Term
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Definition
The major features of schizophrenia are labelled as positive or negative symptoms and refer to the presence (positive) or absence (negative) of a symptom. Positive symptoms are the more obvious signs of psychosis and are characterised by an excess or distortion. Positive symptoms include delusions, hallucinations, and formal thought disorders. Negative symptoms reflect an absence or deficit and may include features such as reduced emotions, poor judgement and social withdrawal.
About 1 person out of every 100 has schizophrenia. There are no gender differences in these figures. However, there are more men represented in treatment facilities than women. This is because men are usually more disruptive than women and therefore more visible and intolerable to families. |
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Term
| Positive symptoms (Schizophrenia) |
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Definition
- Delusions
- Hallucinations
- Disorganised speech
- Disorganised behaviour |
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Term
| Negative symptoms (Schizophrenia) |
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Definition
- Avolition
- Alogia
- Anhedonia
- Asociality |
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Term
Positive symptoms (Schizophrenia)
- Delusions
- Hallucinations |
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Definition
- Delusions
Delusions are characterised by disordered thought content. Delusions generally include fixed false beliefs not accounted for by a patient's sociocultural background. Types include: grandiose; persecutory (paranoid); nihilistic (death); reference (things need to be in a particular order); guilt; erotomanic; passivity phenomena; control; thought insertion; thought withdrawal; thought broadcasting.
Patients display a lack of insight and behaviour that would be considered bizarre. Inappropriate affect can also be present.
Hallucinations
Hallucinations are a disorder of perception. They are often auditory (about 75%) but can be any modality. Hallucinations can include sounds, voices, vision, taste, or feeling things (e.g. creeping). |
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Term
Positive symptoms (Schizophrenia)
- Disorganised speech
- Disorganised behaviour |
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Definition
Disorganised speech
This may be evident in a breakdown in the connection of ideas in the person's speech, which can be referred to using various terms including cognitive slippage, derailment or loosening of associations. When extreme the person may be impossible to follow, which is referred to as incoherence.
Disorganised behaviour
This involves impairment of goal-directed activity and can occur in areas of daily life such as work, social relations, and self-care. It can also involve catatonia, which is characterised by minimal movement or stupor, sometimes with the person adopting an unusual posture. Catatonic excitement may also occur in which the person engages in excessive grossly disorganised behaviour. Catatonia is one of the less common psychotic presentations in psychiatric settings in Australia today, but has been more common historically and is more common in some cultures. |
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Term
| Negative symptoms (Schizophrenia) |
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Definition
Avolition
Little insight, poor judgement.
Alogia
Reduced cognition.
Anhedonia
Diminished capacity to experience pleasant emotions.
Asociality
Social withdrawal. |
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Term
| Pharmacotherapy for Schizophrenia |
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Definition
| Medications are now widely used in the treatment of schizophrenia. Over 60 different antipsychotic drugs have been developed. The common property that they all share is their ability to block dopamine D2 receptors in the brain |
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Term
| Biological factors associated with risk for psychosis |
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Definition
The diathesis-stress model is the currently accepted model for schizophrenia. Originally proposed by Paul Meehl in 1962, this model suggests that some people possess a biological vulnerability of enduring factors such as a genetic predisposition, or a brain abnormality. This predisposition is expressed behaviourally in the form of schizophrenia only if a stressful environment triggers onset of the disorder. Stressors can include role expectations, daily hassles, or major life events. They may also include harping criticism from family members, poverty, or poor diet.
Young people around their early 20s are particularly vulnerable to role expectations with the added responsibility and expectations of moving into adulthood. Once these individuals' ability to cope with a stressful situation is exceeded they are more likely to develop schizophrenia. Stressors may be kept below thresholds and therefore the person does not develop schizophrenia. This model of schizophrenia suggests that schizophrenia is most likely to develop in people who have both a genetic vulnerability and a stressful life event(s). |
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Term
| Psychosocial factors associated with risk for psychosis |
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Definition
The median age of onset for schizophrenia is the early-mid 20s in males or the late 20s in females. The onset of schizophrenia can be abrupt, although most people show some symptoms (often minor ones) before a full diagnosis can be made. For some people the course of schizophrenia has relapses and then remissions, whereas for others (about 15% of people) they are just chronically ill. A complete remission is rare but not impossible.
The course of schizophrenia can be adversely affected by concurrent abuse of alcohol, stimulant drugs (cocaine, amphetamines), or marijuana. These agents are all well documented stressors in the exacerbation of psychosis in individuals vulnerable to schizophrenia. It is not a self-medication as drugs tend to exacerbate rather than ameliorate symptoms.
Other factors that complicate the course of schizophrenia are co-morbidity with developmental disabilities such as autism since birth, depression (which is a risk factor for suicidality), and anxiety disorders. For example the presence of OCD is a predictor of poor prognosis. |
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Term
| Other psychotic disorders of DSM-5 |
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Definition
The DSM has identified many different forms of of schizophrenia and psychotic disorders.
- Schizoaffective disorder: a hybrid of - schizophrenia and mood disorder.
- Schizophreniform disorder: like schizophrenia but only occurs for one to six months.
- Delusional disorder: delusions but otherwise normal behaviour.
- Brief psychotic disorder: usually lasts only a matter of days.
- Shared psychotic disorder: a second person believes the delusions of the first person. |
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Term
Psychosis is a striking and essential feature of schizophrenia. Psychosis means:
a tendency to be unpredictably violent.
significant loss of contact with reality.
an inability to know right from wrong.
an abrupt shift in personality from one pattern to another. |
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Definition
| significant loss of contact with reality. |
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Term
The majority of cases of schizophrenia begin:
late adulthood or old age.
late adolescence or early adulthood.
late childhood or early adolescence.
there is no age where the majority of cases begin. |
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Definition
| late adolescence or early adulthood. |
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Term
Delusions are:
perceptions with no basis in reality.
only seen in schizophrenia.
necessary for a diagnosis of schizophrenia.
disturbances in the content of thought. |
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Definition
| disturbances in the content of thought. |
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Term
Sterling believes that the TV special that was on last night was shown to tell her that she should break up with her boyfriend. She is absolutely certain this is true and plans to do it. This type of belief is an example of a:
thought broadcasting delusion.
delusion of reference.
made feelings delusion.
thought insertion delusion. |
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Definition
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Term
Which of the following is an example of the most common type of hallucination seen in schizophrenia?
Sondra tried to ignore the voices in her head.
Ned believed he was Elvis.
Bill was convinced that his mother was inserting evil thoughts into his mind.
Rachel would frequently see her husband, even though he had been dead for several years. |
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Definition
| Sondra tried to ignore the voices in her head. |
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Term
Julia clearly had psychotic symptoms. As she also showed symptoms of bipolar disorder, she was ultimately diagnosed with:
schizoaffective disorder.
schizophreniform disorder.
undifferentiated type.
residual type. |
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Definition
| schizoaffective disorder. |
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Term
What is the major difference between a diagnosis of schizophrenia and schizophreniform disorder?
The presence of delusions and hallucinations.
The age of the person when they develop the disorder.
The degree of emotional instability and disconnection from other people.
The duration of symptoms. |
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Definition
| The duration of symptoms. |
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Term
Which of the following is a plausible explanation for how maternal influenza might lead to schizophrenia later in life?
The flu virus may lie dormant in the brain until adolescence when it becomes active and initiates the degeneration that results in the symptoms of schizophrenia.
The flu exposure may alter the fetal genes such that a susceptibility to schizophrenia is now part of the child's genetic makeup.
Maternal antibodies could cross the placenta such that the viral antibodies could interfere with the foetus’ brain development
The flu virus frequently has long-tern effects on the behaviour of affected individuals; maternal infection with influenza may result in an environment that is likely to trigger schizophrenia in the susceptible individual. |
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Definition
| Maternal antibodies could cross the placenta such that the viral antibodies could interfere with the foetus’ brain development |
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Term
One aspect of family environment that has been found to be important in schizophrenia is:
the level of parental grief over their child's illness.
the level of expressed emotion.
if the mother is cold and aloof.
if lots of double-bind communications are used. |
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Definition
| the level of expressed emotion. |
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Term
Which of the following is true about second generation antipsychotics in the treatment of schizophrenia?
They work by decreasing frontal lobe activity.
They are more effective than first generation antipsychotics.
They prevent prenatal brain damage.
They are no more effective than first generation antipsychotics. |
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Definition
| They are no more effective than first generation antipsychotics. |
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Term
| What is the evidence for and against the dopamine hypothesis? |
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Definition
| Answer: Early antipsychotic drugs that blocked dopamine receptors reduced psychotic symptoms. Amphetamine psychosis is due to increased dopamine. Drugs that raise dopamine, for example Parkinson's drugs, cause psychotic-like side effects. However, there is no evidence that people with schizophrenia have increased levels of dopamine. |
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Term
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Definition
| , the hallmark of schizophrenia is a significant loss of contact with reality, referred to as psychosis. |
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Term
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Definition
that one’s private thoughts are being broadcast indiscriminately to others (thought broadcasting), that thoughts are being inserted into one’s brain by some external agency (thought insertion), or that some external agency has robbed one of one’s thoughts (thought withdrawal).
Also common are delusions of reference, where some neutral environmental event (such as a television program or a song on the radio) is believed to have special and personal meaning intended only for the person |
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Term
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Definition
| Overall, however, the research find- ings suggest that auditory hallucinations occur when patients misinterpret their own self-generated and ver- bally mediated thoughts (inner speech or self-talk) as coming from another source. |
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Term
| Formal thought disorder (Disorganised Speech) |
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Definition
| Formal thought disorder (a term clinicians use to refer to problems in the way that disorganized thought is expressed in disorganized speech) |
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Term
| Catanio (Disorganised Behaviour) |
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Definition
| Catatonia is an even more striking behavioral distur- bance. The patient with catatonia may show a virtual absence of all movement and speech and be in what is called a catatonic stupor. At other times, the patient may hold an unusual posture for an extended period of time without any seeming discomfort. |
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Term
| positive- and negative-syndrome schizophrenia. |
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Definition
Positive symptoms are those that reflect an excess or distortion in a normal repertoire of behavior and experience, such as delusions and hallucinations. Disorganized thinking (as revealed by disorganized speech) is also thought of in this way.
Negative symptoms, by contrast, reflect an absence or deficit of behaviors that are normally present. |
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Term
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Definition
| paranoid schizophrenia (where the clinical picture is dominated by absurd and illogical beliefs that are often highly elaborated and organized into a coherent, though delusional, frame- work), |
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Term
| disorganized schizophrenia |
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Definition
| disorganized schizophrenia (characterized by dis- organized speech, disorganized behavior, and flat or inappropriate affect) |
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Term
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Definition
| catatonic schizophrenia (which involves pronounced motor signs that reflect great excite- ment or stupor) |
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Term
| schizoaffective disorder ( |
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Definition
chizophrenia and severe mood disorder. In other words, the person not only has psychotic symptoms that meet cri- teria for schizophrenia but also has marked changes in mood for a substantial amount of time. Because mood dis- orders can be unipolar or bipolar in type, these are recog- nized as subtypes of schizoaffective disorder.
DSM-5 specifies that mood symptoms have to meet criteria for a full major mood episode and also have to be present for more than 50 percent of the total duration of the illness. |
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Term
| Schizophreniform disorder |
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Definition
| Schizophreniform disorder is a category reserved for schizophrenia-like psychoses that last at least a month but do not last for 6 months and so do not warrant a diagnosis of schizophrenia |
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Term
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Definition
| hold beliefs that are considered false and absurd by those around them. Unlike individuals with schizophrenia, however, people given the diagnosis of delu- sional disorder may otherwise behave quite normally. T |
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Term
| erotomania (subtype of delusional disorder) |
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Definition
| ). One interesting subtype of delusional disorder is erotomania. Here, the theme of the delusion involves great love for a person, usually of higher status. Some evidence suggests that a significant proportion of female stalkers are diagnosed with erotomania ( |
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Term
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Definition
| It involves the sudden onset of psychotic symptoms or disorganized speech or catatonic behavior. Even though there is often great emotional turmoil, the episode usually lasts only a matter of days (too short to warrant a diagno- sis of schizophreniform disorder). After this, the person returns to his or her former level of functioning and may never have another episode again |
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Term
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Definition
| Candidate genes are genes that are involved in pro- cesses that are believed to be aberrant in schizophrenia. An example is the COMT (catechol-O-methyltransferase) gene. |
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Term
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Definition
endophenotypes—discrete, stable, and measurable traits that are thought to be under genetic control. By studying different endophenotypes, researchers hope to get closer to specific genes that might be important in schizophrenia
By studying these traits rather than the disorder itself, researchers hope to speed up progress in the search for the genes related to schizophrenia. |
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Term
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Definition
| VIRAL INFECTION You have just learned that new genetic research is linking schizophrenia to the presence of genes involved with immune function. |
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Term
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Definition
RHESUS INCOMPATIBILITY Another example of how the mother’s immune system might damage the develop- ing brain of the fetus comes from a completely different source. Rhesus (Rh) incompatibility occurs when an Rh- negative mother carries an Rh-positive fetus
How might Rh incompatibility increase the risk for schizophrenia? One possibility is that the mechanism involves oxygen deprivation, or hypoxia. This suggestion is supported by studies that have linked the risk for schizo- phrenia to birth complications. Recent research also suggests that incompatibility between the blood of the mother and the blood of the fetus may increase the risk of brain abnor- malities of the type known to be associated with schizo- phrenia |
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Term
| EARLY NUTRITIONAL DEFICIENCY |
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Definition
| EARLY NUTRITIONAL DEFICIENCY Yet another piece of evidence that supports the idea that schizophrenia might be caused or triggered by environmental events that interfere with normal brain development comes from a tragedy that occurred in the Netherlands toward the end of World War II. |
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Term
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Definition
| MATERNAL STRESS If a mother experiences an extremely stressful event late in her first trimester of pregnancy or early in the second trimester, the risk of schizophrenia in her child is increased |
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Term
| diagnosis of attenuated psychosis syndrome |
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Definition
| Attenuated psychosis syndrome is characterized by mild psychotic symptoms that are not severe enough to meet clinical criteria for another full-blown psychotic disorder. People with this syndrome are thought to be at risk for later psychosis. They are also experiencing some distress or disability and are seeking help for their problems. |
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Term
| Schizophrenia and the brain |
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Definition
| . In other words, we can think of schizophrenia as a dis- order characterized by abnormal maturation (excessive pruning of synapses, abnormal myelination) of the brain and its networks. |
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Term
| Genetic risk of Schizophrenia |
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Definition
| researchers found was that the patients with schizophrenia had smaller brain volumes than their well co-twins. What was interest- ing, however, was that these well co-twins also had smaller brains than the healthy control twins. Baaré and colleagues propose that genetic risk for schizophrenia may be associ- ated with reduced brain development early in life. |
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Term
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Definition
The most well-studied neurotransmitter implicated in schizophrenia is dopamine. Eventu- ally, it was learned that the therapeutic benefits of chlorprom- azine were linked to its ability to block dopamine receptors.
How could dopamine induce psychosis? Activity in the dopamine system may play a role in determining how much salience we give to internal and external stimuli. Dysregu- lated dopamine transmission may actually make us pay more attention to and give more significance to stimuli that are not especially relevant or important. This is called “aber- rant salience” |
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Term
| Neurochemisty (Glutamate) |
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Definition
Glutamate is an excitatory neurotransmitter that is widespread in the brain. As was the case for dopamine, there are a number of reasons why researchers suspect that a dysfunction in glutamate transmission might be involved in schizophrenia. First, PCP, or angel dust, is known to block glutamate receptors. PCP also induces symptoms (both positive and negative) that are very similar to those of schizophrenia. Moreover, when people with schizophre- nia take PCP, it exacerbates their symptom
Like PCP, ketamine blocks glutamate receptors.
Finally, does the importance of glutamate challenge the importance of dopamine in the neurochemistry of schizophrenia? No. One action of dopamine receptors is to inhibit the release of glutamate. Simply stated, an overac- tive dopaminergic system could result in excessive sup- pression of glutamate, leading to the underactivity (hypofunction) of the NMDA receptors. The dopamine hypothesis of schizophrenia is actually made all the more credible by discoveries about glutamate. |
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Term
| Double-bing hypothesis (linked to causing schizophrenia) |
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Definition
| Another idea that has not stood the test of time is the double-bind hypothesis (Bateson, 1959, 1960). A double bind occurs when the parent presents the child with ideas, feelings, and demands that are mutually incompatible (e.g., a mother may complain about her son’s lack of affection but freeze up or punish him when he approaches her affection- ately). |
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Term
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Definition
| Of course, some families do show unusual communication patterns that we now refer to as “communication deviance” |
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Term
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Definition
expressed emotion, or EE. Expressed emotion is a measure of the family environ- ment that is based on how a family member speaks about the patient during a private interview with a researcher (Hooley, 2007). It has three main elements: criticism, hostil- ity, and emotional overinvolvement (EOI).
Expressed emotion is important because it has been repeatedly shown to predict relapse in patients with schizo- phrenia. |
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Term
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Definition
| The researchers found that chil- dren who had spent the first 15 years of their lives living in an urban environment were 2.75 times more likely to develop schizophrenia in adulthood than were children who had spent their childhoods in more rural settings. |
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Term
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Definition
| The findings showing that urban living raises a person’s risk for developing schizophrenia suggest that stress or social adversity might be important factors to consider with respect to this disorder. Supporting this idea, research is also showing that recent immigrants have much higher risks of developing schizophrenia than do people who are native to the country of immigration. |
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Term
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Definition
| wedish army shows that, compared to those who had never used cannabis, young men who were heavy cannabis users by the time they were 18 were more than six times more likely to have developed schizophrenia 27 years later (Zammit et al., 2002). This association also remained even after people who had used other kinds of drugs were removed from the statistical analysis |
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Term
| Nongenetic Risk Factors for Schizophrenia |
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Definition
- Older father
- Virus exposure
- Obstetric complications
- Urban upbringing
- Head injury
- Cannabis use
- Migrant status |
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Term
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Definition
Studies of clinical outcome show that 15 to 25 years after developing schizophrenia, around 38 percent of patients have a generally favorable outcome and can be thought of as being recovered. Although these rates have changed in modern times due to new invesstigations
Interestingly, patients who live in less industrialized countries tend to do better overall than patients who live in more industrialized nations (Jablensky et al., 1992). This may be because levels of EE are much lower in countries such as India than in the United States and Europe. |
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Term
| Pharmalogical Approaches (First Generation) |
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Definition
First-generation antipsychotics work best for the posi- tive symptoms of schizophrenia. In quieting the voices and diminishing delusional beliefs, these medications provide patients with significant clinical improvement (Tandon et al., 2010). This comes at a cost, however. Common side effects of these medications include drowsiness, dry mouth, and weight gain. Many patients on these antipsy- chotics also experience what are known as extrapyramidal side effects (EPS). These are involuntary movement abnor- malities (muscle spasms, rigidity, shaking) that resemble Parkinson’s disease. Fist generation: This means that they block the action of dopamine, primar- ily by blocking (occupying) the D2 dopamine receptors.
Some patients who have been treated with neuroleptics for long periods of time may also develop tardive dyskinesia. This involves marked involuntary movements of the lips and tongue (and sometimes the hands and neck)
Finally, in very rare cases there is a toxic reaction to the medication that is called neuroleptic malignant syndrome This condition is characterized by high fever and extreme muscle rigidity, and if left untreated it can be fatal. |
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Term
| Pharmalogical Approaches (Second Generation) |
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Definition
“second-generation antipsychotics” is that they cause fewer extrapyramidal symptoms than the earlier antipsy- chotic medications such as Thorazine and Haldol.
Although they are less likely to cause movement prob- lems, the newer neuroleptic medications are not without other side effects. Drowsiness and considerable weight gain are very common. Diabetes is also a very serious con- cern (Sernyak et al., 2002). In rare cases, clozapine also causes a life-threatening drop in white blood cells known as agranulocytosis. For this reason, patients taking this medication must have regular blood tests. |
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Term
| Pharmalogical Approaches (Second Generation) |
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Definition
| The reason why these medications are called “second-generation antipsychotics” is that they cause fewer extrapyramidal symptoms than the earlier antipsy- chotic medications such as Thorazine and Haldol. Although it was initially believed that second-generation antipsychot- ics were more effective at treating the symptoms of schizo- phrenia, recent research provides no support for this view |
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Term
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Definition
| How well patients do in their everyday lives is referred to as functional outcome. (This is in contrast to clinical outcome, which is concerned with symptoms.) Improving the functional outcomes of patients with schizophrenia is now an active area of research |
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Term
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Definition
| Patients with schizophrenia benefit from psychosocial treatments. These include individual therapy, case management, cognitive remediation, and family therapy. |
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