believe that someone loves them back (when they, in reality, do not love them back)?
Erotomaniac (delusional disorder)
In what type of delusional disorder does one often show 'paradoxical conduct'?
Erotomaniac (delusional disorder); paradoxical conduct: any denials or negative reactions from the 'love' are interpreted a positive
In what type of delusional disorder does one have a delusion of inflated worth, power, and knowledge (megalomania)?
What is megalomania?
the delusion of having inflated worth, power, and knowledge.
In what type of delusional disorder does one believe that their thoughts, feelings, and actions under someone else's control?
Of being controlled (delusional disorder)
In what type of delusional disorder does one feel like they are being attacked, cheated, harassed, harmed, etc.?
Persecutory (sometimes these individuals become obsessed with pursuing litigation against their supposed harassers)
In what type of delusional disorder does one feel like their thoughts are being broadcasted out loud?
Thought broadcasting
In what type of delusional disorder does one feel like their thoughts are inserted into their mind?
Thought Insertion
What is another name for the jealous type of delusional disorder?
Othello Syndrome
Is the jealous syndrome more common in men or women?
The typical patient of this delusional disorder would be a lonely, unattractive woman in a low-level job. (read this notecard as if you were on jeopardy ;)
What is a term for the lack of desire to pursue meaningful goals?
What is a term for the complete lack of speech?
What is the term for the inability to experience pleasure?
What is the type of delusional disorder where one has a delusion pertaining to the appearance or functioning of the body?
somatic delusion
What is Delusional Parisitosis and what type of delusional disorder is it?
where a person is convinced that their body is infested with parasites---it is a SOMATIC delusional disorder
What is the type of delusional disorder where one has the idea that events/things/etc. in the person's immediate vicinity have some sort of unusual significance?
"Of Reference" delusional disorder
What type of delusional disorder is this an example of?
"I'm starting to think that music is basically being aimed at me to communicated something, i.e. someone must've called the radio station and requested these songs because they wanted to say something to me. Or, some kind of synchronicity or divinity is trying to communicate or influence me"
"Of Reference" delusional disorder
Delusional disorders can be Mood _____________ or Mood ____________.
Congruent, Incongruent
Someone manic is having delusions of grandiosity. Would they be considered mood congruent or incongruent?
mood congruent
Someone depressed is having delusions of grandiosity. Would this be considered mood congruent or incongruent?
mood incongruent
What type of delusional disorder is where one person begins to believe/share another person's delusion?
shared psychotic disorder (patients usually have known each other a long time and the secondary person is typically gullible, less intelligent, with low self esteem).
If they had a delusional disorder NOS, this disorder would be it, as it's not a delusion of one person alone.
Shared Psychotic Disorder
Brief Psychotic Disorder lasts at least ________ but not more than _______.
1 day, 1 month
True or False: In brief psychotic disorder, patients show full remission.
Brief psychotic disorders are more common in younger or older people?
younger (20-30)
True or False: Brief psychotic disorder has an abrupt onset and typically follows major life stressors.
What are some psychotic disorders NOS?
Autoscopic and Postpartum psychosis
In which NOS psychotic disorder does a patient see a 'phantom' of themselves, colorless and transparent (it is very rare)?
Autoscopic disorder
Which NOS psychotic disorder occurs soon after birth (to the mother, not the baby)?
Postpartum psychosis
What drugs can cause psychosis?
amphetamine, cocaine, and PCP
What syndromes are found only within a certain culture or region and there is no physiological/biochemical evidence for them?
Culture-bound syndromes
What culture-bound syndrome involves a perceived insult/slight resulting in a violent or homicidal outburst?
Amok (Malaysia)--> occurs only in men and a period of brooding follows
What culture-bound syndrome involves severe hypochondriacal and anxiety concerns associated with discharge of semen and whitish discoloration of urine?
Dhat (India)
What culture-bound syndrome involves extreme excitement for about 30 minutes followed by seizures and coma up to 12 hours?
Piblokto -->patients can become very violent and occurs in Inuit (Eskimo) population
What culture-bound syndrome involves a preoccupation with death and the deceased, occurring in Native American tribes?
Ghost sickness-->symptoms include bad dreams, fainting, hallucinations, and fear
What is Rootwork/Hoodoo?
a culturally-bound syndrome that involves but just putting curses on people, etc; NOT voodoo; based in part on components of Christianity
What ethnic groups have Rootwork/Hoodoo?
African-American or Caucasians in southern US/Caribbean
What is Brain Fag?
a culturally-bound syndrome that is predominantly in male students, symptoms are vague somatic concerns, depression, etc.
"Brain fag" was once a common term for mental exhaustion and is now exclusive to West African regions.
What does the 'fag' part come from in Brain fag?
What is the culturally-bound syndrome that is a rare condition affecting French-Canadian lumberjacks?
The Jumping Frenchman of Maine
In what culturally-bound syndrome does a person have an exaggerated startle response? (they may jump, hit, yell, just way more than normal people-they may also show echolalia and echopraxia)
The Jumping Frenchman of Maine
In what culturally-bound syndrome does a person have an intense fear that one's genitalia are shrinking?
What ethnic groups have the culturally-bound syndrome "Koro"?
Asian/Southeast Asians-->more prevalent in men who cheat, visit prostitutes, etc (i.e. guilt)
What are some other subtypes of psychotic disorders?
Bouffee Delirante and Oneiroid
What is Bouffee Delirante?
a subtype of psychotic disorders that describes a brief psychosis with good prognosis (kinda between brief psychotic disorder and schizophreniform disorder)
"Bouffee Delirante" is a French term that is becoming less used
What is Oneiroid?
a subtype of psychotic disorders that describes a dream like state in which the patient exists almost exclusively in their hallucinatory state, not well oriented to time and place, seems very confused.
What is 5-HT?
In psychosis there is an over-activity of __________.
D1 is _________ and D2 is __________.
inhibitory or excitatory (find out which one)
If a person isn't schizophrenic or delusional, they fit into this category.
Psychotic Disorder NOS
T or F: Children don't usually become psychotic, adults and adolescents do.

Onset is early in children, late
starting over age 45. Symptoms, prognosis, progression for early onset similar to that for diagnosis of adult schizophrenia.
What should you not mix "Of reference delusional disorder" up with?
Thought Insertion: is not thought insertion because it involves a nonspecific message and no knowledge of who is putting the message in something just thinks that there is a message

Paranoid Schizophrenia: is not paranoid schizophrenia because paranoid schizophrenics will put a lot more detail into the suspicion ("the CIA put the message in my newspaper")
T or F: Delusional disorders affect quality of life.
False: they do not affect quality of life.