PSY664 Schizophrenic Disorders

list and describe the two main positive symptoms

hallucinations - false perceptions (Auditory · Visual · Tactile · Olfactory · Gustator)

delusions - false beliefs (Persecutory · Grandiose · Referential, Erotomanic · Somatic · Nihilistic · Bizarre)

what are the 5 A's of negative symptoms?

Affective Flattening - reduced emotion expressivity

Alogia - poverty of speech, empty replies

Avolition - inability to initiate or sustain goal-directed activities

Anhedonia - reduced pleasure from what you once enjoyed

Asociality - diminished interest in social interactions

what are the differences between positive and negative symptoms?

positive = added

negative = subtracted from normal functioning

*normal are usually more disabling over time and harder to treat*

what are Disorganized symptoms?

speech - derailment, tangentiality, word salad

grossly disorganized behavior

inappropriate affect

catatonic (stupor)

what are Cognitive symptoms?

working memory deficits

attention impairment

reduced processing speed

executive functioning disruption

verbal learning and memory deficits

impaired social cognition

*these symptoms are strongest outcome predictor*

how is tangential speech different from circumstantial speech?

tangential never returns to main topic

what are the main features of Schizotypal PD?

no full psychosis

odd beliefs (NOT delusions)

social isolation

cluster A

what are the main features of Delusional Disorder?

non-bizarre delusions, no hallucinations, no other psychotic symptoms, functioning intact

what are the main features of brief psychotic disorder?

lasts 1 day - 1 month, 1 or more positive symptoms, full remission; NOT precursor to schizophrenia

what are the main features of Schizophreniform?

lasts 1 - 6 months, same criteria as schizophrenia, may fully recover; "schizophrenia waiting room"

what are the main features of Schizophrenia?

lasts longer than 6 months with 1 or more month active, 2 or more criterion A symptoms for significant portion of one month, functional decline

what are the main features of Schizoaffective Disorder?

schizophrenia + a major mood episode present for majority of illness, psychosis 2+ weeks without mood symptoms

what are the 9 symptoms for Schizotypal PD, and how many do you need to have the disorder?

need 5//9

1. ideas of reference (not delusions)

2. odd beliefs/magical thinking

3. unusual perceptual experiences

4. odd thinking and speech

5. suspiciousness/paranoid ideation

6. inappropriate or constricted affect

7. odd or eccentric behavior

8. lack of close friends

9. excessive social anxiety

*Not psychotic*

what is considered a criterion A symptom?

delusions, hallucinations, disorganized speech, disorganized/catatonic behavior

what are the specifiers of brief psychotic disorder?

with marked stressor - triggered by known thing

without marked stressor - unknown exact cause

with peripartum onset - onset within days to weeks after delivery

true/false: you can diagnose schizophrenia in real time at first break

FALSE; you diagnose schizophreniform and monitor

what is the main specifier for schizophreniform?

rapid onset: full psychosis occurs within 4 weeks after first symptom appeared

who generally has later onset and better prognosis of schizophrenia?

women

how is schizoaffective disorder different from bipolar disorder with psychotic features?

psychosis must be present WITHOUT mood symptoms for at least 2 weeks (criterion B)

how is schizoaffective disorder different from schizophrenia?

mood episode must be present for MAJORITY of total illness duration

what are the two specifiers of schizoaffective disorder?

1. bipolar type (includes manic episodes)

2. depressive type (only MDE episodes)

what are the 4 different types of beliefs and their characteristics?

1. normal belief - open to revision, culturally shared, not distressing

2. strongly held belief - resistant to change, ego-syntonic, may be idiosyncratic, identity-connected

3. overvalued idea - unreasonable, sustained, some insight remains, not correctable, identity-infused, *held with extraordinary intensity but not delusional*

4. delusion - fixed, false in cultural context, not correctable, full conviction, no insight

list and describe the 4 treatment phases

1. acute - stabilize + safety, antipsychotic initiation, psychoeducation

2. stabilization - consolidate gains, medication adherence, reduce relapse risk

3. maintenance - prevent relapse, psychosocial rehab, functional recovery

4. recovery - employment, relationships, self-management, community integration

list examples and describe uses for FGAs vs SGAs

FGA - effective for positive symptoms, blocks D2 receptor, low metabolic burden, higher risk of EPS and tardive dyskinesia, available as LAIs (chlorpromazine, fluphenazine, haloperidol)

SGA - modest benefit for negative symptoms, higher metabolic risk, D2 + 5-HT2A antagonism (risperidone, olanzapine, aripiprazole)

what does CBTp do?

targets appraisal of psychotic experience instead of arguing client out of beliefs; reduces distress w/o requiring renouncing beliefs

how does family psychoeducation help those with schizophrenic disorders?

expressed emotion (comments, hostility, emotional over-involvement) of family is one of the strongest predictors of relapse (lower = better)

what is IPS (supported employment)?

gives individual placement and support to client; place then train

what is coordinated specialty care (CSC)?

team based early treatment program occurring right after first episode that helps clients navigate their life

what is the dopamine hypthesis?

too much mesolimbic DA drives positive symptoms, while deficits in mesocortical DA drives the negative and cognitive symptoms

what does the dopamine hypothesis explain?

explains why antipsychotics are good for positive symptoms but limited for negative (they block DA everywhere, including where more is needed)

what is the glutamate hypothesis?

NMDA receptor hypofunction contributes to symptom profile

what are the genetic inheritance chances for schizophrenic disorders?

≈80%; concordance in identical twins ≈50% (not 100% — environmental factors matter)

what are some neurodevelopmental factors that could contribute to schizophrenic disorders?

Prenatal stressors, birth complications, cannabis use in adolescence

what medication is reserved for treatment-resistant schizophrenia and what does it additionally require?

clozapine; requires monitoring for agranulocytosis (severe blood disorder)

generally, what are the 3 phases during the course of schizophrenic disorders?

1. Prodromal: social withdrawal, attenuated psychotic symptoms, declining function (before active phase)

2. Active (acute): Criterion A symptoms present

3. Residual: Attenuated positive symptoms, prominent negative symptoms (after active phase)