Question 1: Answer:
First, what are considered negative symptoms: These symptoms are relatively enduring, are much more resistant to treatment, and underlie much of chronic disability in patients with schizophrenia. Negative symptoms are the absence or insufficiency of normal behaviour and include:
            – Affective flattening
            – Avolition/Apathy
            – Anhedonia
            – Asociality
            – Attentional impairment

Second, three recently developed alternative therapy methods that could be used in conjunction with neuroleptic drugs to treat these negative symptoms as discussed in presentation 1 include:
            (1) Music therapy – Patients discuss the music with their therapist and about how the
            music makes them feel which facilitates emotional expressiveness, verbalization of
            feelings and thoughts, improves cognitive development, and develops better coping
            skills..
            – Improves symptoms of alogia, avolition, anhedonia, and attention by focusing on
            creative expression and cultural appropriateness.
            – Leads to better interpersonal functioning in the future.
            (2) Drama therapy – combines traditional psychotherapy with experimentation in role-
            playing, taking on a character; being in the shoes of another.
            – Promotes emotional expressiveness, creativity, imagination, and everything that may be
            blunted by drugs.
            – Patients experience more security in expressing themselves and are more compliant
            with therap.
            – Treats anhedonia, avolition, asociality, and improves social functioning.
            (3) Animal-assisted therapy – twice every week the therapist brings an animal for the
            patient to care for throughout the session.
            – Facilitates emotional expressiveness, encourages development of social bonds, teaches
            the patient to care for self and others, and motivates the patient to come to therapy
            sessions.
            – Improves social functioning and self-care.
Question 2:
Jenna is a patient in a psychiatric ward who suffers from schizophrenia. She displays lack of will to do anything but lay in her bed all day sitting face-up with all four limbs pointing straight in the air. She rarely washes and does not have any form of self-care routine. She also expresses florid delusions and auditory hallucinations, none of which seem to be linked to each other. Throughout the day, she will alternate between periods of stupor and then sudden bursts of excitement in which she will insist on running around the room and tapping her head and rubbing her belly; if you ask her to stop she will not and increase the intensity of her activity. She is able to answer questions clearly and directly, but refuses to expand on her answers, lacking the will to go any further in explanation. She has experienced 3 acute psychotic episodes with signs of deterioration becoming worse after each and recently her deterioration has become so severe she cannot function outside the psychiatric hospital. Which of the 4 subtypes of schizophrenia discussed in class would Jenna belong to given the clinical picture described above?
            (a) Paranoid
            (b) Hebephrenic (Disorganized)
            (c) Catatonic
            (d) Simple

Question 2: Answer:
The answer would be (c) Catatonic. The catatonic schizophrenic subtype is characterized by bizarre behaviour, multiple motor abnormalities (posturing, mannerisms, immobility, stereotypies), extreme avolition, self-neglect, and individuals who fall in this category usually cannot live outside of the hospital. First, although there may be florid delusions and hallucinations, they are not pervasively held and do not string together in any coherent fashion, as in the paranoid sub-type. Second, although she is disorganized in her delusions, she displays no formal thought disorder, and can explain herself quite clearly, which rules out the hebephrenic subtype which holds at the forefront formal thought disorder and poverty in speech. Finally, Simple schizophrenia rarely progresses to severe deterioration, as Jenna has come to experience, and usually is not associated with florid symptoms so much as changed personality, narrowing interest, and blunted forms of schizophrenic symptoms.

d) Changes in personality

A: b

Though the term “dementia” is commonly associated with Alzheimer’s and memory loss, memory loss is not a symptom of FTD in the early stages of the disease. However, people with FTD often demonstrate attention difficulties. This could affect the processing of information and may be mistaken for memory loss. Social disinhibition, hyperorality and personality changes are all characteristic of FTD.

2. Q: A patient with Hebephrenic (Disorganized) Schizophrenia will likely:

a) Experience remission and recurrence of symptoms throughout the course of the disorder.

b) Commit bizarre acts and demonstrate self neglect.

c) Experience severe hallucinations.

d) Experience numerous ill-formed delusions.

A: d

Remission and recurrence are characteristic of paranoid schizophrenia. People with Hebephrenic Schizophrenia are more likely to experience a smooth progression and deterioration. Bizarre acts and self neglect are commonly seen in people with catatonic schizophrenia.  Severe hallucinations are more common in catatonic and paranoid schizophrenia.

a)      homogeneous/schizophrenia

b)      dangerous/Parkinson’s

c)      heterogeneous/schizophrenia

d)      homogeneous/Parkinson’s

2) No active symptoms, no signs of deterioration, no vocational impairment, no or minimal social impairment and ____________________ are all characteristics of ____________________ when discussing schizophrenia.

a)      only one episode of illness/complete recovery

b)      only one episode of illness/improved recovery

c)      more than one episode of illness/complete recovery

d)      only one episode or illness/unimproved or worse recovery

1. Increase drug addiction
2. Modulate positive and negative symptoms
3. Increase chances of recovery
4. Decrease dopamine release

B is the right answer: As the presenters indicating, nicotine may have a modulatory effect on positive and negative symptoms by increasing dopamine releasing in the prefrontal cortex.

2)      A schizophrenic patient who believes that a spirit is speaking to them from heaven and is telling them what they should do and who they should speak to may have:

1. Visual Hallucinations
2. Delusions of reference
3. Third party, auditory hallucinations
4. Perceptual distortions

The correct answer is C: Third party auditory hallucinations. An schizophrenic patient who hears others speaking to them and is telling them what to do is having auditory hallucinations. Visual hallucinations would involve actually seeing the ‘spirit.’ Delusions of reference suggest that things in the environment are referring to the schizophrenic. Perceptual distortions are visually seeing distorted images (no mouth on a person for example).

Good luck with your studying!