kaplan schiz

According to DSM-5 Criterion A for schizophrenia, how many symptoms are required and for how long?

Two (or more) symptoms, each present for a significant portion of time during a 1‑month period (or less if successfully treated).

According to DSM-5 Criterion A for schizophrenia, at least one of the required symptoms must be which?

Delusions, hallucinations, or disorganized speech (frequent derailment or incoherence).

What does DSM-5 Criterion B for schizophrenia require regarding functioning?

For a significant portion of the time since the onset, level of functioning in one or more major areas (work, interpersonal relations, self‑care) is markedly below the level achieved before the onset.

What does DSM-5 Criterion C for schizophrenia specify about the total duration?

Continuous signs of the disturbance persist for at least 6 months, including at least 1 month of symptoms (or less if treated) that meet Criterion A.

What does DSM-5 Criterion D for schizophrenia rule out?

Schizoaffective disorder and depressive or bipolar disorder with psychotic features must be ruled out.

What does DSM-5 Criterion E for schizophrenia state about etiology?

The disturbance is not attributable to the physiological effects of a substance (drug of abuse, medication) or another medical condition.

According to DSM-5, if there is a history of autism spectrum disorder, when can an additional diagnosis of schizophrenia be made?

Only if prominent delusions or hallucinations, in addition to the other required symptoms, are also present for at least 1 month.

According to DSM-5 Criterion A for schizoaffective disorder, what must be present?

An uninterrupted period of illness during which there is a major mood episode (major depressive or manic) concurrent with Criterion A of schizophrenia.

According to DSM-5 Criterion B for schizoaffective disorder, what psychotic symptom requirement exists?

Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode during the lifetime duration of the illness.

According to DSM-5 Criterion C for schizoaffective disorder, what is required regarding mood episodes?

Symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the active and residual portions of the illness.

What does DSM-5 Criterion D for schizoaffective disorder rule out?

The disturbance is not attributable to the effects of a substance (drug of abuse, medication) or another medical condition.

In DSM-5, what are the two subtypes of schizoaffective disorder?

Bipolar type (manic episode part of presentation) and depressive type (only major depressive episodes).

According to DSM-5 Criterion A for schizophreniform disorder, what symptoms are required?

Two (or more) of the following: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, or negative symptoms.

According to DSM-5 Criterion B for schizophreniform disorder, what is the duration?

An episode of the disorder lasts at least 1 month but less than 6 months.

For schizophreniform disorder, what are the "good prognostic features" and how many must be present to use that specifier?

Onset of prominent psychotic symptoms within 4 weeks of first noticeable change, confusion or perplexity, good premorbid functioning, and absence of blunted or flat affect; at least two of these features must be present.

According to DSM-5 Criterion A for delusional disorder, what is the duration requirement?

The presence of one (or more) delusions with a duration of 1 month or longer.

According to DSM-5 Criterion B for delusional disorder, what must never have been met?

Criterion A for schizophrenia has never been met.

According to DSM-5 Criterion C for delusional disorder, what is stated about functioning and behavior?

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

According to DSM-5 Criterion D for delusional disorder, how do mood episodes relate to the delusions?

If manic or major depressive episodes have occurred, these have been brief relative to the duration of the delusional periods.

According to DSM-5 Criterion E for delusional disorder, what must be excluded?

The disturbance is not attributable to the physiological effects of a substance or another medical condition and is not better explained by another mental disorder.

What is the DSM-5 duration requirement for brief psychotic disorder?

Psychotic symptoms last 1 day or more but less than 1 month, with full return to the premorbid level of functioning.

According to DSM-5, what are the three subtypes of brief psychotic disorder?

(1) with marked stressor(s), (2) without marked stressor(s), and (3) with postpartum onset.

According to DSM-5 Criterion A for substance‑/medication‑induced psychotic disorder, what symptom is required?

Delusions or hallucinations.

According to DSM-5 Criterion B for substance‑/medication‑induced psychotic disorder, what evidence is needed?

Evidence from history, physical examination, or laboratory findings that the symptoms developed during or soon after substance intoxication or withdrawal or after exposure to a medication, and that the involved substance/medication is capable of producing the symptoms.

According to DSM-5 Criterion C for substance‑/medication‑induced psychotic disorder, what must be ruled out?

The disturbance is not better explained by a psychotic disorder that is not substance‑ or medication‑induced.

According to DSM-5, how many symptoms are required for a diagnosis of catatonia?

Three (or more) of the following symptoms: stupor, catalepsy, waxy flexibility, mutism, negativism, posturing, mannerism, stereotypy, agitation, grimacing, echolalia, or echopraxia.

In DSM-5, for catatonia associated with another mental disorder, what is the coding instruction?

Code first the associated mental disorder (e.g., schizophrenia, schizoaffective disorder, bipolar disorder, major depressive disorder) and then use the additional code for catatonia.

What is the lifetime prevalence of schizophrenia in the United States?

About 1 percent (one person in 100 will develop schizophrenia during their lifetime).

What is the peak age of onset for schizophrenia in men?

10 to 25 years.

What is the peak age of onset for schizophrenia in women?

25 to 35 years.

Approximately what percentage of women with schizophrenia present with disease onset after age 40 years?

Approximately 3 to 10 percent.

What is the concordance rate for schizophrenia in monozygotic twins?

Approximately 50 percent.

How many times greater is the risk for schizophrenia in first‑degree biological relatives compared with the general population?

Ten times greater.

What are Bleuler's "four As" (fundamental symptoms) of schizophrenia?

Associational disturbances of thought (especially looseness), affective disturbances, autism, and ambivalence.

Who coined the term "schizophrenia" to replace dementia precox?

Eugene Bleuler.

Who translated "démence précoce" into "dementia precox"?

Emil Kraepelin.

What is the simplest formulation of the dopamine hypothesis of schizophrenia?

Schizophrenia results from too much dopaminergic activity.

Which two observations evolved the dopamine hypothesis of schizophrenia?

First, antipsychotic efficacy correlates with their ability to act as antagonists of dopamine type 2 (D2) receptors. Second, drugs that increase dopaminergic activity (cocaine, amphetamine) are psychotomimetic.

Which dopamine tracts are most often implicated in the dopamine hypothesis of schizophrenia?

The mesocortical and mesolimbic tracts.

Up to what percentage of schizophrenia patients are dependent on nicotine?

Up to 90 percent.

What is the lifetime prevalence of any drug abuse (other than tobacco) in schizophrenia?

Often greater than 50 percent.

What is the lifetime prevalence of alcohol abuse within schizophrenia?

40 percent.

By what factor does cannabis use (more than 50 occasions) increase the risk of schizophrenia compared with nonusers?

Sixfold.

In the Northern Hemisphere, during which months are persons with schizophrenia more often born?

January to April (winter and early spring).

In the Southern Hemisphere, during which months are persons with schizophrenia more often born?

July to September.

What percentage of all mental hospital beds are occupied by patients with schizophrenia?

About 50 percent.

What is the probability of readmission within 2 years after discharge from the first hospitalization for schizophrenia?

About 40 to 60 percent.

Which genetic candidate gene has been linked to negative features of schizophrenia?

Dystrobrevin (DTNBP1) and neuregulin 1.

What neuropathological finding is consistently shown on computed tomography (CT) scans of patients with schizophrenia?

Lateral and third ventricular enlargement and some reduction in cortical volume.

What is the P300 wave in evoked potential studies?

A large, positive evoked‑potential wave that occurs about 300 milliseconds after a sensory stimulus is detected.

In what percentage of schizophrenia patients have abnormal eye movements (smooth pursuit dysfunction) been reported?

50 to 85 percent.

What is the "precox feeling" described by some clinicians?

An intuitive experience of their inability to establish an emotional rapport with a patient.

What are the five subtypes of schizophrenia described in ICD‑10 (but not used in DSM‑5)?

Paranoid, disorganized, catatonic, undifferentiated, and residual.

What is the characteristic feature of the paranoid type of schizophrenia?

Preoccupation with one or more delusions or frequent auditory hallucinations (classically delusions of persecution or grandeur).

What is the characteristic feature of the disorganized type of schizophrenia?

Marked regression to primitive, disinhibited, and unorganized behavior and absence of symptoms meeting criteria for the catatonic type.

What is the classic feature of the catatonic type of schizophrenia?

Marked disturbance in motor function (stupor, negativism, rigidity, excitement, or posturing).

What is the residual type of schizophrenia characterized by?

Continuing evidence of the schizophrenic disturbance in the absence of a complete set of active symptoms (emotional blunting, social withdrawal, eccentric behavior, illogical thinking, mild loosening of associations).

What is the DSM‑5 diagnosis called for a psychotic condition with sudden onset lasting 1 day or more but less than 1 month with full remission?

Brief psychotic disorder.

What is the DSM‑5 diagnosis called for a psychotic condition with symptoms lasting at least 1 month but less than 6 months?

Schizophreniform disorder.

What is the DSM‑5 diagnosis called for a disorder with features of both schizophrenia and mood disorders?

Schizoaffective disorder.

What is the DSM‑5 diagnosis called when a person exhibits nonbizarre delusions of at least 1 month's duration?

Delusional disorder.

What is the prevalence of delusional disorder in the United States?

0.2 to 0.3 percent (much rarer than schizophrenia).

What is the mean age of onset for delusional disorder?

About 40 years (range 18 years to the 90s).

What are the specified types of delusional disorder in DSM‑5?

Erotomanic type, grandiose type, jealous type, persecutory type, somatic type, mixed type, and unspecified type.

What is the erotomanic type of delusional disorder also called?

De Clérambault syndrome or psychose passionelle.

What is the jealous type of delusional disorder also called?

Othello syndrome or conjugal paranoia.

What is the somatic type of delusional disorder also called?

Monosymptomatic hypochondriacal psychosis.

What is the delusion in Capgras syndrome?

The belief that a familiar person has been replaced by an impostor.

What is the disorder characterized by the transfer of delusions from one person to another called in DSM‑5?

"Delusional Symptoms in Partner of Individual with Delusional Disorder" (formerly shared psychotic disorder, folie à deux).

What are the most common relationships in shared psychotic disorder?

Sister‑sister, husband‑wife, and mother‑child.

What is the deficit syndrome (deficit schizophrenia) characterized by?

Enduring, idiopathic negative symptoms (restricted affect, poverty of speech, curbing of interests, diminished sense of purpose, diminished social drive).

What is the single leading cause of premature death among people with schizophrenia?

Suicide.

What percentage of schizophrenia patients make suicide attempts?

20 to 50 percent.

What is the long‑term rate of suicide estimated to be in schizophrenia?

10 to 13 percent.

What is the most important factor for suicide in schizophrenia?

The presence of a major depressive episode.

Which antipsychotic may have particular efficacy in reducing suicidal ideation in schizophrenia patients?

Clozapine.

What is the most common type of hallucination in schizophrenia?

Auditory hallucinations (voices that are often threatening, obscene, accusatory, or insulting).

What are cenesthetic hallucinations?

Unfounded sensations of altered states in bodily organs (e.g., burning sensation in the brain, pushing sensation in the blood vessels).

What is thought broadcasting?

When patients think others can read their minds or that their thoughts are broadcast through television sets or radios.

What is the major distinction between schizophrenia and the mood disorders regarding course?

The failure to return to baseline functioning after each relapse (in schizophrenia).

Over the 5‑ to 10‑year period after first hospitalization, what percentage of schizophrenia patients can be described as having a good outcome?

Only about 10 to 20 percent.

What percentage of schizophrenia patients can be described as having a poor outcome?

More than 50 percent.

What is a reasonable estimate of the percentage of schizophrenia patients who are able to lead somewhat normal lives?

20 to 30 percent.

What factors are associated with a good prognosis in schizophrenia?

Late onset, obvious precipitating factors, acute onset, good premorbid history, mood disorder symptoms, married, family history of mood disorders, good support systems, positive symptoms.

What factors are associated with a poor prognosis in schizophrenia?

Young onset, no precipitating factors, insidious onset, poor premorbid history, withdrawn/autistic behavior, single/divorced/widowed, family history of schizophrenia, poor support systems, negative symptoms, neurological signs, history of perinatal trauma, no remissions in 3 years, many relapses, history of assaultiveness.

In families with high levels of expressed emotion, what happens to the relapse rate for schizophrenia?

The relapse rate is high.

What is the Assertive Community Treatment (ACT) program?

Patients assigned to one multidisciplinary team with a fixed caseload, delivering all services when and where needed 24 hours a day, 7 days a week, with a staff‑to‑patient ratio of 1:12.

What is the double‑bind concept in family dynamics?

A hypothetical family in which children receive conflicting parental messages about their behavior, attitudes, and feelings, leading to withdrawal into a psychotic state.

What is the goal of social skills training in schizophrenia?

To address poor eye contact, unusual delays in response, odd facial expressions, lack of spontaneity, and inaccurate perception of emotions using videotapes, role playing, and homework assignments.

What is the rate of noncompliance with long‑term antipsychotic treatment within 1 or 2 years?

An estimated 40 to 50 percent.

What percentage of patients treated with any antipsychotic achieve remission?

Approximately 70 percent.

What are the two main groups of antipsychotics used to treat schizophrenia?

Conventional antipsychotics (first‑generation / dopamine receptor antagonists, DRAs) and second‑generation antipsychotics (serotonin dopamine antagonists, SDAs).

What is the first effective antipsychotic with negligible extrapyramidal side effects?

Clozapine.

What serious side effect is clozapine associated with?

Agranulocytosis (potentially fatal).

What is the risk of agranulocytosis with clozapine during the first year of exposure?

Approximately 0.3 percent.

What is the risk of seizures with clozapine at doses of more than 600 mg?

Nearly 5 percent.

What percentage of patients on long‑term treatment with a conventional DRA will exhibit symptoms of tardive dyskinesia?

About 20 to 30 percent.

What percentage of young patients receiving a DRA develop tardive dyskinesia each year?

About 3 to 5 percent.

What is the most effective anti‑Parkinson medication for treating extrapyramidal side effects?

Anticholinergic anti‑Parkinson drugs (e.g., benztropine, trihexyphenidyl).

What medication is often effective for treating akathisia?

Centrally acting beta‑blockers such as propranolol (dosages between 30 and 90 mg per day).