1.Which of the following statements is TRUE?

A.You only need to reach criteria for hypomania to get a

diagnosis for Bipolar I
B.People with bipolar disorders are usually treated using
lithium and carbamazepine
C. Bipolar disorders are chronic all through out different
ages
D. None of the Above is TRUE
2. A person who has premenstrual dysphoric disorder is someone
who…

A.Would show increased irritability and heightened interpersonal

conflict during the luteal phase
B. Would have worse symptoms after the onset of the menses and
has increased emotional instability as the weeks go by
C.Would experience manic episodes during the time of menses
D.Would have delusions around the follicular phase of menses
3. In order to get a specifier of rapid cycling, you must have:

A. At least 5 episodes of Mania and 4 Major depressive episodes

within 6 months
B. At least 4 episodes of either manic or depressive states within a
year
C. At least 3 episodes of Mania and 2 Major depressive episodes
within a year
D. At least 2 episodes of either mania or depressive states within a
month
4. Tyrus experienced manic and depressive episodes which
seemingly was “non-stop”. He would often experience pure manic
episodes right after depressive episodes and vice versa. This
ofcourse causes severe distress on his part. On top of that, he also
sees and hears things which aren't even there. Tyrus might be said
to have ____________ and when diagnosed, he should be given a
specifier of _______________.

A. Rapid switching: w/ atypical features

B. Chronic switching: w/ melancholic features
C. Chronic switching: w/ mixed features
D. Rapid switching : w/ psychotic features
5. Manic episodes are often a neurotransmitter imbalance
of...

A. Low serotonin, Low epenephrine

B. High serotonin, Low Acetylcholine
C. Low serotonin, High norepenephrine
D. High serotonin, High dopamine
 SCHIZOPHRENIA
SPECTRUM AND
OTHER PSYCHOTIC
DISORDERS
◦Delusional Disorder
◦Brief Psychotic Disorder
◦Schizophreniform
◦Schizophrenia
◦Schizoaffective Disorder
Causes
◦ Biological causes:
◦ Very high levels of dopamine (dopamine hypothesis),
overstimulation of dopamine-2 receptors in the striatum
(associated w/ movement), deficiency in d-1 prefrontal
receptors (associated w. thinking and reasoning), and
deficiencies in glutamate

◦ Enlarged ventricles (cavities containint cerebrospinal fluid)-

may be taken as a sign that other nearby brain parts have been
damaged or underdeveloped (e.g. temporal and frontal lobes,
smaller white and grey matter, hypo/hyperfrontality)

◦ Prenatal exposure to influenza

◦ Psychological Causes:
◦ Psychodynamic perspective-
Schizophrenia is a regression to a pre-
ego stage (primary narcissism) and an
effort to re-establish ego control

◦ Another perspective by Reichmann:

cold, domineering, and unnurturing
parents may set the stage for the
development of schizophrenia (i.e.
schizophrenogenic mothers). Conflicting
messages from caregivers may also be a
factor (double blind communication)
◦Behavioral Perspective:
◦Unreinforced social cues needed for healthy
development, thus, a refocusing to irrelevant
cues (e.g. brightness of the room, sounds of
the words rather than the words themselves,
etc.) leading to bizarre behavior.
◦Cognitive Perspective:
◦ During hallucinations and other
perceptual distortions (due to biological
causes), people's attempts at trying to
understand these experiences through
asking family members leads to a denial
of this reality and feelings of being
rejected.

◦These leads to development of

incorrect and bizarre conclusions
(delusions)
Other multicultural, social and family
perspectives...
◦ Those with poorer economic spheres
(e.g. african americans, hispanics)
are more likely to be diagnosed w/
schizophrenia than others (e.g. white
americans)

◦ Patients from developing countries

are more likely to recover than those
located in developed countries. This
might indicate differences in
psychosocial environments
◦ Those who do not conform to social
norms of behavior are labeled as
schizophrenic w/c then becomes a
self-fulfilling prophecy

◦ Family characteristics (e.g. high

conflict environments leading to stress,
no proper communication, critical and
overinvolved parents) and high
expressed emotion is associated
with schizophrenia.
5 key Features
◦Delusions
◦Hallucinations
◦Disorganized thinking (as inferred from speech)
◦Grossly disorganized or abnormal motor behavior
(including catatonia)
◦Negative Symptoms
Delusions
◦ Fixed beliefs that are not amenable to change even when
conflicting evidence is presented:
 Persecutory
 Referential
 Grandiose
 Erotomanic
 Nihilistic
 Somatic
 Thought Withdrawal
 Thought Insertion
 Delusions of Control
Hallucinations
◦ Perception-like experiences that occur without an external
stimulus.

◦ Vivid and clear, with the full force and impact of normal
perceptions, and not under voluntary control

◦Auditory hallucinations are most common among

patients with schizophrenia
 Disorganized Thinking (as inferred from
speech)
◦ Derailment/Loose Association
◦ Tangentiality
◦ Incoherence/ Word Salad
◦ Circumstantiality
◦ Neologisms
◦ Thought Blocking
◦ Perseveration
 the symptom must be severe enough to substantially impair
effective communication
Grossly Disorganized Behavior
(Including Catatonia)
◦ May manifest from childlike “silliness” to unpredictable agitation.

◦ Catatonic Behavior- a marked decrease in reactivity to the environment

 resistance to instructions (negativism)
 maintaining rigid, inappropriate or bizarre posture
 complete lack of verbal or motor response (mutism and stupor)
 purposeless or excessive motor activity (catatonic excitement)
 Negative Symptoms
◦Diminished emotional expression
◦ Avolition- decreased motivated, self-initiated purposeful
activities
◦ Alogia- diminished speech output
◦ Anhedonia- decreased ability to experience pleasure from
positive stimuli
◦ Asociality- lack of interest in social interaction

Brief Psychotic
Disorder- at least
1 day to 1 month. More
One or more with than a
at least one month
being 1-3: Del,
Hal, Dis Sp, GDB
Delusions
only?
Delusional Disorder
– at least 1 month
of delusion/s but no
other psychotic
symptoms.
Functioning not
markedly impaired
Schizophreniform-
during 1 month (or
less if treated) to More
less than 6 months. than 6
Two or more with at months
least one being 1-3:
Del, Hal, Dis Sp,
GDB, Nega Symp.
Impaired social and
occupational
functioning Not
Required
Schizophrenia- Two or
more with at least one
being 1-3: Del, Hal, Dis
Sp, GDB, Nega Symp.
Functioning in one or
more major areas
(work, interpersonal
rel., etc.) below the
level achieved prior to
the onset
Experiencing
major mood
episodes?
Schizoaffective
Disorder- having major
mood episodes (major
depressive or manic)
concurrent with
criterion A of
schizophrenia
Treatment
◦Psychosurgery (prefrontal lobotomies) and Electro-
Convulsive therapy

◦Neuroleptics/Antipsychotics (e.g. risperidone and

olanzapine). May have extrapyramidal effects like
parkinsonian symptoms such as akinesia (expresionless,
slow motor activity, monotone speech), tardive
dyskinesia (tic-like movements of tongue, mouth, face or
whole body; involuntary chewing, sucking and
lipsmacking, jerky movements and movement difficulties)
 Milieu Therapy
◦ Institutions cannot be of help unless the social climate
(a.k.a. milieu) promotes productive activity, self-respect,
and individual responsibility

◦ Residents (a.k.a. patients) participated in community

government, worked with staff members to establish
rules and determine sanctions. Residents also took on
special projects, jobs, and recreational activities
◦ Transcranial Magnetic Stimulation-
reduces hallucinations by
generating magnetic fields
that pass through the skull to
the brain

◦ Token Economy- a behaviorist

approach where “tokens” are
given when the patients
behave acceptably and are
not rewarded when doing
unacceptable behaviors
Cognitive-Behavioral Therapy
◦ Psychoeducate about biological cause of hallucinations
◦ Help clients learn that their hallucinations and delusions come
and go. Help identify situations/events w/c trigger these.
◦ Changing perceptions about hallucinations and delusions;
making clients realize that they are harmless
◦ Clients are taught how to reattribute and accurately interpret
these symptoms
◦ Teaching clients to cope w/ these symptoms through different
techniques (e.g. distraction/refocusing, relaxation, positive self-
statements)
◦Some are engaged in what is called acceptance and
commitment therapy
◦Family Therapy- Psychoeducate family members,
reduce expressed emotions and reduce troublesome
interactions. Increase empathy and support provided by
the family
END :)