Chapter 13: Schizophrenia Spectrum and Other Psychotic Disorders (copy)

Schizophrenia

_ , the startling disorder characterized by a broad spectrum of cognitive and emotional dysfunctions, including delusions and hallucinations, disorganized speech and behavior, and inappropriate emotions.

a form of insanity

In Observations on Madness and Melancholy, published in 1809, John Haslam eloquently portrayed what he called “__.”

Démence

Benedict Morel used the French term __ (loss of mind) précoce (early premature) because the onset of the disorder is often during adolescence.

Précoce

Benedict Morel used the French term démence (loss of mind) __ (early premature) because the onset of the disorder is often during adolescence.

writings of Haslam, Pinel, and Morel

German psychiatrist Emil Kraepelin (1899) built on the ___ (among others) to give us what stands today as the most enduring description and categorization of schizophrenia.

Catatonia

alternating immobility and excited agitation

Hebephrenia

silly and immature emotionality

Paranoia

delusions of grandeur or persecution

Skhizein

Eugen Bleuler

The term "schizophrenia" comes from the Greek words __ (to split) and phren (mind)

associative splitting

reflecting Eugen Bleuler’s belief that the core issue in schizophrenia is an __ of the basic functions of personality.

This marked a significant departure from Emil Kraepelin's view, emphasizing disorganized thinking rather than a progressive cognitive decline.

phren

Eugen Bleuler

The term "schizophrenia" comes from the Greek words skhizein (to split) and __ (mind)

Split mind

the concept of “__” inspired the common but incorrect use of the term schizophrenia to mean split or multiple personality.

Hallucinations

Two dramatic symptoms of schizophrenia include:

1. __ – seeing or hearing things that others do not.

2. Delusions – unrealistic, bizarre beliefs not shared by others in the same culture.

Delusions

Two dramatic symptoms of schizophrenia include:

1. Hallucinations – seeing or hearing things that others do not.

2. __ – unrealistic, bizarre beliefs not shared by others in the same culture.

Psychotic Behavior

__ has been used to characterize many unusual behaviors, although in its strictest sense, it usually involves delusions (irrational beliefs) and/or hallucinations (sensory experiences in the absence of external events).

Schizophrenia

_ is one of the disorders that involve psychotic behavior

Positive symptoms of Scizophrenia

These symptoms are the more obvious signs of psychosis and include hallucinations (sensory experiences without external stimuli) and delusions (false, often bizarre beliefs)

Delusion

A belief that would be seen by most members of a society as a misrepresentation of reality is called a disorder of thought content, or a __

the basic characteristic of madness

Because of its importance in schizophrenia, delusion has been called “__”

Delusion of Grandeur

A __ is a false belief in one's own fame, power, or importance—such as believing one can end world hunger or is a famous figure.

Delusions of Persecution

A common delusion in people with schizophrenia is that others are “out to get them.” called __ , these beliefs (plotting against, spying on, or trying to harm the person) can be most disturbing.

Capgras Syndrome

The false belief that someone the person knows has been replaced by an identical impostor or double

Cotard’s Syndrome

The false belief that the person is dead, does not exist, or has lost their organs or blood

Motivational View of Delusions

A __ would look at these beliefs as attempts to deal with and relieve anxiety and stress.

Deficit View of Delusion

a __ sees these beliefs as resulting from brain dysfunction that creates these disordered cognitions or perceptions.

Diagnostic Criteria for Schizophrenia

Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3):

1. Delusions

2. Hallucinations

3. Disorganized speech (e.g., frequent derailment or incoherence)

4. Grossly disorganized or catatonic behavior

5. Negative symptoms (i.e., diminished emotional expression or avolition)

Hallucination

The experience of sensory events without any input from the surrounding environment is called a _

Auditory Hallucination

hearing things that aren’t there or __, the most common form experienced by people with schizophrenia, with 70% of those with the diagnosis endorsing this type

Single Photon Emission Computed Tomography (SPECT)

In one of the first studies of its kind, researchers in London used ___ to study the cerebral blood flow of men with schizophrenia who also had auditory verbal hallucinations and made a surprising discovery

Broca’s area

Brain imaging showed increased activity in __ (involved in speech production) during auditory hallucinations. This is surprising since hallucinations involve "hearing" speech, which would typically activate Wernicke’s area (language comprehension).

These findings support the metacognition theory—the idea that people are actually hearing their own thoughts or inner speech but cannot recognize it as self-generated.

Metacognition Theory

Brain imaging showed increased activity in Broca’s area (involved in speech production) during auditory hallucinations. This is surprising since hallucinations involve "hearing" speech, which would typically activate Wernicke’s area (language comprehension).

These findings support the __ —the idea that people are actually hearing their own thoughts or inner speech but cannot recognize it as self-generated.

Alogia

Derived from the combination of a (“without”) and logos (“words”), _ refers to the relative absence of speech.

Alogia

A person _ with may respond to questions with brief replies that have little content and may appear uninterested in the conversation.

Negative Symptoms

these symptomps of schizophrenia typically involve the absence or insufficiency of normal behaviors, such as lack of motivation or emotional expression.

Avolition

Combining the prefix a, meaning “without,” and volition, which means “an act of willing, choosing, or deciding,” _ is the inability to initiate and persist in activities

Avolition

People with this symptom (also referred to as apathy) show little interest in performing even the most basic day-to-day functions, including those associated with personal hygiene.

Anhedonia

A related symptom is called _, which derives from the combination of a (“without”) and the word hedonic (“pertaining to pleasure”).

Anhedonia

it is the presumed lack of pleasure experienced by some people with schizophrenia.

Anhedonia

Like some mood disorders, _ signals an indifference to activities that would typically be considered pleasurable, including eating, social interactions, and sexual relations.

Disorganized Symptoms

The least studied and therefore the least understood symptoms of schizophrenia are referred to as the “_.”

These include a variety of erratic behaviors that affect speech, motor behavior, and emotional reactions

Flat Affect

A _ can be a negative symptom of schizophrenia, meaning that your emotional expressions don't show outwardly. You may speak in a dull, flat voice, and your face may not change.

Disorganized Speech

it refers to communication problems in schizophrenia, where individuals may:

• Jump from topic to topic (loose associations)

• Speak in an illogical or incoherent manner

Tangentiality

Disorganized Speech:

A response where the person goes off on a tangent and doesn't answer the specific question asked.

Loose Association (Derailment)

Disorganized Speech:

Abruptly changing the topic of conversation to unrelated areas

Inappropriate Affect

__ in schizophrenia refers to emotional responses that are out of context, such as laughing or crying at improper times.

Catatonia

it is one of the most curious symptoms in some individuals with schizophrenia; it b motor dysfunctions that range from wild agitation to immobility

Catatonic Immobility

it is a symptom of schizophrenia where individuals hold unusual postures for extended periods, often appearing fearful of moving due to the belief that something terrible will happen if they do.

few months

Some people experience the symptoms of schizophrenia for a _ only; they can usually resume normal lives

Schizophreniform Disorder

The DSM-5 criteria for __ include:

• Onset of psychotic symptoms within 4 weeks of the first noticeable change in behavior

• Confusion at the height of the psychotic episode

• Good premorbid social and occupational functioning

• Absence of blunted or flat affect

duration of symptoms

The key difference between schizophrenia and schizophreniform disorder is the _:

• Schizophrenia is a chronic (lifelong) condition.

• Schizophreniform disorder is a short-term condition, lasting one to six months.

• Both disorders share similar symptoms.

Schizoaffective Disorder

this disorder is diagnosed when an individual exhibits symptoms of both schizophrenia (such as psychosis) and mood disorders (like depression or bipolar disorder).

Historically, these individuals were classified under schizophrenia, but now they are diagnosed separately with _.

Schizoaffective Disorder

DSM-5 criteria for _ require, in addition to the presence of a mood disorder, delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms

Delusions

they are beliefs that are not generally held by other members of a society.

Delusional Disorder

The major feature of _ is a persistent belief that is contrary to reality, in the absence of other characteristics of schizophrenia.

Erotomanic Type of Delusion

An ___ is the irrational belief that one is loved by another person, usually of higher status. Some individuals who stalk celebrities appear to have this disorder.

Jealous Type of Delusion

A person with the __ believes the sexual partner is unfaithful

Somatic Type of Delusions

in ___, the person feels afflicted by a physical defect or general medical condition

Persecutory Type of Delusion

It is a subtype that applies when the central theme of the delusion involves the individual’s belief that they are being conspired against, cheated, spied on, followed, poisoned or drugged, maliciously maligned, harassed, or obstructed in the pursuit of long-term goals

Shared Psychotic Disorder (folie à deux)

___, the condition in which an individual develops delusions simply as a result of a close relationship with a delusional individual

Diagnostic Criteria for Substance/Medication Induced Psychotic Disorder

A. Presence of one or both of the following symptoms:

1. Delusions

2. Hallucinations

   
   

   B. There is evidence from the history, physical examination, or laboratory findings of both (1) and (2):

   1. The symptoms in Criterion A developed during, or soon after, substance intoxication or withdrawal or after exposure to a medication.

   2. The involved substance/medication is capable of producing the symptoms in Criterion A.

Substance-Induced Psychotic Disorder; Psychotic Disorder

DSM-5 includes two categories of these disorders: _ and _ associated with another medical condition—so that clinicians can qualify the nature of these di culties.

Brief Psychotic Disorder

__, which is characterized by the presence of one or more positive symptoms such as delusions, hallucinations, or disorganized speech or behavior lasting 1 month or less

Attenuated Psychosis Syndrome

it is a proposed psychotic disorder in the DSM-5 for further study.

Individuals with this syndrome may experience some symptoms of schizophrenia but are aware of the troubling and bizarre nature of these symptoms

Genes

_ are responsible for making some individuals vulnerable to schizophrenia.

Dopamine (High/Active)

One of the most enduring yet controversial theories of the cause of schizophrenia involves the neurotransmitter __

Schizophrenia

There is evidence that the prenatal (before birth) and perinatal (around the time of birth) environment are correlated with the development of _

Pregnancy; Delivery

Evidence suggests that complications during _ (e.g., bleeding) and_ (e.g., asphyxia or lack of oxygen) may increase the risk of developing schizophrenia later in life.

These environmental stresses, when combined with genetic and other factors, may trigger the expression of the disorder

Schizophrenia

it is a complex syndrome that has been recognized for many years.

The earliest and best description of this disorder was published in 1809 by John Haslam in his book Observations on Madness and Melancholy.

Schizophrenia

it is characterized by a broad spectrum of cognitive and emotional dysfunctions that include delusions and hallucinations, disorganized speech and behavior, and inappropriate emotions

Positive Symptoms

they are active manifestations of abnormal behavior, or an excess or distortion of normal behavior, and include delusions and hallucinations.

Negative Symptoms

it involves deficits in normal behavior on such dimensions as affect, speech, and motivation.

Disorganized Symptoms

this includese rambling speech, erratic behavior, and inappropriate affect.

Schizophreniform Disorder

Several disorders involve psychotic behaviors like hallucinations and delusions, including:

_: symptoms of schizophrenia lasting less than 6 months.

Schizoaffective Disorder

Several disorders involve psychotic behaviors like hallucinations and delusions, including:

_: Symptoms of schizophrenia along with mood disorder symptoms (e.g., depression or bipolar disorder).

Delusional Disorder

Several disorders involve psychotic behaviors like hallucinations and delusions, including:

__: Persistent, irrational beliefs contrary to reality, without other schizophrenia symptoms

Brief Psychotic Disorder

Several disorders involve psychotic behaviors like hallucinations and delusions, including:

__: One or more positive symptoms (e.g., delusions, hallucinations, disorganized speech or behavior) lasting less than a month

Relapse

_ appears to be triggered by hostile and critical family environments characterized by high expressed emotion.

Antipsychotic Drugs

The typical treatment for schizophrenia involves:

• __ , usually combined with various psychosocial treatments.

• The goal is to reduce relapse, improve deficits (such as social and cognitive skills), and ensure compliance with medication.
  However, treatment effectiveness is limited because schizophrenia is generally a chronic disorder.