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11. Schizophrenia Spectrum Disorders Multiple-Choice Questions 1. The most frequent age of onset for schizophrenia is ______. A. the latency period B. right after puberty C. late adolescence or early adulthood D. mid-20s to early 30s Answer: C 2. Lori Schiller, the high school senior who suffered from schizophrenia, ______ as the first significant symptom of her disorder. A. heard voices B. experienced delusions of persecution C. withdrew from other people D. had a fight with another girl Answer: A 3. Perhaps the most puzzling and disabling of all the mental disorders is ______. A. panic disorder B. schizophrenia C. depression D. antisocial personality Answer: A 4. The clinical syndrome that best corresponds to popular conceptions of "madness" or "lunacy" is ______. A. dissociative identity disorder B. bipolar affective disorder C. antisocial personality D. schizophrenia Answer: D 5. Schizophrenia is a ______ disorder that affects ______ of a person’s life. A. temporary, a small part B. temporary, every aspect C. chronic, a small part D. chronic, every aspect Answer: D 6. The facial expression of a person with schizophrenia would often ______. A. show anger B. seem awkward and distorted C. lack expressiveness D. look confused Answer: C 7. Angela is hospitalized after a suicide attempt. In the hospital, she spends all of her time drawing sketches of fantastic goblins and monsters whom she calls "hellsmen." She claims that these "hellsmen" talk to her and, in fact, ordered her to make her suicide attempt. Often, she seems to be talking to invisible persons in the room and following orders from some unseen source. Her disorder is most likely ______. A. schizophrenia B. dissociative identity disorder C. bipolar affective disorder D. schizoid personality Answer: A 8. Someone experiencing a (n) _________ onset of schizophrenic symptoms typically has symptoms that occur suddenly, often within a few weeks or months, and who appears to have been well adjusted and shown few signs of behavioral disturbance. A. chronic B. onset C. acute D. steady-state Answer: C 9. Phyllis’s behavior is characterized by waning interest in social activities. She has slowly been becoming more remote in her interactions with the world. She just can't seem to keep up with her daily responsibilities. She can't even find the time to bathe or change her clothes regularly. At times she rambles off incoherently when talking to her friends. Her behavior is typical of someone in the _______ phase of schizophrenia. A. residual B. acute C. chronic D. prodromal Answer: D 10. The phase of schizophrenia marked by a slow, steady deterioration and gradual decline in function before clear-cut psychotic behaviors emerge is called the ______ phase. A. residual B. acute C. chronic D. prodromal Answer: D 11. Tracy has schizophrenia. Prior to the rapid onset of symptoms, Tracy was a first-year college student at a local liberal arts college where she was active and involved in the residence life community. Her behavior suddenly became characterized by hallucinations, delusions, talking to herself in the dining hall and classes. She has stopped bathing and does not change her clothes. The description of Tracy’s behavior suggests that she was experiencing the ___________ phase of schizophrenia. A. residual B. acute C. chronic D. prodromal Answer: B 12. Paula has schizophrenia. Her behavior is characterized by difficulties in speaking and thinking clearly, as well as a deep sense of apathy. Although she is not hallucinating or suffering delusions, as she had been a few months previously, she is still having so much difficulty organizing herself to deal with daily tasks that it is nearly impossible for her to live independently. She is in the ______ phase of schizophrenia. A. residual B. acute C. chronic D. prodromal Answer: A 13. During the ______ phase, the person with schizophrenia’s behavior will return to a level where flagrant psychotic symptoms are not present but significant cognitive, social, and emotional deficits are apparent. A. acute B. prodromal C. residual D. chronic Answer: C 14. The typical sequence of phases through which schizophrenia progresses is ______. A. prodromal, residual, acute B. acute, prodromal, residual C. acute, residual, prodromal D. prodromal, acute, residual Answer: D 15. Which of the following is one of the three phases typical of schizophrenia? A. residual B. remitting C. chronic D. acceleration Answer: A 16. After the onset of a schizophrenic episode, a full return to normal behavior ______. A. never occurs B. is uncommon, but does occur C. is common and usually occurs D. always occurs Answer: B 17. ______ have a slightly higher risk of developing schizophrenia and also tend to develop the disorder at a (n) _______ age. A. Women; earlier B. Men; later C. Women; later D. Men; earlier Answer: D 18. About ______ percent of Americans warrant a diagnosis of schizophrenia at some point in their lives. A. 1 B. 3 C. 5 D. 7 Answer: A 19. About ______ million people worldwide suffer from schizophrenia A. 12 B. 18 C. 24 D. 30 Answer: C 20. Approximately ______ people are treated for schizophrenia in the United States each year. A. 100,000 B. 1 million C. 5 million D. 8 million Answer: B 21. In men, the most common age of onset for schizophrenia is between ______. A. 12 and 18 B. 18 and 25 C. 25 and 35 D. 35 and 45 Answer: B 22. In women, the most common age of onset for schizophrenia is between ________. A. 12 and 18 B. 18 and 25 C. 25 and 35 D. 35 and 45 Answer: C 23. Women tend to develop schizophrenia ______ and have a ______ severe course of the disorder than do men. A. earlier, less B. later, less C. earlier, more D. later, more Answer: B 24. Men with schizophrenia differ from women with the disorder in which of the following ways? A. Men have a later age of onset of the disorder than females. B. Men have fewer cognitive impairments than females. C. Men exhibit more affective qualities such as depression more often than females. D. Men exhibit a poorer response to drug therapy than females. Answer: D 25. Women with schizophrenia differ from men with the disorder in each of the following Ways except A. Women exhibit a poorer response to drug therapy than men. B. Women exhibit more behavioral deficits than men. C. Women exhibit a better history of adjustment than men prior to exhibiting the disorder. D. Women demonstrate more cognitive impairments than men. Answer: C 26. Compared to women, men have a ______ risk of developing schizophrenia. A. significantly lower B. slightly lower C. slightly higher D. significantly higher Answer: C 27. Compared to men, women tend to achieve a ______ of functioning before the onset of the disorder and have a ______ severe course of the disorder. A. lower, less B. higher, less C. lower, more D. higher, more Answer: B 28. According to your text, ______ hallucinations are more common in some non-Western cultures than in Western cultures. A. auditory B. visual C. tactile D. olfactory Answer: B 29. Malcolm is a 20-year-old African college student who is hospitalized for acute schizophrenia. Because he is from a non-Western culture, he is more likely to experience ______ than acute schizophrenics in the United States. A. social withdrawal B. visual hallucinations C. muteness D. delusions of grandeur Answer: B 30. Schizophrenia is a ______ disorder that affects a ______ range of psychological processes. A. temporary, narrow B. temporary, wide C. pervasive, narrow D. pervasive, wide Answer: D 31. The diagnosis of schizophrenia in the DSM-5 requires that at least ______ features of the disorder be present and that at least ___ of these features should include the cardinal symptoms of delusions, hallucinations, or disorganized speech. A. five, three B. four, two C. three, two D. two, one Answer: D 32. Which of the following are the cardinal symptoms of schizophrenia of which at least one must be present for a diagnosis in the DSM-5? A. delusions, hallucinations, or disorganized speech B. catatonia, disturbances of volition, and loss of appetite C. waxy flexibility, catatonia, and loss of sensory sensations D. reduced sensation, catatonic behavior, and loss of ego boundaries Answer: A 33. ______ symptoms of schizophrenia represent the more flagrant symptoms of schizophrenia such as hallucinations, delusions, bizarre behavior, and thought disorder. A. Primary B. Secondary C. Positive D. Negative Answer: C 34. ______ symptoms of schizophrenia represent behavioral deficiencies such as social withdrawal, poverty of speech and thought, flattened affect, and psychomotor retardation. A. Primary B. Secondary C. Positive D. Negative Answer: D 35. The diagnosis of schizophrenia requires that signs of the disorder are present continuously for at least ______ months. A. 3 B. 6 C. 9 D. 12 Answer: B 36. The diagnosis for schizophrenia requires that active phase symptoms such as hallucinations, delusions, and disorganized or catatonic behavior must be present a significant amount of the time for at least ______. A. 1 month B. 3 months C. 6 months D. 9 months Answer: A 37. False beliefs that remain fixed in a person's mind despite their illogical basis and lack of evidence are ______. A. obsessions B. compulsions C. hallucinations D. delusions Answer: 3 38. Which of the following is a common type of delusion? A. acceptance B. sexual arousal C. transformative D. grandeur Answer: D 39. Hiram believes he is Martin Luther King, Jr. Despite the fact that he is White, he is alive, and he has never been involved in the civil rights movement, he is absolutely convinced that he is Martin Luther King Jr. Hiram's beliefs represent ______. A. an obsession B. a compulsion C. a hallucination D. a delusion Answer: D 40. Bob believes that people are spying on him. He claims that the CIA has put a microphone in his dog's stomach so that they can listen to his private conversations. Bob's beliefs represent delusions of ______. A. grandeur B. persecution C. reference D. being controlled Answer: B 41. Dean believes that people on the street talk about him when he walks by. He also believes that the people on the bus are talking about him when he rides the bus to work. At work, he believes his coworkers standing at the water-cooler are talking about him. Dean's beliefs represent delusions of ______. A. grandeur B. persecution C. reference D. being controlled Answer: C 42. Hal believes that his actions are being manipulated by evil demons who are trying to possess his body. He truly believes that when he shot those 14 innocent people at his office it was because the demons, talking to him through his neighbour’s cat, made him do it. Hal's beliefs represent delusions of ______. A. grandeur B. persecution C. reference D. being controlled Answer: D 43. As Ira watches the evening news, he becomes convinced that the news reporters are broadcasting coded information about him to his friends, neighbours, and enemies. Ira's beliefs represent delusions of ______. A. grandeur B. persecution C. reference D. being controlled Answer: C 44. Warren believes he is Jesus Christ. He is convinced he has returned to pass judgment on the world and offer salvation to true Christians. Despite a complete lack of evidence to support his beliefs, he remains convinced that he is Christ and that he is all-powerful. Warren's beliefs represent delusions of ______. A. grandeur B. persecution C. reference D. being controlled Answer: A 45. Matt believes that his thoughts leave his head like a ticker-tape and other people can read his mind if they pass the tape through their heads. His thinking represents ______ delusions. A. thought insertion B. thought broadcasting C. thought withdrawal D. thought distortion Answer: B 46. Jim believes that his next-door neighbour is capable of flashing her thoughts into his mind whenever she wants to. He says, "I will be sitting in my living room, minding my own business when suddenly my mind is flooded with her thoughts and I cannot get them out of my mind." Jim's beliefs represent ______ delusions. A. thought insertion B. thought broadcasting C. thought withdrawal D. thought transference Answer: A 47. Gary believes that his thoughts are periodically sucked out of his mind by some external force, leaving him disoriented and confused. His beliefs represent ______ delusions. A. thought insertion B. thought broadcasting C. thought withdrawal D. thought distortion Answer: C 48. The breakdown in the organization, processing, and control of thought common in schizophrenia is called a ______. A. delusion B. hallucination C. thought disorder D. brief psychotic disorder Answer: C 49. Which of the following are signs of a thought disorder? A. coherent thoughts B. rapid speech C. frequent changing of conversational topics D. blocking Answer: A 50. Poverty of speech, neologisms, and blocking are signs of ______. A. an affective disorder B. a behavioral disorder C. a thought disorder D. an attention disorder Answer: C 51. Jose has schizophrenia. His speech patterns are jumbled and disorganized. He strings syllables together nonsensically in meaningless rhymes that are often incoherent to anyone listening. He often mixes real words in with word fragments or non-existent words making it impossible for others to understand what he is talking about. His symptoms are best described as ______. A. blocking B. looseness of association C. perseveration D. poverty of speech Answer: B 52. Jenny has schizophrenia. She speaks coherently, but very slowly and deliberately. Usually there is little useful content in what she speaks, as her utterances tend to be vague and limited. Her symptoms are best described as ______. A. blocking B. loose association C. perseveration D. poverty of speech Answer: D 53. Words that are made up by the speaker and have little or no meaning to others are known as ______. A. clanging B. perseveration C. neologisms D. thought intrusions Answer: C 54. Keith suffers from schizophrenia. One of his symptoms is that he constantly makes up new words that have little or no meaning to his listeners. When he does this, he is engaging in ______. A. blocking B. clanging C. neologisms D. perseveration Answer: C 55. Inappropriate but persistent repetition of the same words or train of thought is ______. A. blocking B. clanging C. neologisms D. perseveration Answer: D 56. Jess suffers from schizophrenia. One of his symptoms is that while talking to others Jess will inappropriately, but persistently, keep repeating the same words or thoughts over and over again. When he does this, he is engaging in ______. A. blocking B. clanging C. neologisms D. perseveration Answer: D 57. Juan suffers from schizophrenia. One of his symptoms is that while talking to others, Juan will string words together on the basis of rhyming, without regard to the meaning of the words. As a result, many of his "clever little poems" lack any comprehensible meaning to his listeners. When Juan does this, he is engaging in ______. A. blocking B. clanging C. neologisms D. perseveration Answer: B 58. People with schizophrenia who tend to string words together because they rhyme or sound alike are engaging in ______. A. blocking B. clanging C. neologisms D. perseveration Answer: B 59. The involuntary, abrupt interruption of speech or thought is known as ______. A. blocking B. clanging C. neologisms D. perseveration Answer: A 60. Melvin suffers from schizophrenia. One of his symptoms is that while talking to others, he will abruptly stop speaking, often in mid-sentence. He complains that he suffers these same types of involuntary interruptions in his thoughts, too. Melvin's symptoms represent ______. A. blocking B. clanging C. neologisms D. perseveration Answer: A 61. Which of the following is true of thought disorders? A. Many but not all schizophrenic individuals manifest thought disorder. B. Thought disorder has not been found to exist in normal people. C. Thought disorder has been only been found to exist among schizophrenics. D. Thought disorder among schizophrenic individuals tends to be short-lived and reversible. Answer: A 62. Thought disorders in people with schizophrenia tend to be ______. A. short-lived and reversible B. persistent but reversible C. short-lived but recurrent D. persistent and recurrent Answer: D 63. Thought disorders in people experiencing a manic episode tend to be ______. A. short-lived and reversible B. persistent but reversible C. short-lived but recurrent D. persistent and recurrent Answer: A 64. Among people with schizophrenia, thought disorder occurs most often during ______. A. the prodromal phase B. the chronic phase C. the residual phase D. acute episodes Answer: D 65. A person with schizophrenia is said to be ______ when he or she is acutely sensitive to extraneous sounds. A. perseverating B. clanging C. hypervigilant D. blocking Answer: C 66. People with schizophrenia are noted to have a(n) ____ where their eyes do not steadily track a target but instead fall back and then catch up in a kind of jerky movement. A. eye movement dysfunction B. visual movement disorder C. sensory perception dysfunction D. lethargy transduction Answer: A 67. John is asked to track a dot as it moves across the screen. Rather than the eyes steadily tracking the target, they fall back and then catch up in a jerky fashion. Which of the following common characteristics of people with schizophrenia does john display? A. movement disorder B. sensory reduction C. transduction disorder D. eye movement dysfunction Answer: D 68. Eye movement dysfunctions appear to involve defects in the brain’s control of _______. A. visual attention B. sensory reduction C. motor control D. attention to pain Answer: A 69. Researchers suspect that ______ may be a genetic marker for schizophrenia. A. eye movement dysfunctions B. thought disorders C. hypervigilance D. attention deficits Answer: A 70. Eye movement dysfunctions have been found to exist among people with ______ disorder. A. antisocial personality B. obsessive-compulsive C. bipolar D. conversion Answer: C 71. Eye movement dysfunction ______ unique to schizophrenia and ______ people with schizophrenia show eye movement dysfunctions. A. is, all B. is, not all C. is not, all D. is not, not all Answer: D 72. Recently, investigators reported a(n) ________ accuracy in discriminating people with schizophrenia from healthy control subjects based on a set of eye movement indicators. A. low B. moderate C. above average D. extremely high Answer: D 73. Brain wave patterns that occur in response to external stimuli like sounds and flashes of light are called ______. A. alpha waves B. event-related potentials C. neurological infarctions D. delta waves Answer: B 74. ______ suppress ERPs to repeated stimuli. A. Neither healthy people nor schizophrenia patients B. Healthy people, but not schizophrenia patients C. Schizophrenia patients, but not healthy people D. Both schizophrenia patients and healthy people Answer: B 75. People with schizophrenia exhibit ______ as a result of greater difficulty filtering out distracting stimuli. A. sensory deficiency B. sensory numbness C. sensory overload D. sensory excitability Answer: C 76. Studies of deficiencies in event-related potentials suggest that schizophrenic individuals would have difficulty in ______. A. looking someone in the eyes B. filtering out irrelevant stimuli C. recalling names D. remembering faces Answer: B 77. Compared to others, patients with schizophrenia are ______ able to filter out irrelevant information and ______ able to focus on stimuli in ways that allow them to extract meaningful information from those stimuli. A. less, less B. less, more C. more, less D. more, more Answer: A 78. The most common form of perceptual disturbances in schizophrenia are ______. A. obsessions B. delusions C. compulsions D. hallucinations Answer: D 79. Sensory images, perceptions, or disturbances that occur in the absence of external stimuli are called ______. A. obsessions B. compulsions C. delusions D. hallucinations Answer: D 80. The most common types of hallucinations are ______. A. auditory B. visual C. tactile D. olfactory Answer: A 81. Auditory hallucinations occur in about ______ percent of the cases of schizophrenia. A. 30 B. 50 C. 75 D. 90 Answer: C 82. Which of the following types of hallucinations is the LEAST common for someone with schizophrenia? A. auditory B. tactile C. somatic D. visual Answer: D 83. Marcy has schizophrenia. She feels like snakes or aliens are crawling around inside her stomach and intestines. Her feelings represent ______ hallucinations. A. gustatory B. somatic C. tactile D. olfactory Answer: B 84. Rita has schizophrenia. She persistently complains of tasting mustard, even though there is nothing in her mouth. Her sense of tasting mustard represents a(n) ______ hallucination. A. gustatory B. somatic C. tactile D. olfactory Answer: A 85. Marcy has schizophrenia. She complains of continuously smelling the foul, putrid Odor of rotting flesh, even though there is nothing around her that could be generating such an Odor. Her complaints represent a(n) ______ hallucination. A. gustatory B. somatic C. tactile D. olfactory Answer: D 86. Deion has schizophrenia. He often hears voices telling him to run away or to harm others. He feels compelled to do what the voices tell him to do. Deion is experiencing ______. A. command hallucinations B. delusions of reference C. hallucinations of reference D. delusions of persecution Answer: A 87. People having grief-induced hallucinations ______ differentiate them from reality, and people having schizophrenic hallucinations ______ differentiate them from reality. A. cannot, cannot B. can, cannot C. cannot, can D. can, can Answer: B 88. Drug-induced hallucinations tend to be ______. A. auditory B. visual C. tactile D. olfactory Answer: B 89. Kim, who is 19, is taken by her friends to the mental health crisis unit after taking a hallucinogenic drug. She says that she is frightened because she thinks that she is seeing flashes of light that her friends are not seeing. The emergency room psychiatrist would be correct to hypothesize that Kim was manifesting ______. A. an acute schizophrenic episode B. the manic phase of a bipolar disorder C. glaucoma D. a drug-induced hallucination Answer: 3 90. Lara is taken by her friends to the mental health crisis unit. She suffer from chronic alcoholism but has had no other previous history of mental problems. She says that she is frightened because she believes that bugs are crawling on her skin. The emergency room psychiatrist would be correct to hypothesize that Lara was manifesting ______. A. delirium tremens from alcohol withdrawal B. an acute schizophrenic episode C. the manic phase of a bipolar disorder D. a pseudo-epileptic seizure Answer: A 91. Hallucinations seem to be related to abnormalities in the production of ______ in the brain. A. serotonin B. epinephrine C. dopamine D. acetylcholine Answer: C 92. Auditory hallucinations in schizophrenia patients may represent __________. A. damage to the auditory nerve B. eruption of the id into conscious awareness C. seizure-like activity in the brain D. a type of inner speech Answer: D 93. Which of the following appears to be the MOST likely explanation for auditory hallucinations? A. hallucinogenic drug use B. uninhibited daytime dreams C. projections of the individual’s own internal self-talk D. overly sensitive auditory nerves Answer: C 94. Auditory hallucinations appear to be a form of ______ speech attributed to ______ sources. A. internal, internal B. external, internal C. internal, external D. external, external Answer: C 95. Cognitive-behavior therapists have attempted to train schizophrenic individuals to reattribute their auditory hallucinations to ______. A. the therapists B. their closest relatives C. themselves D. their favourite fictional characters Answer: C 96. Emotional response in schizophrenic individuals is typified by ______ affect. A. flat B. normal C. enhanced D. explosive Answer: A 97. Which of the following is true of people with schizophrenia? A. They use nonverbal communication effectively. B. They speak with a good deal of prosody. C. Their emotional responses are typified by either inappropriate or blunted affect. D. They have more intense positive emotions than others. Answer: C 98. Laboratory-based evidence suggests people with schizophrenia experience ______ intense negative emotions and ______ intense positive emotions compared to people without schizophrenia. A. less, less B. more, more C. less, more D. more, less Answer: D 99. Which of the following statements is true regarding people with schizophrenia? A. They are very aware of and highly sensitive to the emotions in others. B. They increase their ego boundaries. C. Although they have difficulty returning to the goals they had before a schizophrenic episode, they do not lose their initiative to pursue goal-directed activities. D. They withdraw from social interactions. Answer: D 100. The loss of initiative to pursue goal-directed activities in schizophrenics is referred to as ______. A. a motivational syndrome B. stalled drive C. disturbance in volition D. unintentional meandering Answer: C 101. A trait of many schizophrenic individuals that precedes the onset of their psychoses is ______. A. creativity B. impulsivity C. introversion D. neatness Answer: C 102. The behavior exhibited by some people with schizophrenia that is characterized by gross disturbances in motor activity is known as ______. A. paranoid B. residual C. catatonia D. disorganized Answer: C 103. People with schizophrenia who show unusual mannerisms or grimacing, or maintain bizarre strenuous postures for hours are exhibiting as ______. A. residual behaviors B. paranoid behaviors C. disorganized behaviors D. catatonic behaviors Answer: D 104. A.J.'s behavior is characterized by markedly impaired motor activity that slows to a stupor but then switches abruptly into an agitated phase. He sometimes "freezes" in bizarre, uncomfortable-looking postures which he maintains for hours, even as his limbs become stiff and swollen. He acts mute during these periods and displays waxy flexibility. He is best described as displaying ______ behaviors. A. paranoid B. disorganized C. catatonic D. undifferentiated Answer: C 105. Catatonia was recognized _______ schizophrenia in previous versions of the diagnostic manual. A. as the most serious form of B. as the only type of C. as a separate subtype of D. as the least serious form of Answer: C 106. The adoption of a fixed posture into which one has been positioned by others is called ______. A. catatonia B. waxy flexibility C. la belle indifference D. autistic paralysis Answer: B 107. Juanita is working in a psychiatric hospital. She places one of her patients with schizophrenia in a position with his hands over his heads. He maintains that position for hours. The patient is most likely displaying which of the following? A. extreme lethargy disorder B. waxy flexibility C. drug induced coma D. paralysis dysfunction Answer: B 108. Catatonia is more common in people with ______ than with schizophrenia. A. brain damage B. mood disorders C. autism D. body dysmorphic disorder Answer: B 109. Susan’s brother was recently hospitalized when he was found dancing wildly in the center of a public fountain. Her brother had not slept in five days before being hospitalized. Her brother is now very quiet and maintains the same awkward pose for hours. Susan is adamant that her brother does not have schizophrenia. Which of the following diagnoses is most likely to be assigned to Susan’s brother? A. schizophrenia B. bipolar disorder C. panic disorder D. generalized anxiety disorder Answer: B 110. Although the underlying causes of schizophrenia remain elusive, they are presumed to involve ____________ in combination with _______________ influences. A. brain abnormalities; psychological, social, and environmental B. early childhood trauma; bizarre patterns of communication in the family C. brain abnormalities; the use of alcohol during adolescence D. environmental toxins; chronic exposure to lead Answer: A 111. The causes of schizophrenia are generally believed to be ______. A. exclusively biological in nature B. exclusively psychological in nature C. exclusively social and environmental in nature D. biological, psychological, social, and environmental in nature Answer: D 112. Psychodynamic theory asserts that schizophrenia represents ______. A. a severe fixation in the anal stage B. failure to adequately resolve the anxiety associated with the Oedipus or Electra complex C. overwhelming of the superego by the ego D. overwhelming of the ego by the id Answer: D 113. According to psychodynamic theory, schizophrenia represents a retreat by the ego to an early period in the ______ stage. A. oral B. phallic C. genital D. anal Answer: A 114. Psychodynamic theory states that schizophrenia represents a regression to a level of functioning known as ______. A. primary narcissism B. secondary narcissism C. tertiary narcissism D. universal narcissism Answer: A 115. According to psychodynamic theory, the period in which the infant has not yet learned that the world and itself are two distinct entities is known as the period of ______. A. primary narcissism B. secondary narcissism C. tertiary narcissism D. universal narcissism Answer: A 116. Freud’s followers, such as Harry Stack Sullivan, placed ______ in the development of schizophrenia. A. no emphasis on either intrapsychic or interpersonal factors B. more emphasis than Freud on intrapsychic rather than interpersonal factors C. more emphasis than Freud on interpersonal rather than intrapsychic factors D. equally strong emphasis on both interpersonal and intrapsychic factors Answer: C 117. Harry Stack Sullivan (1962) emphasized that impaired mother–child relationships can set the stage for ______________. A. the child to rely on fantasy as a source of comfort B. gradual withdrawal from other people C. the child’s need for nurturance and reassurance from others D. independence and achievement Answer: B 118. Jake is in treatment for schizophrenia. His therapist says that his schizophrenia results from his ego being overwhelmed by primitive, normally unconscious urges and retreating to a pattern of infantile behavior typical of a two-month-old. Jake's therapist is most likely a ______. A. behavioral therapist B. humanistic therapist C. social learning therapist D. psychodynamic therapist Answer: D 119. Haughton and Ayllon conditioned a woman with chronic schizophrenia to cling to a broom by ______. A. pairing her sweeping with the sound of a bell B. smiling at her as she swept C. giving her cigarettes as she held the broom D. patting her on the back as she held the broom Answer: C 120. Max is in treatment for schizophrenia. His therapist suggests that much of his schizophrenic behavior was modelled after the behavior of other hospitalized patients and unintentionally rewarded by the hospital staff. Max's therapist is most likely a ______ therapist. A. learning-oriented B. humanistic C. social-cognitive D. psychodynamic Answer: C 121. Evidence for a genetic contribution to the development of schizophrenia is ______. A. non-existent B. weak C. moderate D. compelling Answer: D 122. Cross-cultural studies from Europe and the United States confirm an increased risk of schizophrenia in people who ______. A. were sexually abused as children B. were physically abused as children C. have biological relatives with the disorder D. grew up in poverty Answer: C 123. The concordance rate of schizophrenia among identical (monozygotic) twins is about ______ percent. A. 28 B. 48 C. 68 D. 88 Answer: B 124. The concordance rate of schizophrenia among fraternal (dizygotic) twins is about ______ percent. A. 17 B. 37 C. 57 D. 77 Answer: A 125. Research on genetics and schizophrenia indicates that ______ play a significant role in the development of schizophrenia. A. neither genetics nor environmental factors B. genetics, but not environmental factors C. environmental factors, but not genetics D. both genetics and environmental factors Answer: D 126. Adoption studies of schizophrenia have found that schizophrenia ______ when they are raised by normal adoptive parents. A. does not occur among children of schizophrenic biological parents nor children of normal biological parents B. occurs more frequently among children of schizophrenic biological parents than among children of normal biological parents C. occurs more frequently among children of normal biological parents than among children whose parents had schizophrenia D. occurs equally among the children of normal parents and the children whose parents had schizophrenia Answer: B 127. A technique comparing the incidence of schizophrenia among children whose parents either had or didn't have schizophrenia, and who were reared by adoptive parents who either had or didn't have schizophrenia, is the ______ study. A. familial B. adoption C. cross-fostering D. cross-sectional Answer: C 128. According to the 1974 Wender study, which used the cross-fostering approach, children were at the greatest risk of developing schizophrenia when they ______. A. had nonschizophrenic biological parents and were raised by nonschizophrenic adoptive parents B. had nonschizophrenic biological parents and were raised by schizophrenic adoptive parents C. had schizophrenic biological parents no matter what the state of their adoptive parents mental health D. were raised by schizophrenic adoptive parents no matter what the state of their biological parents' mental health Answer: C 129. Children born to normal parents but raised by schizophrenic adoptive parents are at ______ of developing schizophrenia themselves as children raised by normal parents. A. half the risk B. just the same risk C. twice the risk D. 4 times the risk Answer: B 130. Scientists believe that ______ is(are) implicated in the causation of schizophrenia. A. multiple genes B. a single gene that affects dopamine receptor sites C. a single gene that affects both dopamine and serotonin receptor sites D. a single gene that affects both thought and affect Answer: A 131. Scientists have found that the offspring of ____ stand an increased risk of developing schizophrenia and autism, presumably because the sperm of older men are more prone to mutations. A. older fathers B. older mothers C. younger mothers D. younger fathers Answer: A 132. The offspring of older fathers stand an increased risk of developing schizophrenia and autism presumably because which of the following? A. older men have higher cholesterol B. the sperm of older men are more prone to mutations C. older men tend to have higher incidence of diabetes D. older men are more prone to schizophrenia compared to younger men Answer: B 133. The prevailing view today about the causes of schizophrenia is the ______ model. A. single gene B. social learning C. cognitive behavioral D. diathesis-stress Answer: D 134. People with schizophrenia appear to ______ than other people. A. produce more estrogen B. produce less epinephrine C. have irregularities in the use of dopamine D. excrete more dopamine in the urine Answer: C 135. Phenothiazines block the action of ______. A. norepinephrine B. serotonin C. dopamine D. thyroxin Answer: C 136. The major source of evidence supporting the dopamine model of schizophrenia comes from observing the effects of ______. A. neuroleptics B. barbiturates C. tricyclics D. hallucinogenics Answer: A 137. One source of evidence supporting the dopamine model of schizophrenia comes from observing the effects of ______. A. MAO inhibitors B. barbiturates C. amphetamines D. tricyclics Answer: C 138. High doses of amphetamines produce behavior in normal people that mimics ______ of schizophrenia. A. asexual behaviors B. catatonic behaviors C. disorganized behaviors D. delusions of paranoia Answer: D 139. High doses of ______ produce behavior in normal people that mimic delusions of paranoia in schizophrenia. A. amphetamines B. barbiturates C. phenothiazines D. benzodiazepines Answer: A 140. Which of the following is a true statement? A. Amphetamines can cause behavior in normal people that mimics generalized anxiety disorder. B. Some positive symptoms of schizophrenia are associated with decreased dopamine activity. C. Phenothiazines inhibit schizophrenic behavior patterns. D. Autopsies on the brains of schizophrenics show decreased numbers of dopamine receptor sites in certain parts of the brain. Answer: C 141. Research evidence indicates that over reactivity of dopamine receptors may play ______. A. little or no role in either positive or negative symptoms of schizophrenia B. a greater role in the development of positive symptoms than negative symptoms of schizophrenia C. a greater role in the development of negative symptoms than positive symptoms of schizophrenia D. an equal role in the development of both positive and negative symptoms of schizophrenia Answer: B 142. It appears that ______ of dopamine is associated with ______ in schizophrenia. A. over reactivity; negative symptoms B. under reactivity; negative symptoms C. over reactivity; both positive and negative symptoms D. under reactivity; both positive and negative symptoms Answer: B 143. It appears that ______ of dopamine is associated with ______ in schizophrenia. A. over reactivity, positive symptoms B. under reactivity, positive symptoms C. over reactivity, both positive and negative symptoms D. under reactivity, both positive and negative symptoms Answer: A 144. Which of the following neurotransmitters appear to be involved in schizophrenia? A. glutamate B. noradrenaline C. cortisol D. endorphin Answer: A 145. Evidence for the viral theory of schizophrenia is ______. A. non-existent B. inconclusive C. strong D. compelling Answer: B 146. Individuals exposed to the influenza virus during the first trimester of pregnancy are ______ likely than others to develop schizophrenia. A. less B. slightly more C. three times as D. seven times as Answer: D 147. According to the text, the most prominent finding of pathology in the brains of schizophrenics is ______. A. an enlarged hippocampus B. an enlarged reticular formation C. a loss of brain tissue D. an enlarged amygdala Answer: C 148. Persons with schizophrenia have a loss of ______ compared to individuals without schizophrenia. A. white matter B. gray matter C. dendrite per neuron D. axons per neuron Answer: B 149. The clearest sign of deterioration of brain tissue in people with schizophrenia is the presence of abnormally enlarged _________, which are hollow spaces in the brain. A. frontal lobes B. occipital lobes C. interneurons D. ventricles Answer: D 150. One indication of the possible role of prenatal complications in schizophrenia is the finding of an association between _____ and later schizophrenia. A. low birth weight B. high IQ C. amount of crying D. amount of time the baby sleeps Answer: A 151. People with schizophrenia show reduced brain activity in the ______. A. prefrontal cortex B. hindbrain C. motor cortex D. parietal lobes Answer: A 152. The part of the brain that serves as a sort of mental clipboard for holding information needed to guide organized behavior and for regulating attention is the ______. A. hippocampus B. amygdala C. reticular formation D. prefrontal cortex Answer: D 153. Evidence suggests that disturbances in brain physiology in the ______ regions of the brain may contribute to the emotional and cognitive problems seen in schizophrenia. A. hippocampus B. prefrontal cortex C. occipital D. parietal Answer: B 154. Evidence also points to abnormalities in brain circuitry connecting the prefrontal cortex and lower brain structures involved in regulating _________. A. emotions and memory B. breathing and sleeping C. digestion and respiration D. hearing and seeing Answer: A 155. ______ claimed in 1961 that mental illness does not exist in his book, The Myth of Mental Illness. A. Oliver Sacks B. Lawrence Frank C. Thomas Szasz D. Hans Strupp Answer: C 156. Thomas Szasz believes that mental illness ______. A. results from a diet overloaded with preservatives and processed foods B. is the biggest health problem facing the world in the 21st century C. is overblown by researchers and scientists who use it to build their own careers and enrich themselves D. is a convenient fiction society uses to stigmatize and subjugate deviant people Answer: D 157. To Szasz, mental illnesses are really ______. A. usually mundane family-based conflicts B. problems in living C. biologically based disorders like asthma or diabetes D. amenable to short-term treatment Answer: B 158. Szasz believes that ______ is a form of tyranny disguised as therapy. A. involuntary hospitalization B. psychiatric medication C. electroshock therapy D. Alcoholics Anonymous Answer: A 159. A since-discarded concept of a cold but overprotective mother who was believed to be capable of causing schizophrenia in her children is known as the ______. A. communication deviant mother B. schizophrenogenic mother C. double-bind mother D. expressed emotion mother Answer: B 160. The schizophrenogenic mother is best described as ______. A. schizophrenic herself B. cold, aloof, domineering, and overprotective C. overly nurturing, passive, helpless, and unintelligent D. passive-aggressive, overemotional, hysteric, and negligent Answer: B 161. The idea that schizophrenia results from being raised by a schizophrenogenic mother is _______. A. not supported by research B. partially supported by research C. strongly supported by research D. conclusively supported by research Answer: A 162. Which of the following has research linked with an increased risk of schizophrenia? A. being adopted by parents who have schizophrenia B. growing up with parents who exhibit communication deviance C. growing up with a schizophrenogenic mother D. growing up in a family low in expressed emotion Answer: B 163. The pattern of unclear, vague, disruptive, or fragmented communication that is often seen among parents and family members of schizophrenic patients is known as ______. A. communication deviance B. expressed emotion C. double-bind communication D. schizophrenogenia Answer: A 164. The tendency of family members to be hostile, critical, and unsupportive of their schizophrenic family members is known as ______. A. emotional distancing B. expressed emotion C. double-bind communication D. deviant expression Answer: B 165. Britney's father is frequently critical of her. He is quick to find fault with her and express frequent criticism and hostility. He is prone to telling Britney what she “really” thinks rather than allowing Britney to formulate her own thoughts and feelings. Britney’s father could be described as having A. low expressed emotion. B. high communication deviance. C. double-bind communication. D. low communication deviance. Answer: B 166. Which of the following is true of expressed emotion in families with a family member with schizophrenia? A. High expressed emotion in relatives is related to a lower rate of relapse. B. High levels of expressed emotion in a family may serve as a buffer for the family member with schizophrenia against outside stressors. C. High Expressed emotion in a family is a predictor of the recurrence of schizophrenic episodes. D. Disruptive behavior on the part of a family member with schizophrenia may increase the likelihood of expressed emotion by other family members. Answer: D 167. High EE families tend to be most prevalent in ______. A. developing countries B. industrialized countries C. religious countries D. nonreligious countries Answer: B 168. ______ are likely to view the psychotic behavior of a family member with schizophrenia as residing within the person's control. A. Neither Mexican American families with low or high expressed emotion B. Mexican American families with high expressed emotion C. Mexican American families with low expressed emotion D. Mexican American families with high and low expressed emotion Answer: B 169. Among which of the following groups is high EE in family members of schizophrenics associated with a positive outcome? A. Anglo Americans B. Mexican Americans C. African Americans D. Chinese Answer: C 170. Candace is Anglo American. She has been hospitalized three times for schizophrenia. She has returned to her family after each hospitalization and continued taking medication. However, she relapses after about five months. Her family probably ______. A. includes a schizophrenogenic mother B. needs to be educated about schizophrenia C. is high in expressed emotion D. includes at least one other schizophrenic at home Answer: C 171. The evidence that family factors such as negative family interactions can lead to schizophrenia in children who do not have a genetic vulnerability is ______. A. non-existent B. consistent, but weak C. strong D. compelling Answer: A 172. The ______ model recognizes the interaction of stress from disturbed family communication with genetic vulnerability in increasing the risk of developing schizophrenia. A. psychodynamic B. double-bind C. family systems D. diathesis-stress Answer: D 173. To many Mexican Americans, a person suffering from schizophrenia is perceived as suffering from ______. A. nerves B. depression C. spiritual possession D. dissociation Answer: A 174. The Spanish term "Nervios" refers to a wide range of problems that includes which of the following? A. normal sadness B. autism C. manic episodes D. schizophrenia Answer: C 175. By conceptualizing schizophrenia as "nerves" rather than as "craziness," Mexican Americans may ______. A. see it as a curable condition, which bears less social stigma and may positively impact on the person's chances of recovery B. not take it as seriously as they should, thus decreasing schizophrenics' long-term chances of recovery C. place themselves and the person at risk by not treating schizophrenic persons before they become violent D. stigmatize traditional males in a way that makes it more difficult for them to recover, as "nerves" is seen as a female disorder and a sign of weakness Answer: A 176. ______ proposed that certain people have a genetic predisposition to schizophrenia that receives behavioral expression only if they are reared in stressful environments. A. Gregory Bateson B. Paul Meehl C. Theodore Ayllon D. Harriet Lefley Answer: B 177. The diathesis-stress model of schizophrenia was formulated by ______. A. Zubin and Spring B. Lazarus C. Rosenthal and Watt D. Selye Answer: A 178. The model of schizophrenia which proposes that certain people have a genetic predisposition toward schizophrenia that is expressed behaviourally only if they are raised in stressful environments is the ______ model. A. multifactorial-polygenic B. monogenic C. distinct heterogeneity D. diathesis-stress Answer: D 179. Which statement lacks sufficient scientific support to currently serve as a foundation for the diathesis-stress model of schizophrenia? A. The age of onset is often associated with a great deal of stress. B. Stress directly triggers the initial onset of schizophrenia. C. Criticism from family members worsens symptoms and increases the risk of relapse. D. Economic hardship and living in a distressed neighbourhood increases the risk in genetically vulnerable people. Answer: B 180. What percent of the general population suffers from schizophrenia? A. 1 B. 2 C. 4 D. 5 Answer: A 181. Research has shown that ______ percent of children with one schizophrenic parent develop schizophrenia. A. 10 to 25 B. 25 to 40 C. 40 to 55 D. 55 to 70 Answer: A 182. Research has shown that ______ percent of children with two schizophrenic parents develop schizophrenia. A. 25 B. 45 C. 65 D. 85 Answer: B 183. Research by the Mednick group found that a major predictor of schizophrenia in high-risk children was ______. A. mother absenteeism during childhood B. difficulties or complications during childbirth C. drinking by the mother in the last three months of pregnancy D. an episode of high fever sometime during the first three months of infancy Answer: B 184. A(n) _____________ is a measurable process or mechanism, unseen by the unaided human eye, which explains how genetic instructions encoded in an organism’s DNA influence an observable characteristic of the organism. A. genotype B. phenotype C. endophenotype D. endogenotype Answer: C 185. _____________ are outward expressions of traits, such as eye color or observed behavior. A. Genotypes B. Phenotypes C. Endophenotypes D. Endogenotypes Answer: B 186. _______________ are mechanisms or critical links by which genes become expressed in behavioral or physical traits or disorders. A. Genotypes B. Phenotypes C. Endophenotypes D. Endogenotypes Answer: C 187. Most people with schizophrenia in organized mental health settings are treated with ______. A. antipsychotic medication B. electroconvulsive therapy C. psychosurgery D. sociocultural therapy Answer: A 188. Antipsychotic drugs are also referred to as ______. A. antigens B. neuroleptics C. minor tranquilizers D. neuroinhibitors Answer: B 189. Antipsychotic drugs are also referred to as ______. A. antidepressants B. minor tranquilizers C. neuroinhibitors D. major tranquilizers Answer: D 190. Which of the following is a phenothiazine? A. Paxil B. Prolixin C. Wellbtrin D. Haldol Answer: B 191. Antipsychotic drugs block ______ receptors in the brain. A. epinephrine B. testosterone C. white blood cells D. dopamine Answer: D 192. A disorder that is characterized by involuntary movements of the face, mouth, neck, trunk, or extremities and caused by long-term use of antipsychotic medication is known as ______. A. agranulocytosis B. schizophrenogenia C. tardive dyskinesia D. Addison’s disease Answer: C 193. Tardive dyskinesia is especially common among ______ patients. A. younger male B. younger female C. older male D. older female Answer: D 194. Sam has been on antipsychotic drugs for about 8 months. In recent weeks he has begun to frequently blink his eyes, smack his lips, make facial grimaces, pucker his lips, and make involuntary spasmodic movements of his arms and legs. His symptoms may indicate he has developed ______. A. Wernicke's syndrome B. institutionalization syndrome C. tardive dyskinesia D. Huntington's Chorea Answer: C 195. Tardive dyskinesia is most common among ______ and ______. A. men, older people B. women, older people C. men, younger people D. women, younger people Answer: B 196. The newest generation of drugs to treat schizophrenia are called ______. A. neuroleptics B. phenothiazines C. mood stabilizers D. atypical antipsychotics Answer: D 197. Which drug is considered an atypical antipsychotic? A. haloperidol B. Mellaril C. risperidone D. prolixin Answer: C 198. An important potentially adverse side effect of clozapine is ______. A. kidney failure B. chromosomal damage that could affect the health of unborn babies in pregnant schizophrenics C. reduced production of white blood cells D. development of cataracts Answer: C 199. Asians tend to require ______ doses of neuroleptics than Caucasians to achieve an optimal response. They tend to experience ______ side-effects from the same dosage. A. smaller, fewer B. smaller, more C. larger, fewer D. larger, more Answer: B 200. In treating Asian Americans for schizophrenia, the failure of clinicians to ______ often compromises the value of the therapy. A. prescribe antipsychotic drugs B. treat the patient with respect C. include the family D. discuss family history Answer: C 201. Research with Asian Americans in treatment for schizophrenia indicates that clinicians might increase the success of treatment with Caucasian patients if they ______. A. included family members in the therapy process B. lowered the dosages of antipsychotic drugs C. used a wider variety of alternative approaches to therapy D. treated patients with a greater degree of respect and equality Answer: A 202. ______ are more likely to emphasize individualism and self-responsibility in the treatment of schizophrenia for a family member. A. Asian Americans B. Non-Hispanic White Americans C. Hispanic Americans D. African Americans Answer: B 203. Freud believed that traditional psychoanalysis ______. A. was not appropriate for the treatment of schizophrenia B. was useful, but probably not the best method for treating schizophrenia C. was one of several equally effective treatments for schizophrenia D. was the best method for treating schizophrenia Answer: A 204. Which of the following is a learning-based therapeutic technique typically used to treat schizophrenia? A. intermittent reinforcement of desirable behaviors B. aversive conditioning to eliminate undesirable behaviors C. token economies D. self-actualization training Answer: C 205. As a patient in a mental hospital, Ethan can earn poker chips for engaging in adaptive behaviors such as attending meetings, maintaining proper grooming, and using appropriate communications. When he collects enough chips, he can exchange them for rewards such as privacy time, food, passes, and other privileges. This approach is called ______. A. social skills training B. personal therapy C. compensatory learning D. a token economy Answer: D 206. The basic social skills training model used in treating schizophrenia employs ______. A. the "empty chair" technique B. systematic desensitization C. role-playing exercises D. guided fantasies Answer: C 207. Some recent studies have found ______ to be promising in reducing delusions and hallucinations in medication-resistant schizophrenics. A. electroshock therapy B. short-term psychoanalysis C. cognitive-behavioral therapy D. milieu therapy Answer: C 208. Cognitive-behavioral therapy may also be helpful in reducing _________, such as lack of motivation and apathy, the kinds of problem behaviors that make it difficult for patients to adjust to the demands of community living. A. positive symptoms B. hallucinations C. delusions D. negative symptoms Answer: D 209. “Clubhouses” serve to ______. A. provide a place for terminally ill people with schizophrenia to die with dignity B. provide treatment for severely disturbed people with schizophrenia who cannot get the individual care they need from a traditional mental hospital C. provide a permanent shelter for people with schizophrenia who do not fully need hospitalization but cannot effectively survive independently D. provide self-help services such as social support and assistance with finding employment for people with schizophrenia attempting to maintain their independence in the community Answer: D 210. Investigations of family intervention programs for the treatment of schizophrenia have found that they ______. A. reduce the risk of recurrent episodes of schizophrenia B. have no effect on the risk of recurrent episodes of schizophrenia C. increase the risk of recurrent episodes of schizophrenia D. increase the risk that other family members will develop schizophrenia Answer: A 211. In sum, ______ meet(s) all the needs of people with schizophrenia. A. social learning programs B. family intervention approaches C. psychodynamic approaches D. no single treatment approach Answer: D 212. Besides schizophrenia, the DSM-5 classifies a range of psychological disorders within the schizophrenia spectrum of disorders. They include which of the following? A. conversion disorder B. hallucination disorder C. major affective disorder D. schizoaffective disorder Answer: D 213. The DSM-5 category of ______ applies to a psychotic disorder that lasts from a day to a month. A. schizoaffective disorder B. brief psychotic disorder C. schizophreniform disorder D. acute reactive psychosis Answer: B 214. In the DSM-5, a brief psychotic disorder is one that lasts for no more than ______. A. 1 day B. 1 week C. 1 month D. 6 months Answer: C 215. Ellen's husband was killed in an automobile accident two weeks ago. Since that time she has had repeated episodes of fleeting hallucinations and delusions. Her behavior has been marked by periods of incoherent speech, screaming, suicidal and aggressive behavior, and disorientation. After about a month, her behavior slowly returns to normal. She would be best diagnosed as suffering from ______. A. schizophreniform disorder B. schizoid disorder C. schizotypal disorder D. brief psychotic disorder Answer: D 216. ______ consists of abnormal behaviors identical to those in schizophrenia that have persisted for at least 1 month but fewer than 6 months. A. Schizophreniform disorder B. Brief psychotic disorder C. Schizotypal disorder D. Schizoid disorder Answer: A 217. Audrey's behavior is characterized by hallucinations, delusions, incoherent speech, and disorientation. She talks to herself and screams and yells at passersby on the street. She sifts through garbage dumpsters for food, and collects garbage from the dumpsters. She never bathes or changes her clothes. She has been acting this way for about 3 months. She is best diagnosed as suffering from ______. A. schizophreniform disorder B. schizophrenia C. schizoaffective disorder D. brief psychotic disorder Answer: A 218. Which of the following is true of erotomania? A. Erotomania is found almost exclusively in women. B. Antipsychotic medications typically eliminate the delusion. C. Psychotherapy does not help people with this disorder. D. Direct confrontation by the love object in the protected environment of psychotherapy can quell the desire to pursue the love object. Answer: C 219. Which of the following is true of men and women suffering from erotomania? A. Neither men nor women have much potential for violence resulting from their delusion. B. Men are more likely than women to threaten or commit acts of violence in the pursuit of their love objects. C. Women are more likely than men to threaten or commit acts of violence in the pursuit of their love objects. D. Both men and women are likely to threaten or commit acts of violence in the pursuit of their love objects. Answer: B 220. Jake has persistent beliefs that his boss is out to kill him. Although his behavior is otherwise normal, Jake is convinced that because he embarrassed his boss a few months ago, his boss is now out to get even by having him killed. While his beliefs are certainly possible, it turns out that his boss has no desire at all to kill him. Jake is most likely suffering from ______. A. paranoid schizophrenia B. paranoid personality C. delusional disorder D. schizophreniform disorder Answer: C 221. Which of the following is true of the differences between delusional disorder and paranoid schizophrenia? A. The paranoid content in paranoid schizophrenia is less coherent and more bizarre than in delusional disorder. B. In delusional disorder, the delusion itself may be the only clear sign of abnormality. C. Persons with delusional disorder display the jumbled thinking characteristic of schizophrenia. D. Hallucinations are less likely to occur and are less prominent when they occur in delusional disorder. Answer: D 222. Daniel believes that Shakira is in love with him. Although he has never met her, he has written her several letters. He believes she hasn't replied because she's "playing hard to get." Daniel is suffering from the ______ type of delusional disorder. A. somatic B. erotomania C. grandiose D. jealous Answer: B 223. Which of the following is true with regard to delusional disorder? A. delusional disorders often respond to antipsychotic medication B. the individual’s concerns never wanes over the years C. only one kind of delusional disorder exists D. the disorder never permanently disappears Answer: A 224. Glenn believes he has special powers that allow him to communicate directly with God. He has started his own church in which his followers listen to his pronouncements which he claims to get directly from God. Glenn is suffering from the ______ type of delusional disorder. A. somatic B. erotomania C. grandiose D. persecutory Answer: C 225. After discovering some spots on the bed sheets, Bruce is convinced that his wife of twenty years is being unfaithful to him. He has never found her with anyone and there is no other evidence that she has been unfaithful, but Bruce remains convinced that she is "fooling around" on him. He is suffering from the ______ type of delusional disorder. A. persecutory B. erotomania C. grandiose D. jealous Answer: D 226. Lloyd believes that his business partners are trying to cheat him out of his "fair share" of the profits from the business. Although they have hired an independent auditor who confirms that he profits are being distributed fairly, Lloyd remains convinced that his partners are cheating him and they paid off the auditor to lie for them. Lloyd is suffering from the ______ type of delusional disorder. A. persecutory B. somatic C. grandiose D. jealous Answer: A 227. The most common form of delusional disorder is the ______ type. A. persecutory B. somatic C. erotomanic D. jealous Answer: A 228. Rob believes that foul, swamp-like odors are emanating from his body. He believes they are caused by parasites eating away at his insides. He is suffering from the ______ type of delusional disorder. A. persecutory B. somatic C. grandiose D. erotomanic Answer: B 229. The delusional disorder in which a person believes that he or she is loved by someone of high social status, even when they have never even met the person is called ______. A. egomania B. megalomania C. erotomania D. narcissistic personality disorder Answer: C 230. Arlene has suffered several episodes of major depression since she was fired from her job two years ago. She has also suffered from recurrent hallucinations, delusions, and periods of disorientation and incoherent speech. These symptoms all seem related to her major depressive episodes. She is most likely suffering from ______. A. schizophreniform disorder B. schizotypal disorder C. schizoaffective disorder D. a brief psychotic episode Answer: C 231. A common characteristic of schizophrenia and schizoaffective disorder is ______. A. displays of depressed mood B. responsiveness to antipsychotic medication C. successful treatment through social skills training D. short-term severity of symptoms Answer: B True-False Questions 232. Schizophrenia touches every aspect of the affected person's life. Answer: True 233. Schizophrenia usually develops during late childhood or early adolescence. Answer: False 234. Schizophrenia is characterized by disturbances in thinking and the conveyance of thought. Answer: True 235. Most cases of schizophrenia show a slower and more gradual decline in functioning. Answer: True 236. During the prodromal stage of schizophrenia, some patients return to the residual stage. Answer: False 237. As many as one-half to two-thirds of schizophrenia patients improve significantly over time. Answer: True 238. Women tend to have a slightly higher risk of developing schizophrenia than men. Answer: False 239. Women tend to have a less severe course of schizophrenia than men. Answer: True 240. A full return to normal behavior following an acute episode of schizophrenia is relatively common. Answer: False 241. Schizophrenia exists in the same form with no noted variation in symptomatology in virtually every culture that has been available for study. Answer: False 242. The diagnosis of schizophrenia in the DSM-5 requires that at least two features of the disorder be present and that at least one of these features should include the cardinal symptoms of delusions, hallucinations, or disorganized speech. Answer: True 243. Schizophrenia affects thoughts but not feelings. Answer: False 244. People with schizophrenia show no marked decline in occupational and social functioning. Answer: False 245. The thoughts of people with schizophrenia tend to be tightly knit together. Answer: False 246. All people with schizophrenia show evidence of thought disorder. Answer: False 247. Thought disorders in people experiencing schizophrenia tend to be short-lived and reversible. Answer: False 248. Thought disorder in schizophrenia occurs most often during the residual phase. Answer: False 249. People with schizophrenia appear to be hypervigilant. Answer: True 250. The belief that people with schizophrenia suffer from attentional deficits is supported by various studies which focus on the psychophysiological aspects of attention. Answer: True 251. Eye movement dysfunctions are unique to schizophrenia. Answer: False 252. Eye movement dysfunctions tend to run in the families of schizophrenics. Answer: True 253. Recently, investigators reported 98% accuracy in discriminating people with schizophrenia from healthy control subjects based on a set of eye movement indicators. Answer: True 254. Hallucinations are the most common form of perceptual disturbances among people with schizophrenia. Answer: True 255. Visual hallucinations are the most common type of hallucination in people with schizophrenia. Answer: False 256. Hallucinations may involve any of the five senses. Answer: True 257. Hallucinations are unique to people with schizophrenia. Answer: False 258. Hallucinations are occasionally experienced by people in the general population and are not necessarily a sign of psychopathology. Answer: True 259. Hallucinations in people without psychiatric conditions are often associated with high fevers and states of bereavement. Answer: True 260. Evidence shows that command hallucinations are linked to a higher risk of violent behavior. Answer: True 261. Drug-induced hallucinations tend to be auditory. Answer: False 262. Auditory hallucinations may be a form of inner speech. Answer: True 263. Disturbances in emotional response among people with schizophrenia are typified by exaggerated and inappropriate affect. Answer: False 264. The DSM-5 now recognizes catatonic schizophrenia as a new subtype of schizophrenia. Answer: False 265. While catatonia was recognized as a separate subtype of schizophrenia in previous versions of the diagnostic manual, it is now used in the DSM-5 as a type of specifier for further describing the psychiatric conditions in which it occurs. Answer: True 266. Disturbances of volition are most often seen in the acute phase of schizophrenia. Answer: False 267. Catatonic behaviors do not involve severely impaired cognitive and motor functioning. Answer: False 268. Some people with schizophrenia sustain unusual, uncomfortable positions for hours and will not respond to questions or communicate during these periods. Answer: True 269. Psychoanalysts have been able to demonstrate that certain early childhood experiences or family patterns predict schizophrenia. Answer: False 270. A 54-year-old hospitalized woman diagnosed with schizophrenia was conditioned to cling to a broom by being given cigarettes as reinforcers. Answer: True 271. It appears that family linkages in schizophrenia follow shared environments, not shared genes. Answer: False 272. If you have two biological parents with schizophrenia, it’s nearly certain that you will develop schizophrenia yourself. Answer: False 273. The mode of genetic transmission in schizophrenia remains unknown. Answer: True 274. Biological investigations of schizophrenia have focused primarily on the role of the neurotransmitter dopamine. Answer: True 275. People with schizophrenia show fewer than normal dopamine receptor sites in their brains. Answer: False 276. It appears that the brain of a schizophrenia patient has too much dopamine. Answer: False 277. It now appears that prenatal exposure to certain viruses may explain the vast majority of cases of schizophrenia. Answer: False 278. People with schizophrenia tend to have larger-than-normal ventricles in their brains. Answer: True 279. People with schizophrenia tend to have larger-than-normal frontal lobes. Answer: False 280. Evidence also points to abnormalities in brain circuitry connecting the prefrontal cortex to parts of the limbic system involved in regulating emotions and memory. Answer: True 281. In sum, evidence suggests that schizophrenia involves impairments in networks of neurons in different parts of the brain, rather than a defect or pathology in any one area. Answer: True 282. All people with schizophrenia have cold, overprotective mothers. Answer: False 283. Constant criticism from family members worsens symptoms in people with schizophrenia. Answer: True 284. Living in a family that is hostile, critical, and unsupportive can increase the risk of relapse in people with schizophrenia. Answer: True 285. The degree to which relatives perceive family members with schizophrenia as having control over their disorder may determine how they respond to them. Answer: True 286. There is solid research evidence that families are sometimes directly responsible for causing schizophrenia. Answer: False 287. What we now call schizophrenia may actually turn out to be more than one disorder. Answer: True 288. There is no cure for schizophrenia. Answer: True 289. Tardive dyskinesia is especially common among younger male patients treated for schizophrenia with antipsychotic drugs. Answer: False 290. Medications alone are usually enough to meet the treatment needs of people with schizophrenia. Answer: False 291. Drugs developed in the past few years not only treat schizophrenia but can cure it in many cases. Answer: False 292. Most people with schizophrenia who are discharged from long-term care facilities are successfully reintegrated into the community. Answer: False 293. Freud believed that traditional psychoanalysis was not well-suited to the treatment of schizophrenia. Answer: True 294. Reinforcement programs, such as token economies, foster adaptive behavioral changes only in the hospital settings in which they are administered. Answer: False 295. No single treatment approach meets all the needs of people with schizophrenia. Answer: True 296. Delusional disorders are relatively common. Answer: False 297. Men with erotomania are more likely than women with erotomania to become violent when their attentions are rebuffed. Answer: True 298. Erotomania is a delusion involving the person’s physical or medical condition. Answer: False 299. Both schizophrenia and schizoaffective disorder are chronic. Answer: True Essay Questions 300. Describe the DSM-5 changes made to the diagnostic criteria for schizophrenia. Answer: DSM-5 Changes to Schizophrenia Diagnostic Criteria: The DSM-5 made several important updates to the diagnostic criteria for schizophrenia to improve accuracy and reliability: 1. Symptom Requirements: • Two Symptoms Required: At least two of the following symptoms must be present for a significant portion of time during a one-month period (or less if successfully treated): delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms (e.g., diminished emotional expression or avolition). Previously, only one symptom was required if delusions were bizarre or hallucinations included a running commentary or two or more voices conversing. 2. Subtypes Removed: • Elimination of Subtypes: The DSM-IV subtypes of schizophrenia (paranoid, disorganized, catatonic, undifferentiated, and residual) were removed due to their limited diagnostic stability, low reliability, and poor validity. 3. Severity Rating: • Severity Scale: A dimensional approach was introduced, allowing clinicians to rate the severity of the core symptoms on a scale, providing a more nuanced understanding of the disorder. 4. Criteria Clarification: • Clarification: The diagnostic criteria were refined to emphasize that one of the symptoms must be either delusions, hallucinations, or disorganized speech, highlighting the importance of these core features. 301. Describe the various patterns in the course of schizophrenia, referring to the concepts of acute episode, prodromal phase, and residual phase. Answer: Patterns in the Course of Schizophrenia: 1. Acute Episode: • Description: This phase is characterized by a severe and sudden onset of psychotic symptoms, including delusions, hallucinations, disorganized speech, and behavior. • Impact: Individuals may experience significant distress and impairment in functioning, often requiring hospitalization or intensive treatment. 2. Prodromal Phase: • Description: The prodromal phase precedes the acute episode and involves subtle, gradual changes in behavior and functioning. Symptoms may include social withdrawal, decreased motivation, unusual thoughts or perceptual experiences, and cognitive difficulties. • Duration: This phase can last from weeks to years, with varying degrees of symptom severity and progression. 3. Residual Phase: • Description: Following an acute episode, the residual phase involves a reduction in the intensity of psychotic symptoms. Individuals may continue to experience some symptoms, particularly negative symptoms (e.g., reduced emotional expression, lack of motivation), and cognitive deficits. • Functioning: While there may be some improvement, individuals often continue to face challenges in daily functioning and may require ongoing treatment and support. 302. Describe the positive and negative symptoms of schizophrenia. Provide examples. Answer: Positive Symptoms: These symptoms reflect an excess or distortion of normal functions: 1. Delusions: Fixed, false beliefs that are resistant to reasoning or contrary evidence. Examples include persecutory delusions (belief that one is being plotted against) and grandiose delusions (belief that one has exceptional abilities or importance). 2. Hallucinations: Perceptions in the absence of external stimuli, often auditory (hearing voices) but can also be visual, tactile, or olfactory. 3. Disorganized Speech: Incoherent or illogical speech, often characterized by derailment (frequent topic shifts) or tangentiality (irrelevant responses). 4. Disorganized or Catatonic Behavior: Grossly disorganized behavior (e.g., unpredictable agitation, bizarre postures) or catatonia (motor immobility, excessive motor activity without purpose). Negative Symptoms: These symptoms reflect a reduction or loss of normal functions: 1. Affective Flattening: Diminished emotional expression, including facial expressions, voice tone, and gestures. 2. Avolition: Decreased motivation to initiate and sustain purposeful activities, leading to neglect of self-care and social activities. 3. Alogia: Reduced speech output or impoverished content of speech. 4. Anhedonia: Decreased ability to experience pleasure from previously enjoyed activities. 5. Asociality: Lack of interest in social interactions or relationships. 303. What are delusions? Describe types of delusions common to schizophrenia. Answer: Delusions: Delusions are fixed, false beliefs that are not grounded in reality and are resistant to evidence or reasoning. Common types of delusions in schizophrenia include: 1. Persecutory Delusions: Belief that one is being targeted, harassed, or conspired against by others. 2. Grandiose Delusions: Belief that one has exceptional abilities, wealth, fame, or a special relationship with a deity or famous person. 3. Referential Delusions: Belief that ordinary events, objects, or behaviors of others have particular and unusual significance directed at oneself (e.g., believing that newspaper articles or TV shows are specifically about them). 4. Erotomanic Delusions: Belief that another person, often someone of higher status, is in love with them. 5. Nihilistic Delusions: Belief that a major catastrophe will occur, or that one is dead or no longer exists. 6. Somatic Delusions: Belief that one has a physical defect or medical condition. 304. Discuss deficits in attention, referring to recent psychophysiological research. Answer: Deficits in Attention: Individuals with schizophrenia often experience significant deficits in attention, affecting their ability to focus, sustain, and shift attention as needed. Recent psychophysiological research has provided insights into these deficits: 1. Continuous Performance Tasks (CPT): • Research Findings: Studies using CPTs have shown that individuals with schizophrenia exhibit difficulties in maintaining attention over time, resulting in increased errors and decreased performance accuracy. • Implications: These deficits contribute to challenges in everyday functioning, such as completing tasks, following conversations, and maintaining employment. 2. Event-Related Potentials (ERPs): • P300 Component: Reduced amplitude of the P300 wave, an ERP component associated with attention and information processing, has been observed in individuals with schizophrenia. This suggests impaired cognitive processing and attention allocation. • N2 Component: Alterations in the N2 wave, related to conflict monitoring and cognitive control, indicate difficulties in filtering out irrelevant stimuli and responding to important information. 3. Eye-Tracking Studies: • Findings: Abnormalities in smooth pursuit eye movements and saccadic eye movements have been found in individuals with schizophrenia, reflecting deficits in visual attention and tracking. • Implications: These deficits affect the ability to smoothly follow moving objects or maintain gaze on a target, impacting daily activities such as reading or driving. 4. Functional Neuroimaging: • Brain Regions: Neuroimaging studies have identified reduced activation in the prefrontal cortex and other brain regions involved in attention and executive functions in individuals with schizophrenia. • Implications: These findings support the notion that attentional deficits in schizophrenia are linked to underlying neural dysfunctions, particularly in areas critical for cognitive control and attention regulation. Conclusion: Deficits in attention are a core feature of schizophrenia, impacting various aspects of cognitive and daily functioning. Understanding these deficits through psychophysiological research can inform the development of targeted interventions aimed at improving attention and cognitive performance in individuals with schizophrenia. 305. Summarize the findings in the research evaluating eye movement dysfunction and schizophrenia. Answer: Research on Eye Movement Dysfunction and Schizophrenia Findings in Eye Movement Dysfunction: Research evaluating eye movement dysfunction in individuals with schizophrenia has consistently found several abnormalities: 1. Smooth Pursuit Eye Movements: • Impairment: Individuals with schizophrenia often exhibit impaired smooth pursuit eye movements, which is the ability to smoothly follow a moving target with their eyes. • Findings: Studies show reduced gain (eye velocity relative to target velocity) and increased saccadic intrusions (jerky eye movements) during smooth pursuit tasks. 2. Saccadic Eye Movements: • Increased Errors: Schizophrenic individuals often make more errors in tasks requiring saccadic eye movements, such as antisaccade tasks, where they need to look away from a visual stimulus. • Latency: Increased latency (delay) in initiating saccadic movements has been observed. 3. Visual Fixation: • Instability: People with schizophrenia show difficulties in maintaining stable visual fixation, often displaying small, involuntary eye movements (micro-saccades). 4. Neurophysiological Correlates: • Brain Regions: Abnormalities in eye movement are linked to dysfunctions in brain regions responsible for motor control and visual processing, particularly the prefrontal cortex, cerebellum, and superior colliculus. Implications: • Diagnostic Potential: Eye movement dysfunctions are considered potential biomarkers for schizophrenia due to their high sensitivity and specificity. • Cognitive Deficits: These dysfunctions are related to broader cognitive deficits in attention, executive function, and sensory processing, common in schizophrenia. 306. What has been revealed about through the research on evoked rate potentials (ERPs) and schizophrenia? Answer: Research on Evoked Response Potentials (ERPs) and Schizophrenia Findings on ERPs: Research on evoked response potentials (ERPs) has revealed several key insights into the cognitive and neural dysfunctions in schizophrenia: 1. P300 Component: • Reduction: Individuals with schizophrenia typically show a reduction in the amplitude of the P300 wave, which is associated with attention and the processing of salient stimuli. • Implications: This reduction indicates deficits in attention allocation and information processing. 2. N2 Component: • Alterations: Abnormalities in the N2 component, which is related to conflict detection and cognitive control, are often observed. • Implications: This suggests difficulties in filtering out irrelevant information and managing cognitive control processes. 3. Mismatch Negativity (MMN): • Diminished Response: Schizophrenic individuals show a diminished MMN response, which reflects automatic detection of changes in auditory stimuli. • Implications: This indicates impairments in pre-attentive sensory processing and auditory discrimination. 4. P50 Suppression: • Reduced Suppression: Schizophrenia is associated with reduced P50 suppression, reflecting deficits in sensory gating—the ability to filter out repetitive or irrelevant stimuli. • Implications: This contributes to sensory overload and cognitive fragmentation experienced by individuals with schizophrenia. Implications: • Cognitive Deficits: ERP abnormalities highlight specific cognitive deficits in attention, sensory processing, and executive function. • Neural Mechanisms: These findings provide insights into the underlying neural mechanisms of schizophrenia and potential targets for therapeutic interventions. 307. Describe the types of hallucinations typically experienced by someone with schizophrenia. How do schizophrenic hallucinations differ from drug-induced hallucinations? What other psychological disorders can have hallucinations present? Answer: Types of Hallucinations in Schizophrenia and Comparisons Types of Hallucinations in Schizophrenia: 1. Auditory Hallucinations: • Description: Hearing voices or sounds that are not present. Voices may be critical, commanding, or conversing with the individual. • Prevalence: Most common type of hallucination in schizophrenia. 2. Visual Hallucinations: • Description: Seeing things that are not there, such as people, shapes, or lights. • Prevalence: Less common than auditory hallucinations. 3. Tactile Hallucinations: • Description: Feeling sensations on the skin, such as bugs crawling or being touched. • Prevalence: Relatively rare. 4. Olfactory and Gustatory Hallucinations: • Description: Smelling odors or tasting flavors that are not present. • Prevalence: Rare and often associated with more severe cases. Schizophrenic vs. Drug-Induced Hallucinations: • Duration and Content: Schizophrenic hallucinations tend to be chronic and related to the disorder’s themes (e.g., persecution). Drug-induced hallucinations are typically acute, vivid, and often bizarre or colorful. • Context: Drug-induced hallucinations occur in the context of substance use and may include altered states of consciousness, whereas schizophrenic hallucinations are more likely to be consistent and pervasive. Other Psychological Disorders with Hallucinations: 1. Bipolar Disorder: During manic or depressive episodes, individuals may experience auditory or visual hallucinations. 2. Major Depressive Disorder with Psychotic Features: Severe depression can include hallucinations, often congruent with depressive themes (e.g., guilt, worthlessness). 3. Post-Traumatic Stress Disorder (PTSD): Flashbacks can include hallucinatory experiences, often related to traumatic events. 4. Substance Use Disorders: Hallucinations can occur during intoxication or withdrawal from substances like alcohol, cocaine, or hallucinogens. 5. Delirium: Acute confusional states can include hallucinations, often visual or tactile. 308. What may be the cause of auditory hallucinations for individuals with schizophrenia? Discuss the role of internal speech. Answer: Cause of Auditory Hallucinations in Schizophrenia and Role of Internal Speech Causes of Auditory Hallucinations: • Dysfunctional Brain Activity: Research suggests that auditory hallucinations in schizophrenia are linked to abnormal activity in the brain’s auditory cortex and related networks. • Neurotransmitter Imbalances: Imbalances in dopamine and glutamate systems may contribute to the generation of hallucinations. Role of Internal Speech: • Internal Speech Misattribution: Auditory hallucinations may result from the misattribution of internally generated thoughts or self-talk to external sources. Individuals with schizophrenia might have difficulty distinguishing between their own internal dialogue and external voices. • Auditory Cortex Activation: Neuroimaging studies show that areas of the brain involved in processing external speech are activated during auditory hallucinations, supporting the idea that these experiences are perceived as real. • Cognitive Mechanisms: Deficits in self-monitoring and reality testing, common in schizophrenia, may lead to the erroneous perception of internal thoughts as external auditory phenomena. Conclusion: Understanding the causes and mechanisms of auditory hallucinations in schizophrenia, particularly the role of internal speech, can inform therapeutic approaches aimed at improving reality testing and cognitive control, thereby reducing the frequency and impact of these hallucinations on individuals’ lives. 309. Summarize the criticisms of Freud’s hypothesis about the origins of schizophrenia. Answer: Freud's hypothesis about the origins of schizophrenia, which he described as stemming from unresolved conflicts and early childhood trauma, has faced significant criticism over the years. Critics argue that Freud's psychoanalytic theory lacks empirical support and is based on speculative assumptions rather than scientific evidence. Key criticisms include: 1. Lack of Empirical Evidence: Freud's ideas are primarily theoretical and not supported by empirical research. Modern studies have not found consistent evidence linking early childhood trauma or repressed conflicts directly to the development of schizophrenia. 2. Biological Factors Overlooked: Freud's hypothesis largely ignores the biological and genetic factors that have been shown to play a significant role in schizophrenia. Advances in neuroscience and genetics have highlighted the importance of these factors in the disorder's etiology. 3. Reductionist Approach: Critics argue that Freud's hypothesis is overly reductionist, simplifying the complex interplay of genetic, environmental, and neurobiological factors into a single psychodynamic framework. This oversimplification fails to capture the multifaceted nature of schizophrenia. 4. Lack of Treatment Efficacy: Psychoanalytic therapies based on Freud's theories have not demonstrated effectiveness in treating schizophrenia. In contrast, pharmacological treatments and evidence-based psychosocial interventions have shown more promise in managing the symptoms and improving the quality of life for individuals with schizophrenia. Overall, the shift towards more scientifically grounded explanations has led to a decline in the acceptance of Freud's hypothesis regarding the origins of schizophrenia. 310. Summarize the evidence for a genetic factor in schizophrenia coming from twin studies’ concordance rates. Answer: Twin studies have been instrumental in understanding the genetic component of schizophrenia. Concordance rates, which measure the likelihood that both twins in a pair will develop schizophrenia if one twin has the disorder, provide compelling evidence for a genetic factor: 1. Higher Concordance in Monozygotic Twins: Monozygotic (MZ) twins, who share 100% of their genetic material, have significantly higher concordance rates for schizophrenia compared to dizygotic (DZ) twins, who share about 50% of their genes. Studies have shown concordance rates of around 40-50% for MZ twins, while DZ twins have concordance rates of approximately 10-15%. 2. Genetic Contribution: The substantial difference in concordance rates between MZ and DZ twins strongly suggests a genetic contribution to the risk of developing schizophrenia. If schizophrenia were solely due to environmental factors, the concordance rates for MZ and DZ twins would be similar. 3. Heritability Estimates: Twin studies have also been used to estimate the heritability of schizophrenia, which is the proportion of variance in liability to the disorder attributable to genetic factors. Estimates of heritability for schizophrenia are typically high, around 70-80%, indicating a strong genetic influence. 4. Environmental Interactions: While the genetic component is significant, the fact that concordance rates for MZ twins are not 100% indicates that environmental factors and gene-environment interactions also play a critical role in the development of schizophrenia. These findings from twin studies underscore the importance of genetic factors in schizophrenia, while also acknowledging the influence of environmental and other non-genetic factors. 311. Identify and describe various protective and vulnerability factors for children at high risk of developing schizophrenia. Answer: Protective and Vulnerability Factors for Children at High Risk of Developing Schizophrenia Children at high risk of developing schizophrenia can be influenced by a variety of protective and vulnerability factors. Understanding these factors can help in designing preventive interventions and support systems. Vulnerability Factors: 1. Genetic Predisposition: A family history of schizophrenia or other psychotic disorders increases the risk, with first-degree relatives of individuals with schizophrenia being more susceptible. 2. Prenatal and Perinatal Complications: Adverse events during pregnancy or birth, such as maternal malnutrition, infections, stress, or complications during delivery, can increase the risk. 3. Environmental Stressors: Exposure to significant stressors, such as trauma, abuse, neglect, or severe social adversity during childhood, can heighten vulnerability. 4. Substance Abuse: Early use of psychoactive substances, particularly cannabis, has been associated with an increased risk of developing schizophrenia later in life. 5. Neurodevelopmental Abnormalities: Early signs of neurodevelopmental issues, such as motor or cognitive delays, can be indicative of a higher risk for schizophrenia. Protective Factors: 1. Supportive Family Environment: A stable, nurturing, and supportive family environment can mitigate the impact of genetic and environmental risk factors. 2. Early Intervention: Access to mental health services and early intervention programs can help address early symptoms or risk factors before they develop into full-blown schizophrenia. 3. Good Coping Mechanisms: Teaching and fostering effective coping strategies and resilience can help children manage stress and reduce the likelihood of developing schizophrenia. 4. Positive Social Relationships: Strong social support networks and positive relationships with peers and mentors can provide emotional support and stability. 5. Healthy Lifestyle: Encouraging a healthy lifestyle, including proper nutrition, regular physical activity, and avoidance of substance abuse, can contribute to overall mental well-being and reduce risk factors. Understanding and addressing these factors can play a crucial role in preventing the onset of schizophrenia in high-risk children and promoting their long-term mental health. 312. Discuss evidence for the diathesis-stress model of schizophrenia. Answer: Evidence for the Diathesis-Stress Model of Schizophrenia The diathesis-stress model posits that schizophrenia results from the interaction between a predispositional vulnerability (diathesis) and environmental stressors. Evidence supporting this model includes: 1. Genetic Predisposition: Studies consistently show that genetic factors significantly contribute to the risk of developing schizophrenia. Twin studies, family studies, and adoption studies all indicate a higher prevalence of schizophrenia among individuals with a family history of the disorder, suggesting a genetic diathesis. 2. Prenatal and Perinatal Stressors: Adverse conditions during pregnancy and birth, such as maternal malnutrition, infections, and birth complications, have been linked to a higher risk of schizophrenia. These factors can act as early environmental stressors that interact with genetic vulnerabilities. 3. Childhood Trauma: Evidence indicates that individuals who experience trauma or severe stress during childhood, such as abuse or neglect, have a higher likelihood of developing schizophrenia. This supports the idea that early life stress can trigger the onset of the disorder in those with a predisposition. 4. Cannabis Use: Research shows that cannabis use, particularly during adolescence, is associated with an increased risk of developing schizophrenia, especially in individuals with a genetic predisposition. This highlights how environmental factors like substance use can interact with genetic vulnerability. 5. Urbanicity: Higher rates of schizophrenia have been observed in urban environments compared to rural areas. The increased stress associated with urban living, including social fragmentation and environmental stressors, can exacerbate the risk in genetically predisposed individuals. 6. Epigenetic Changes: Studies suggest that environmental stressors can lead to epigenetic changes that affect gene expression related to schizophrenia. These changes may mediate the interaction between genetic predisposition and environmental stress. Together, these findings support the diathesis-stress model by illustrating how genetic vulnerability and environmental stressors interact to increase the risk of schizophrenia. 313. Discuss research concerning the effects and side effects of antipsychotic medication. Answer: Research Concerning the Effects and Side Effects of Antipsychotic Medication Antipsychotic medications are a cornerstone in the treatment of schizophrenia, aimed at reducing symptoms such as hallucinations, delusions, and thought disorders. Research has focused on their efficacy and associated side effects. Effects: 1. Symptom Reduction: Antipsychotics, particularly second-generation or atypical antipsychotics (e.g., risperidone, olanzapine, quetiapine), are effective in reducing positive symptoms of schizophrenia. These medications help patients manage hallucinations and delusions. 2. Relapse Prevention: Maintenance therapy with antipsychotics reduces the risk of relapse in patients with schizophrenia. Long-term adherence to medication can help maintain symptom control and prevent acute episodes. 3. Improved Quality of Life: Effective symptom management through antipsychotics can improve the overall quality of life for patients, enabling better social functioning and daily living. Side Effects: 1. Extrapyramidal Symptoms (EPS): First-generation or typical antipsychotics (e.g., haloperidol, chlorpromazine) are associated with EPS, including tremors, rigidity, bradykinesia, and tardive dyskinesia. Atypical antipsychotics have a lower risk of EPS but are not free from these side effects. 2. Metabolic Syndrome: Atypical antipsychotics are linked to metabolic side effects, such as weight gain, diabetes, and dyslipidemia. These side effects increase the risk of cardiovascular diseases. 3. Sedation: Many antipsychotics can cause sedation, which may interfere with daily functioning and adherence to medication. 4. Prolactin Elevation: Some antipsychotics, like risperidone, can increase prolactin levels, leading to side effects such as galactorrhea, gynecomastia, and sexual dysfunction. 5. Cardiovascular Risks: Antipsychotics can prolong the QT interval, increasing the risk of cardiac arrhythmias and sudden cardiac death. Efforts to balance efficacy with side effect management continue, with ongoing research into new antipsychotic drugs that minimize adverse effects while maintaining therapeutic benefits. 314. What is tardive dyskinesia and what efforts have been made to control it? Answer: Tardive Dyskinesia and Efforts to Control It Tardive dyskinesia (TD) is a serious and often irreversible side effect of long-term use of antipsychotic medications, characterized by repetitive, involuntary movements, particularly of the face, lips, and tongue, as well as limbs and trunk. Efforts to control TD include: 1. Medication Adjustments: Reducing the dose of the offending antipsychotic or switching to an atypical antipsychotic with a lower risk of TD can sometimes reduce symptoms. 2. Discontinuation: In some cases, discontinuing the antipsychotic medication can lead to improvement, though this is not always possible due to the need for ongoing treatment of schizophrenia. 3. Use of Medications Specifically for TD: Two drugs, valbenazine (Ingrezza) and deutetrabenazine (Austedo), have been approved for the treatment of TD. These medications work by inhibiting vesicular monoamine transporter 2 (VMAT2), reducing the severity of involuntary movements. 4. Regular Monitoring: Routine monitoring for early signs of TD in patients on long-term antipsychotic therapy can lead to earlier intervention and management. 5. Non-Pharmacological Interventions: Behavioral interventions, physical therapy, and supportive therapies can help manage symptoms and improve quality of life for individuals with TD. Ongoing research is focused on understanding the mechanisms underlying TD and developing new treatments to prevent or mitigate this debilitating side effect. 315. Discuss biological, psychodynamic, learning-based, psychosocial-rehabilitation, and family intervention treatments of schizophrenia. Answer: Treatments of Schizophrenia Schizophrenia treatment involves a multifaceted approach, incorporating biological, psychodynamic, learning-based, psychosocial-rehabilitation, and family intervention strategies. Biological Treatments: 1. Antipsychotic Medications: As discussed, these are the primary treatment for managing symptoms of schizophrenia. They include both first-generation and second-generation antipsychotics. 2. Electroconvulsive Therapy (ECT): Used in severe cases or when medications are ineffective, ECT can help reduce symptoms by inducing controlled seizures. Psychodynamic Treatments: 1. Psychoanalysis: Historically used but now less common, psychoanalysis aimed to explore unconscious conflicts and traumas. It is generally considered less effective for schizophrenia due to the disorder's nature. 2. Supportive Psychotherapy: Focuses on providing emotional support, improving self-esteem, and helping patients manage daily life and social relationships. Learning-Based Treatments: 1. Cognitive Behavioral Therapy (CBT): CBT helps patients challenge and change distorted thoughts and behaviors. It can be effective in reducing residual symptoms and preventing relapse. 2. Behavioral Therapy: Techniques such as token economies and social skills training can improve daily functioning and social interactions. Psychosocial-Rehabilitation Treatments: 1. Vocational Training: Helps individuals with schizophrenia gain skills and find employment, improving their social integration and quality of life. 2. Social Skills Training: Focuses on enhancing interpersonal skills and communication, crucial for daily interactions and relationships. 3. Assertive Community Treatment (ACT): Provides comprehensive, community-based psychiatric treatment, rehabilitation, and support to individuals with severe mental illness. Family Intervention Treatments: 1. Psychoeducation: Educating family members about schizophrenia, its symptoms, treatment options, and coping strategies can reduce stress and improve outcomes. 2. Family Therapy: Involves the whole family in treatment, addressing dynamics that may contribute to the patient's condition and providing support for all members. 3. Support Groups: Family support groups offer a platform for sharing experiences and gaining insights from others in similar situations. Integrating these diverse treatment approaches can provide comprehensive care for individuals with schizophrenia, addressing the disorder's multifaceted nature and improving overall outcomes. 316. Detail the differences in criteria in the diagnoses of schizophrenia, brief psychotic disorder, and schizophreniform disorder. Answer: Differences in Criteria for Diagnoses of Schizophrenia, Brief Psychotic Disorder, and Schizophreniform Disorder Schizophrenia, brief psychotic disorder, and schizophreniform disorder are all part of the schizophrenia spectrum and other psychotic disorders, but they differ in terms of duration, symptomatology, and functional impairment. Schizophrenia: 1. Duration: Symptoms must be present for at least six months, with at least one month of active-phase symptoms (hallucinations, delusions, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms). 2. Symptoms: Requires two or more of the following symptoms, with at least one being from the first three: • Delusions • Hallucinations • Disorganized speech • Grossly disorganized or catatonic behavior • Negative symptoms (e.g., diminished emotional expression, avolition) 3. Functional Impairment: Significant impairment in one or more major areas of functioning (e.g., work, interpersonal relations, or self-care). Brief Psychotic Disorder: 1. Duration: Symptoms last for at least one day but less than one month, with eventual full return to premorbid level of functioning. 2. Symptoms: Presence of one or more of the following symptoms, with at least one being from the first three: • Delusions • Hallucinations • Disorganized speech • Grossly disorganized or catatonic behavior 3. Functional Impairment: May or may not be present, but the episode is typically brief and resolves fully. Schizophreniform Disorder: 1. Duration: Symptoms last for more than one month but less than six months. 2. Symptoms: Requires two or more of the following symptoms, with at least one being from the first three: • Delusions • Hallucinations • Disorganized speech • Grossly disorganized or catatonic behavior • Negative symptoms 3. Functional Impairment: Impairment is not required for diagnosis, but it may be present. If symptoms persist beyond six months, the diagnosis is revised to schizophrenia. In summary, the primary distinctions between these disorders are the duration of symptoms and the requirement for functional impairment in schizophrenia. 317. Discuss the features of delusional disorder and describe the subtypes. Answer: Features of Delusional Disorder: Delusional disorder is characterized by the presence of one or more delusions for at least one month. Unlike schizophrenia, delusional disorder does not significantly impair other areas of functioning, and apart from the delusions, behavior is not markedly odd or bizarre. The disorder does not include prominent hallucinations, disorganized speech, or negative symptoms as seen in schizophrenia. Subtypes of Delusional Disorder: 1. Erotomanic Type: The individual believes that another person, often someone of higher status, is in love with them. 2. Grandiose Type: The individual has an over-inflated sense of worth, power, knowledge, or identity. They may believe they have a special relationship with a deity or a famous person. 3. Jealous Type: The individual believes that their partner is unfaithful without any real proof. 4. Persecutory Type: The individual believes that they are being conspired against, cheated, spied on, followed, poisoned, or harassed. 5. Somatic Type: The individual believes they have a physical defect or medical condition. 6. Mixed Type: Delusions characteristic of more than one of the above types, but no one theme predominates. 7. Unspecified Type: The dominant delusional belief cannot be clearly determined or does not fit the specific types listed above. 318. How do schizoaffective disorder and schizophrenia differ? Discuss the role of affect in the distinction between the two disorders. Answer: Differences Between Schizoaffective Disorder and Schizophrenia Schizoaffective Disorder: 1. Symptoms: The individual experiences symptoms of both schizophrenia and mood disorder (either bipolar type with manic or mixed episodes, or depressive type with major depressive episodes). 2. Duration: There must be a period where there are delusions or hallucinations for at least two weeks in the absence of a major mood episode (depressive or manic). 3. Mood Episodes: Mood episodes are prominent and concurrent with the symptoms of schizophrenia for a substantial portion of the illness. 4. Functional Impairment: Functional impairment can occur, but the mood component distinguishes it from schizophrenia. Schizophrenia: 1. Symptoms: Characterized by delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms. 2. Duration: Symptoms persist for at least six months, with at least one month of active-phase symptoms. 3. Mood Symptoms: Mood symptoms, if present, are brief relative to the duration of psychotic symptoms and are not a predominant feature. 4. Functional Impairment: Significant impairment in functioning is required. Role of Affect in Distinction: The key difference between schizoaffective disorder and schizophrenia lies in the prominence and duration of mood symptoms. In schizoaffective disorder, mood episodes are a central feature and are present for a significant portion of the illness, while in schizophrenia, mood symptoms are either absent or are not a major feature. The presence of mood symptoms without accompanying psychotic symptoms for at least two weeks is crucial for distinguishing schizoaffective disorder from schizophrenia. Test Bank for Abnormal Psychology in a Changing World Jeffrey S. Nevid, Spencer A. Rathus, Beverly Greene 9780205965014, 9780135821688, 9780134458311, 9780205961719, 9780130052162

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CH-11 Schizophrenia Spectrum Disorders – Abnormal Psychology in a Changing World : Exam Guide

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