psych week 6

Where is schizophrenia classified in DSM-5-TR?

Within the chapter on schizophrenia spectrum and other psychotic disorders.

What are the 5 core domains of psychosis listed in the lecture?

Delusions; hallucinations; disorganized thinking, usually evident in speech; grossly disorganized or abnormal motor behavior, including catatonia; and negative symptoms.

What do the core manifestations of psychosis represent?

Impaired reality testing.

What are positive symptoms of schizophrenia?

Abnormal functions/experiences that are "added" to normal functioning — e.g., delusions, hallucinations, disorganized speech/thinking, and disorganized behavior.

What are negative symptoms?

Reduction or loss of normal functions. (ie loss of talking)

What are the major examples of negative symptoms? [5]

Diminished emotional expression, avolition (little motivation), alogia (speaks little), anhedonia, and asociality (little socializing interests).

How common and severe is schizophrenia?

It is one of the most common severe mental disorders and usually causes long-lasting impairment requiring ongoing care, with financial cost and social stigma.

What is the typical age of onset of schizophrenia in males versus females?

Males: usually 10-25 years; females: usually 25-35 years.

How often does schizophrenia begin in childhood, and what is late-onset schizophrenia?

Only a small minority present before age 10; late-onset means onset after age 45 and is more likely in females.

What is the usual long-term course of schizophrenia?

It usually persists throughout life.

Does schizophrenia affect only certain social classes?

No. It affects all social classes.

What proportion of homeless Americans does the lecture attribute to schizophrenia, and what is the U.S. prevalence?

Schizophrenia accounts for about 15-45% of homeless Americans despite a low U.S. prevalence of about 0.3-0.6%.

How does schizophrenia prevalence and outcome differ by sex?

It is equally prevalent in men and women, but outcomes are better in females.

How does heavy cannabis use affect schizophrenia risk according to the lecture?

Heavy cannabis users have about a 40% increased risk of schizophrenia.

What are major long-term consequences of schizophrenia?

Long-lasting impairment, ongoing care, financial cost, and social stigma.

How prevalent is schizophrenia in the U.S., and among homeless Americans?

U.S. prevalence: ~0.3-0.6%; schizophrenia accounts for ~15-45% of homeless Americans.

What structural brain findings are associated with schizophrenia?

Reduced cortical gray matter, reduced brain symmetry, and Limbic system (emotional control) decreased size of the amygdala and hippocampus in the limbic system.

Which neurotransmitter abnormality is associated with positive psychotic symptoms?

Excessive dopamine release.

What other neurotransmitter findings are listed in schizophrenia?

Increased glutamate and GABA, which regulate dopamine, and excess serotonin.

What do electrophysiology studies suggest in schizophrenia?

Abnormal sensitivity to activation, with inability to filter irrelevant sounds and increased sensitivity to background noise.

What genetic-risk figures are listed for schizophrenia?

Risk increases with a first- or second-degree relative; heritability is about 60-80%; and twin concordance is about 50%.

What paternal-age risk factor is associated with schizophrenia?

Being born to a father older than 60, attributed to greater genetic damage in sperm.

Is any single clinical feature pathognomonic for schizophrenia?

No. Every feature can also occur in other psychiatric or neurologic disorders.

What is essential to properly diagnose schizophrenia?

A thorough patient history plus the mental status examination.

Why must schizophrenia findings be interpreted over time?

Clinical features can change over time.

What patient background factors should shape interpretation of a schizophrenia interview?

Education, intellectual ability, and cultural membership; evaluate the interview in the context of the patient's background.

Why might inability to grasp abstract concepts be interpreted differently between patients?

It is more clinically meaningful in someone whose education or baseline ability would normally support abstract thinking.

Is the typical course of schizophrenia formally divided into fixed DSM-5-TR stages?

No. The course is variable, and the premorbid, prodromal, active, and residual descriptions are clinical patterns rather than fixed DSM-5-TR stages.

What is the premorbid period of schizophrenia?

Baseline development and functioning before recognizable illness.

What may be present during the premorbid period?

Longstanding social, cognitive, academic, or functional vulnerabilities, although functioning may be entirely normal.

What is the prodromal period of schizophrenia?

A new change or decline from the patient's prior baseline occurring before the first full psychotic episode.

What findings may occur during the prodromal period?

Withdrawal, reduced self-care, functional decline, suspiciousness, unusual ideas, or attenuated perceptual changes.

How specific are prodromal findings for schizophrenia?

(i think she said these are for both premorbid & prodromal)

They may be subtle and nonspecific, are not diagnostic, may become clearer only after psychosis develops, and vary widely in presence and severity.

What occurs during an active psychotic episode?

Prominent delusions, hallucinations, disorganized thinking or speech, and/or grossly disorganized or abnormal motor behavior become evident.

What additional findings can accompany an active psychotic episode?

Negative and cognitive symptoms may be present, and functional impairment is usually apparent.

What characterizes the remission or residual period?

Positive symptoms improve or become less prominent, while negative, cognitive, or attenuated psychotic symptoms may persist.

How does functional recovery compare with symptom improvement in schizophrenia?

Functional recovery may lag behind symptom improvement; relapse, partial remission, or sustained remission may occur.

Why is schizophrenia described as a thought disorder?

It can affect thought process, thought content, or both.

What delusion types are specifically listed in schizophrenia?

Persecutory, grandiose, religious, and somatic delusions.

Give lecture examples of schizophrenia delusions.

Believing the government implanted a microchip, believing one can cause the sun to rise, or believing aliens replaced one's family members.

What is loss of ego boundary?

A lack of a clear boundary between the self and the external world.

What are examples of loss of ego boundary?

Believing newspapers refer directly to oneself or believing one has physically fused with an external object. "I am the tree."

Which sensory modality is most commonly involved in schizophrenia hallucinations?

Auditory hallucinations, although any sense may be affected.

What may auditory hallucinations sound like in schizophrenia?

Threatening, insulting, accusatory, or obscene voices.

Which hallucination modalities should especially prompt evaluation for an underlying medical abnormality?

Tactile, olfactory, and gustatory hallucinations.

What do thought-process and speech abnormalities describe?

How ideas are organized and expressed through speech.

What is circumstantiality?

Excessive, unnecessary detail, but the patient eventually returns to the point.

What is tangentiality?

The patient moves away from the topic and does not return to answer the original question.

What are loose associations?

Shifts between ideas with weak, illogical, or difficult-to-follow connections.

What is flight of ideas?

Rapid shifts between topics with recognizable associations, often with pressured speech in mania.

What are neologisms?

Newly created words or phrases that have meaning only to the patient.

What is perseveration?

Repeatedly returning to the same response, idea, or topic despite attempts to move on.

What is thought blocking?

A sudden interruption in the flow of thought, often with the patient stopping mid-sentence.

What are clang associations?

Word choice based mainly on sound, rhyme, or pun rather than meaning.

What is word salad?

Speech so severely disorganized that its meaning cannot be understood.

What is mutism?

Little or no verbal speech despite an apparent ability to speak.

What is echolalia?

Automatic or repetitive imitation of another person's words.

What is verbigeration?

Persistent, stereotyped repetition of words or phrases without a meaningful communicative purpose.

What is aprosodia?

Impaired ability to produce or interpret the rhythm, melody, and emotional inflection of speech.

A patient repeats, "Feeling nervous today... nervous today," after the examiner asks whether they are nervous. What speech abnormality is this?

Echolalia: repeating the examiner's words instead of generating an independent response.

A patient answers every question with "Blue morning, blue morning, blue morning." What speech abnormality is this?

Verbigeration: persistent, stereotyped repetition without clearly answering or communicating a purpose.

A patient says, "I just won a million dollars," in a flat monotone. What abnormality is demonstrated?

Impaired production of prosody, a form of aprosodia. (should have normal excitement or vocal emphasesis)

A patient interprets obvious sarcasm literally because they cannot recognize tone. What abnormality is demonstrated?

Impaired interpretation of prosody, a form of aprosodia.

What does cognitive impairment predict in schizophrenia?

Greater disease severity.

What subtle cognitive deficits are typical in schizophrenia?

Deficits in attention, executive function, working memory, and episodic memory.

Are patients with schizophrenia usually oriented?

Yes. They are usually oriented to person, place, and time.

How is memory usually affected in schizophrenia on the MSE?

It is usually intact, though minor deficiencies may occur; assessment can be difficult because close participation may be limited.

How is insight usually affected in schizophrenia?

Insight into the nature and severity of the disorder is usually poor, contributing to poor treatment compliance.

What affective finding is common in schizophrenia?

Flat or blunted affect.

Why can flat or blunted affect be difficult to interpret?

It may result from schizophrenia itself, a comorbid symptom, or a medication adverse effect.

What can severe reduction in emotional responsiveness resemble?

Anhedonia.

What overly active or inappropriate emotions may occur in schizophrenia?

Extreme rage, happiness, or anxiety; more extreme states include omnipotence, ecstasy, terror, or anxiety about destruction of the universe.

How can appearance and verbal behavior vary in schizophrenia?

From completely disheveled to obsessively groomed and from silent to talkative to screaming.

What grooming and clothing pattern is often seen in schizophrenia?

Poor grooming and dressing too warmly for the temperature.

What behavioral findings may occur in schizophrenia?

Easy agitation, sometimes to violence; tics; odd mannerisms; echopraxia; and catatonia.

What is echopraxia?

Imitation of the examiner's behavior.

What is catatonic stupor as described in the lecture?

Apparent lifelessness with muteness, automatic obedience, marked withdrawal, and lack of spontaneous speech or movement.

What do neurologic signs imply in schizophrenia?

Increased severity and poorer prognosis.

What is dysdiadochokinesia?

Inability to perform rapid alternating movements.

What is astereognosis?

Inability to identify or discriminate objects by touch.

Which primitive reflexes may be seen in schizophrenia?

Grasp, palmomental, snout, suck, and persistent glabellar reflexes.

What other motor or ocular findings may occur in schizophrenia?

Diminished dexterity, saccadic rather than smooth eye movements, and an elevated blink rate.

Are patients usually aware of their abnormal involuntary movements?

No. Most are not aware of them.

How is schizophrenia diagnosed?

Entirely by history and mental status examination; there is no diagnostic laboratory or imaging test.

What is the overall DSM-5-TR symptom-duration requirement for schizophrenia?

At least 2 qualifying symptoms for 6 months, with functional impairment and exclusion of substances or another condition.

What 5 qualifying symptom categories are listed for schizophrenia diagnosis?

Delusions; hallucinations; disorganized speech; disorganized behavior or catatonia; and negative symptoms.

What examples of disorganized behavior are listed?

Abnormalities of hygiene, dress, anger, or sexuality, or catatonia.

What examples of negative symptoms are listed in the diagnostic slide?

Flat affect, poor posture, and poor motivation.

Which schizophrenia symptoms must be represented among the required symptoms?

At least one of the first three: delusions, hallucinations, or disorganized speech.

What functional and exclusion criteria accompany schizophrenia symptoms?

Functional impairment must be present, and symptoms must not be due to a substance or another condition.

Are hallucinations or delusions individually required for schizophrenia diagnosis?

No ~ neither is individually necessary as long as the overall criteria are met.

What is brief psychotic disorder?

An acute, transient psychotic syndrome with full remission and return to the premorbid level of function.

What symptom criteria are listed for brief psychotic disorder?

At least 1 of the first 3 symptoms—delusions, hallucinations, or disorganized speech—with or without behavioral symptoms; no negative symptoms.

What is the duration of brief psychotic disorder?

At least 1 day but less than 1 month.

How does schizophreniform disorder differ from schizophrenia?

Exactly the same except for the timing ~

It uses the same symptom criteria but lasts at least 1 month and less than 6 months.

What functional course is expected in schizophreniform disorder according to the lecture?

Patients should return to baseline functioning; it can be episodic, but combined symptoms lasting more than 6 months suggest schizophrenia.

What is schizoaffective disorder?

The patient meets criteria for schizophrenia plus a mood disorder, either major depressive disorder or a manic episode.

What time duration distinguishes schizoaffective disorder?

Mood symptoms are present for the majority of the illness, plus at least a 2-week period of psychosis without mood symptoms.

How does bipolar disorder with psychotic features differ from schizoaffective disorder?

In bipolar disorder with psychotic features, psychosis occurs only during mood episodes.

A patient has months of mania/depression with psychosis, then 3 weeks of hallucinations and referential delusions after mood symptoms resolve. Diagnosis?

Schizoaffective disorder, bipolar type, because substantial mood symptoms occupy most of the illness and psychosis persists for at least 2 weeks without a major mood episode.