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Delusions
False beliefs that are firmly held despite what almost everyone else believes or the existence of contradictory evidence
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Delusions - persecutory
persistent, troubling, false beliefs that one is about to be harmed or mistreated by others in some way
the person thinks they are being followed, tricked, or spied on
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Delusions - referential
mistaken belief that ordinary events and normal human behavior have hidden meanings that somehow relate to the individual experiencing the delusions.
the person believes that passages from nooks and newspapers or other messages are specifically directed at them
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Delusions - Bizarre
involving a phenomenon that the person's culture would regard as totally implausible
the persons delusions are outside the range of ordinary life experiences
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Delusions - erotomanic
an individual believes that another person, usually of higher status, is in love with them
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Delusions - grandiose
unfounded or inaccurate beliefs that one has special powers, wealth, mission, or identity
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Hallucinations
perception-like experiences that occur without an external stimulus
auditory are the most frequent
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disorganized speech
involves a loosening of associations that is manifested as incoherence, answers or comments that are unresponsive to questions and slipping off the track from one topic to another
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grossly disorganized or abnormal motor behavior
can take several forms including unpredictable agitation, disheveled appearance, clearly in appropriate sexual behavior, or catatonia (decreased motor activity and reduced reactivity to environmental stimuli
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Negative symptoms
restriction in the range and intensity of emotions and other functions and include blunted emotional expression, anhedonia (decreased ability to experience pleasure), asociality (lack of interest in social interactions), alogia (diminished speech output), and avolition ( restricted initiation of goal-directed behavior).
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Delusional Disorder
the presence of one or more delusions that last at least one month. Overall psychological functioning is not markedly impaired, and any impairment is directly related to the delusion (the person loses their job because they are afraid to leave the house and repeatedly miss work)
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Delusions - Jealous
the person believes that their spouse or lover is unfaithful
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Delusions - somatic
the person believes that they have an abnormal bodily function or sensation
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Schizophrenia
the presence of at least two active phase symptoms (delusions, hallucinations, disorganized speech, etc.) for at least one month with at least one symptom being delusions, hallucinations, or disorganized speech.
There must be continuous sign of the disorder for at least 6 months and symptoms must cause significant impairment in functioning
Associated feature commonly include inappropriate affect, dysphoric mood, disturbed sleep pattern, and lack of interest in eating.
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What is the most common coexisting disorder with schizophrenia?
Substance use disorders, with tobacco at the highest
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At what age is the usual onset of schizophrenia?
late teens - early 30's with peak age being early to mid 20's for males and late 20's for females.
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What creates the best prognosis for schizophrenia?
goo premorbid adjustment
acute and late onset
female gender
the presence of a precipitating event
a brief duration of active-phase symptoms
insight into the illness
family history of mood disorder
no family history of schizophrenia
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Schizophrenia concordance rates for biological siblings, fraternal twins, identical twins, and child of two parents with schizophrenia?
biological - 10%
dizygotic - 17%
monozygotic - 48%
two parents - 46%
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What brain abnormalities have been linked to schizophrenia?
enlarged ventricles - most common
smaller-than-normal hippocampus, amygdala, and globus pallidus
lower-than-normal activity in the prefrontal cortex
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What is the dopamine hypothesis as it relates to schizophrenia?
Schizophrenia is a result of elevated dopamine levels or oversensitive dopamine receptors
The role of dopamine may differ for positive and negative symptoms
serotonin, glutamate, and GABA may also play a role
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What is linked to high relapse and hospitalization rates for people with schizophrenia?
High levels of expressed emotion among family members.
characterized by open criticism and hostility toward the patient, or overprotectiveness and emotional overinvolvement
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Schizophreniform Disorder
identical to schizophrenia except the disturbance is present for at least one month but less than six months and impaired social or occupational functioning may occur but is not required.
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Brief psychotic disorder
The presence of one or more of four characteristic symptoms (delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior) with at least one symptom being delusions, hallucinations, or disorganized speech.
Symptoms are present for at least one day but less than one month.
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Schizoaffective Disorder
characterized by an uninterrupted period of illness during which, at some time, there are concurrent symptoms of schizophrenia and symptoms of a major depressive or manic episode with a period of at least two weeks without prominent mood symptoms.
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a diagnosis of Delusional Disorder requires the presence of one or more delusions that last for at least _________.
one month
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A personal with the _________ subtype of Delusional Disorder is convinced that a particular person us romantically in love with him or her even though there is no support for that belief.
erotomanic
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A diagnosis of schizophrenia requires the presence of at least two active phase symptoms for at least __________ with continuous signs of the disorder for at least _________.
one month
six months
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In terms of age, the onset of schizophrenia is most often between __________. A better prognosis is associated with an acute and _______ onset and _________ gender.
late teens and early 30's
late
female
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A genetic study for schizophrenia is suggested by studies showing that the concordance rate for biological siblings is about _______ percent, while the rate for monozygotic twins is ________ percent.
10
48
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The _______ hypothesis was the first biochemical theory of schizophrenia.
dopamine
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Of the structural brain abnormalities linked to schizophrenia, _______ have been found in the largest proportion of patients
enlarged ventricles
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The treatment of schizophrenia often includes antipsychotic drugs. The traditional antipsychotics are most effective for eliminating _______ symptoms of the disorder.
positive
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Advantages of clozapine and other atypical antipsychotics are that they are less likely to cause __________ and may be effective for both positive and negative symptoms. Family interventions are beneficial, especially when they target high levels of ___________, which has been linked to high relapse and rehospitalization rates.
tardive dyskinesia
expressed emotion
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Schizophrenia must be distinguished from other psychotic disorder. The duration of symptoms for ______ Disorder is one to six months, while the duration for _________ disorder is at least one day to less than a month. Finally, in ________ Disorder psychotic and mood symptoms occur concurrently with a period of at least two weeks without prominent mood symptoms
schizophreniform
Brief Psychotic
Schizoaffective
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A 28-year-old male client presents with hallucinations and bizarre delusions. His parents report that his symptoms were not preceded by an unusual or stressful event and that he has had these symptoms for about six weeks. Your tentative diagnosis is:
A.Schizophrenia.
B.Schizophreniform Disorder.
C.Brief Psychotic Disorder.
D.Schizoaffective Disorder.
B
The symptoms of Schizophreniform Disorder are similar to those of Schizophrenia, except that the duration of symptoms is between one and six months.
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Researchers have linked Schizophrenia to several structural brain abnormalities, with the most consistent finding being:
A.larger-than-normal prefrontal lobes.
B.an enlarged hippocampus.
C.enlarged ventricles.
D.smaller-than-normal ARAS.
C
Researchers have linked Schizophrenia to several structural and functional brain abnormalities. Of the structural abnormalities, the most frequent finding has been enlarged ventricles.
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If a child has Schizophrenia, their fraternal twin has a _____ percent chance of developing the disorder.
A.5
B.10
C.17
D.48
C
The concordance rate for Schizophrenia for dizygotic (fraternal) twins is approximately 17%, which means that if one fraternal twin is diagnosed with Schizophrenia, their twin has a 17% chance of developing the disorder.
Answer A: The concordance rate for a child who has one grandparent with Schizophrenia is about 5%.
Answer B: The concordance rate for biological siblings is about 10%.
Answer D: The concordance rate for monozygotic (identical) twins is approximately 48%.
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Common associated features of Schizophrenia include:
A.restricted affect, elated mood, restlessness and irritability, and disturbance in psychomotor activity.
B.emotion dysregulation, restlessness and irritability, eccentricities, and increased psychomotor activity.
C.inappropriate affect, dysphoric mood, disturbed sleep pattern, and lack of interest in eating.
D.mood lability, agitation, eccentricities, and disturbed sleep pattern.
C
Common associated features of Schizophrenia include inappropriate affect (e.g., laughing for no apparent reason), dysphoric mood, disturbed sleep pattern, and lack of interest in eating. Some individuals have poor insight into their symptoms (anosognosia), and Substance Use Disorders are also common comorbid diagnoses.
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A 34-year-old woman is convinced that her boss is in love with her although there is irrefutable evidence that her belief is false. The woman's belief is an example of which of the following?
A.Grandiose delusion
B.Erotomanic delusion
C.Idea of reference
D.Illusion
B
A person who believes that another person (usually of higher status) is in love with him or her despite incontrovertible evidence to the contrary is experiencing an erotomanic delusion.
Answer A: A grandiose delusion is characterized by an inflated sense of worth, knowledge, power, or identity or the belief that one has made an important discovery.
Answer C: An idea of reference is the belief that events, people, or objects in the environment have a special significance for the individual.
AnswerD: An illusion is a misperception or misinterpretation of an actual external situation.
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For a diagnosis of Schizophrenia, the DSM-5 requires the presence of two or more active phase symptoms for at least one month, with at least one symptom being:
A.hallucinations, delusions, or disorganized speech.
B.hallucinations, delusions, or grossly disorganized behavior.
C.anhedonia, avolition, or other negative symptom.
D.depersonalization or derealization.
A
The diagnosis of Schizophrenia requires the presence of two or more active phase symptoms for at least one month and continuous signs of the disturbance for at least six months. It also requires at least one active phase symptom to be hallucinations, delusions, or disorganized speech.
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