Big Initial Powerpoint (Midterm) Flashcards
(93 cards)
1
Q
What book us used for the classification of mental disorders?
A
DSM 5
2
Q
Who can use the DSM 5
A
DSM has valuable information for mental health workers, psychiatrists, physicians, psychologists, social workers, nurses, counselors, forensic and legal specialists, occupational and rehabilitation therapists, and other health professionals
3
Q
What is the DSM 5 a tool for?
A
a tool for collecting and communicating accurate public health statistics on mental disorder morbidity and mortality rates
4
Q
How does the DSM 5 relate to The Who International Classification of Diseases (ICD)?
A
The classification of disorders is harmonized with the World Health organization’s International Classification of Diseases (ICD), the official coding system used in The DSM criterion defines disorders identified by ICD diagnostic names and code numbers
5
Q
What coding is in the DSM 5? Have we updated yet?
A
DSM-5 has both ICD-9-CM and ICD-10-CM (adopted in October 2014). ICD-11 was scheduled for release in 2015 the United States of America – still not here tho lol
6
Q
What are the 8 neurodevelopmental disorders?
A
- Intellectual
- Communication
- Autistic
- Attention
Spectrum disorders Deficit/Hyperactivity - Specific Learning Disorder
- Motor
Disorders - Tic Disorders
- Other
Neurodevelopmental Disorders
7
Q
Define Mental Disorder
A
Mental disorder: is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.
8
Q
What are mental disorders usually associated with?
A
Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities.
9
Q
How should you handle stress positively?
A
Exercise; Rest; Talk
10
Q
What is unique to neurodevelopmental disorders?
A
Neurodevelopment disorders are a group of conditions with onset in the Developmental period often before the child enters grade school.
11
Q
What do characteristic developmental deficits produce as a resul of neurodevelopmental disorders?
A
Characteristic Developmental deficits produce impairments of personal, social, academic, or Occupational functioning.
12
Q
Can neurodevelopmental disorders vary in their deficits?
A
Deficits vary from simple limitations in learning to Complex impairments in social skills or intelligence.
13
Q
T/F Neurodevelopmental disorders frequently co-occur
A
True
14
Q
What are the 3 main focus we did for neurodevelopmental disorders?
A
- Intellectual Disability
- Communication Disorders
- Autism Spectrum Disorders
15
Q
Intellectual Disability causes what kinds of impairments?
A
impairments of adaptive functioning; such that the individual fails to meet standards of: reasoning, problem solving, planning, abstract thinking, judgement, academic learning, learning from experience
16
Q
Diagnostic criteria for intellectual disability?
A
- Onset of intellectual and adaptive deficits should be during the developmental period.
- Deficits in intellectual functions (reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience)
- Deficits in adaptive functioning that result in failure to meet developmental and socio-cultural standards for personal independence and social responsibility.
17
Q
Mild Intellectual Disability
A
- No obvious differences seen in conceptualization
- Has difficulty in learning
academic skills but can approach problems and solve them accordingly. - Socially immature in emotions and judgment hence can be manipulated easily.
- May take care of themselves but need support with complex daily living tasks, making healthcare and legal decisions or perform skilled tasks competently.
- IQ 50-55 to approx. 70 “educable” The majority of those affected fall here -85% [aka Intellectual development disorder]
18
Q
Moderate Intellectual Disability
A
- IQ 35-40 to 50-55 “trainable” don’t benefit from ed. Programs 10%
- Behind in conceptual skills compared to peers; slow at academic skills; require daily assistance in academic and conceptual tasks.
- Very immature in social and communicative behavior; misunderstands social cues, judgment, and poor at decision making and interactions.
- Can feed, dress, eliminate, participate in some household tasks without help. Can be employed in jobs requiring limited conceptual and communication skills but with the support of co-workers.
19
Q
Severe Intellectual Disabiltiy
A
- IQ 20-25 to 35-40 little or no communicative speech “survival words”3-4%
- Has limited skills; little
understanding of written language, or concepts involving numbers, time, money - Rely on caretakers for extensive support in problem solving
- Very limited understanding of vocabulary, and grammar.
- Language is used for social communication more than for explication.
- Family relationships and familiar others are a source of pleasure and help
- Requires support for all activities of daily living, including meals, dressing, bathing, and elimination; requires supervision at all times
- Skill acquisition requires long term teaching and ongoing support.
20
Q
Profound Intellectual Disability Disorder
A
- Lack conceptual & symbolic communication skills; has motor and sensory impairment which limit use of objects; communicates through non- symbolic, non-verbal expressions; are dependent on others; are very limited in vocational activities
- IQ level below 20 or 25. Neurological impairment present 1-2%
21
Q
What disorders are within communication disorders?
A
- Language Disorder
- Speech sound disorder
- Social (pragmatic communication disorder
- Childhood onset fluency disorder (stuttering)
22
Q
Language Disorder
A
- When a person has trouble understanding others (receptive language), or sharing thoughts, ideas, and feelings completely (expressive language), then he or she has a language disorder. A stroke can result in aphasia, or a language disorder.
- Language disorder is characterized by
difficulties in the acquisition and use of language due to deficits in the comprehension or production that include:
❑Reduced vocabulary
❑Limited sentence structure
❑Impaired discourse (ability)—that is the ability to use vocabulary and connect sentences
23
Q
Speech Sound Disorder
A
- When a person is unable to produce speech sounds correctly or fluently, or has problems with his or her voice, then he or she has a speech disorder.
- Difficulties pronouncing sounds, or articulation disorders, and stuttering are examples of speech disorders.
- This is the persistent difficulty
with speech sound production
that interferes with speech intelligibility or prevents verbal communication of messages.
24
Q
Disturbances with speech sound disorder can cause what kinds of limitation(s)?
A
The disturbance causes limitation in communication
participation
performance
effective
social
that interferes with
academic achievement, or individually or in any combination.
occupational
25
Childhood-Onset Fluency Disorder
AKA Stuttering
This is disturbance in the normal fluency
and time patterning of speech. ❑It is marked by:
* Sound and syllable repetition
* Sound prolongations of consonants as well as
vowels
* Broken words
* Audible or silent blocking
* Circumlocutions
* Words produced with an excess tension
* Monosyllabic whole-word repetitions (e.g. “I-
I-I-I see him”
26
Social (Pragmatic) Communication Disorder
❑The disorder is characterized by a primary difficulty with pragmatics or the social use of language and communication, as manifested by deficits in:
❑Communication for social purposes like greeting and sharing information in a manner that is inappropriate for the social context.
27
Deficits in Social (Pragmatic) Communication Disorder
Ability to change communication to match context or the needs of the listener. E.g. speaking differently is class than on the playground.
❑ Following rules for conversation and storytelling—as in taking turns, use of verbal or nonverbal signals to regulate interactions.
❑ Understanding what is not explicitly stated (like making inferences)
28
5 Disorders under Autism Spectrum Disorder
1. Autism Disorder (classic autism)
2. Aspergers Disorder (Asperger syndrome)
3. Pervasice Developmental Disorder not otherwise specified (PDD-NOS)
4. Rett's disorder (Rett's Syndrome)
5. Childhood disintegrative disorder (CDD)
29
Common Signs of Autistic Spectrum Disorder (diagnostic criteria)
1. Impaired development
in social interaction
2. Deficits in social communication- delay in spoken language
3. Markedly restricted repertoire of activity and interests.
30
Research Facts about autistic spectrum disorder
- An alteration in brain size is the most consistent replicated finding.
- Autistic children tend to have small heads at birth followed by an excessive increase in head size between 1 and 2 months and 6 and 24 months of age.
- Research has noted
imbalances in
neurotransmitters
-- chemicals that help nerve cells communicate with one another.
31
What two neurotransmitters are related to austism spectrum disorder?
1. serotonin (emotion and behavior)
2. glutamate (neuron activity)
32
Early warning signs for autistic disorder
- 2-5 Months: Babies avoid eye contact
- 5-6 Months: No replication of baby bubble sounds
- 10 Months: No response to
name
- babes will ultimately ignore people trying to get their attention
- 12 Months: Overly sensitive to loud sounds
- Resistance to curdling
- Focus is on favorite object
- Repetitive behaviors e.g. flapping hands and rocking back and forth
- poor development of language
- increased resistance to change in schedules
33
Severity levels for autism spectrum disorder
level 1 - Social communications without support cause noticeable impairments as seen in:
Initiating social interactions Inflexibility of behavior Switching between activities Organization and planning
level 2 - Marked deficits in verbal and nonverbal social communication skills evident even with support as seen in:
* Limited initiation of social interactions
* Reduced or abnormal responses to social overtures from others.
* Inflexibility of behavior and difficulty coping with change.
level 3 - Several deficits in verbal and nonverbal social communication skills cause severe impairments in functioning.
*
*
There is very limited social interactions Minimal responses. Inflexibility of behavior, Extreme difficulty in coping with change
Other repetitive restricted behavior markedly interferes with functioning.
Great distress is seen in response to change.
34
Associated Features to autism disorder
- Intellectual impairment and or language impairment.
- Motor deficits including odd gait, clumsiness, abnormal motor signs (e.g. walking on tiptoes)
- Self-injury (e.g. head banging, biting wrist)
- Anxiety and depression in
adolescents and adults
- 1st symptoms of autism spectrum disorder involve delayed language development often accompanied by lack of social interests & repertoire/stereo types
35
Treatement for autism
- SRIs
- Atypical antipschotics
- Anticonvulsants
- Natural products and bretar restictions like low caseur, gluten
- comprehensive early intervention
speech/intervention
problem behavior intervention (self injury/tantrums)
36
Attention Deficit/Hyperactivity Disorder
this is TWO terms to classify (in the name) .. well actuall 3
The essential feature of attention- deficit/hyperactivity disorder (ADHD) is a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development
37
Innatention
Manifests in ADHD as
❑ wandering of task
❑ lacking persistence
❑having difficulty sustaining focus
❑being disorganized and is not due to defiance or lack of comprehension.
38
Hyperactivity
Referstoexcessivemotor activity e.g. running around when it is not appropriate, or excessive fidgeting, tapping, or talking.
* Inadultsitmanifestsitself as extreme restlessness or wearing others out with their activity
39
Impulsivity
- Referstohastyactions that occur in the moment without forethought that have high potential for harm e.g. darting into road without looking.
-
40
What age is ADHD present by?
ADHDhasachildhood onset. Its symptomatic characteristics have to be present before age 12 years
41
What is needed & for how long to get ADHD diagnosis?
For ADHD to be diagnosed, Six or more of the following symptoms persist for at least 6 months.
42
Prevealence of ADHD is what in kids and adults?
ADHD occurs in most cultures in about 5% of children and about 2.5% of adults.
43
Associated features for ADHD
Mild delay in language, motor, or social developments
* Low frustration tolerance, irritability, or mood liability
* Impairedacademicworkor performance
* Cognitive problems on tests ofattention,memory
Development and course
* Parentsfirstobserve excessive motor activity when the child is a toddler but symptomsaredifficult to distinguish before age 4.
* ADHDisoften
identified in
44
Who generally identifies ADHD first, & where?
Teachers in elementary school
45
Risk and prognostic factors for ADHD
Environment: useo to though sayenuronm.iq Genetic and genetic
* Very low birth weight
* Smoking during pregnancy
* Poor diet
* Reactions to child abuse, neglect, multiple foster placements
* Neurotoxin exposure e.g. lead, infections e.g. encephalitis, alcohol exposure in utero.
Genetic ... 1st degree biological relatives with it is elevated
46
What are some differential diagnosis for ADHD?
Differential diagnosis
Oppositional defiant disorder, intermittent explosive disorder, other neurodevelopmental disorder, specific learning disorder, autism
spectrum disorder, reactive attachment disorder, depressive disorders, bipolar disorder, disruptive mood dysregulation disorder, substance
use disorder
47
Other specified attention- deficit/hyperactivity disorder
Has some characteristics of ADHD but does not meet all the criteria
This category applies to presentations in which symptoms of ADHD that cause clinically significant distress or impairment in social, occupational or other important areas of functioning predominate but do not meet the full criteria for ADHD or any of the disorders in the neurodevelopmental disorders diagnostic class.
48
UNspecified attention deficit/hyperactivity disorder
... generally used in emerrgency situations
This category is used in situations in which the clinician chooses not to specify the reason that the criteria are not met for ADHD or for a specific neurodevelopmental disorders, and includes presentations in which there is insufficient information to make a more specific diagnosis.
49
Specified Learning
One essential feature of specific learning disorder is persistent difficulties learning keystone academic skills (which include reading singly words accurately, reading comprehension, written expression and spelling, arithmetic calculation and mathematical reasonging with onset during eyars of formal schooling
This is a neurodevelopmental disorder with a biological origin that is basis for abnormalities at a cognitive level that is associated with the behabioral signs of the disorder
50
What do you see with specified learning disorder?
Difficulties learning and using academic skills, as indicated by the presence of at least one of the following symptoms that have persisted for a least 6 months despite intervention:
(used to be dyslexia) Inaccurate or slow effortful word reading (reads slowly, incorrectly, hesitantly, guesses words, difficulty sounding words).
Difficulty understanding the meaning of what is read.
Difficulty with spelling (adds, omits, and substitutes vowels or consonants).
Difficulties with written
expressions (makes multiple grammatical or punctuation errors, poor paragraph organization, lack of clarity).
Difficulty mastering
number sense,
facts, or
calculation (has
poor
understanding
of numbers,
their
magnitude, and relationship
Difficulties with mathematical reasoning (difficulty applying mathematical concepts, facts, or procedures)
51
Prevalence for Specific Learning Disorder
Its prevalence across the academic domains of reading, writing and mathematics is 5-15% among school-age children.
52
52
Risk factors for specific learning disorder
Risk factors:
* Environment: premature or very low birth weight, prenatal exposure to nicotine.
* Genetic and physiological: occurs 4-8 times, and 5-10 times in 1st degree relatives.
53
Two types of motor disorders
1. Developmental Coordination Disorder
2. Stereotype Movement disorder
54
Developmental Coordination Disorder
Impaired motor coordination, sensory impairment
Cannot participate in life and daily activities, etc.
Neurodevelopmental immaturities or neurological soft signs ...
Will see in MRI and find specific mylination within brain as to why they do not walk right
55
Risk factors for developmental coordination disorder
Risk factors:
Environmental; Prenatal exposure to alcohol and in preterm and low birth- weight children
2. Genetics: Neurodevelopmental
motor and visual impairment,
Cerebellar dysfunction has been proposed
56
Stereotpe Movement Disorder
MRI looks like nothing is wrong
Repetitive, seemingly driven, and apparently purposeless motor behavior (e.g. hand shaking or waving, body rocking, head banging, self-biting, hitting own body).
he behaviors are often rhythmic
movements of the head, hands, or body without obvious adaptive function and may not respond to efforts to stop them.
The repetitive motor behavior is not attributed to the physiological effects of a substance or neurological condition
57
Risk Factors for sterotype movement disorder
Environmental: social isolation is a risk factor for self-stimulation that may progress to stereotypic movements with repetitive self-injury. Environmental stress triggers movements too.
Genetic and
physiological: lower cognitive functioning is linked to greater risk for stereotypic behaviors and poorer response to interventions. (caused by stress is 85%)
^ Behaviors occur in varying contexts like when one is engrossed in activities, when excited, stressed, fatigued, or bored.
58
Tic Disorder
A tic is a sudden, rapid,
recurrent, non- rhythmic motor movement or vocalization (simple or complex)
59
Simple Tic
Short ie. millisecond duration like blinking or shrugging shoulders
60
Complex Motor Tic
Longer duration like seconds and could be like turning head with simple tics and shoulder shrugging and just build up tics
61
4 Diagnostic Categories for tics
1. Tourette’s disorder
Onset is before age 18. Both motor and vocal tics must be present and persist for more than 1 year.
2. Persistent (chronic) Motor or Vocal Tic Disorder
Only motor or only vocal tics are present but must persist for more than 1 year.
3. Provisional Tic Disorder
Motor and/or vocal may be present. There may be a single or multiple
If motor and/or vocal tics. ... more with stress less without stress and are less than a year
4. Other specified or ilessly unspecified Tic Disorder
The movement disorder symptoms
are best characterized as tics but are
a typical in presentation or age at onset, or have a known etiology.
62
Complex tics can appear purposeful such as in:
1: copropraxia (sexual or obscene gesture)
2. echopraxia (tic like imitations of someone elses movements)
3. echolalia: repeating the last yeard word or phrase
4. coprolalia: uttering socially unacceptable words, like obscenties, ethnic or racial or religious slurs
63
What are the risk and prognostic factors for Tics?
Temperamental: tics are made
worse by anxiety, excitement, and
exhaustion.
* Environmental: observing
gestures or sound in another person may result in and individual with a tic disorder making a similar gesture or sound.
64
Genetic and physicological factors influencing tic symptoms
Genetic and physiological: genetic and environmental factors influence tic symptom severity and expression. Obstetrical complications, older paternal age, lower birth weight, and maternal smoking during pregnancy are associated with increased tic severity.
65
5 key features defind psychotic disorders
1. delusions
2. hallucinations
3. disorganized speech
4. grossley disorganied or catatonic behavior
5. negative symptoms
66
Do you need all 5 to have schizophrenia spectrum or other psychotic disorders?
Nope you do not have to have all 5
67
Delusions
- Delusions are fixed beliefs that are not amenable to change in light of conflicting evidence
- Their content may include a variety of themes (e.g. persecutory, referential, somatic, religious, grandiose).
68
What are the 6 categories of delusions?
1. Persecutory delusions - one is worried about being harmed most common
2. referential delusions - one beliefs specific gestures, comments, environemntal cues are directed at them
3. grandiose delusions - one thinks they have exceptional skills, fame, etc.
4. eretomanic delusions - believe another person is in love with them
5. Nihillistic delusions - worry major disaster will occur
6. somatic delusions - preoccupation with ones health and organ function
69
Hallucinations
Hallucinations are perception-like experiences that occur without an external stimulus.
* They are vivid, and clear with full force and impact of normal perceptions, and not under voluntary control.
* They may occur in any sensory modality but auditory hallucinations are the most common. Auditory hallucinations are usually experienced as voices, whether familiar or unfamiliar, that are perceived as distinct from the individual’s own thoughts.
70
Disorganized thinking
Disorganized thinking (formal thought disorder) is typically inferred from the individual’s speech.
* He may switch from topic to topic (derailment or loose associations).
* Answers to questions may be obliquely related or completely unrelated.
71
Grossly disorganized or abnormal motor behavior (includes catatonia)
This may manifest itself from childlike ‘silliness’ to unpredictable agitation.
* Catatonic behavior is a marked decrease in reactivity to the environment. This ranges from resistance to instructions (negativism); to maintaining a rigid, inappropriate or bizarre posture; to a complete lack of verbal and motor responses (mutism and stupor). It can also include purposeless and excessive motor activity without obvious cause (catatonic excitement).
* Repeated stereotyped movements, staring, grimacing, mutism, and echoing of speech may also be seen.
72
Negative symptoms (2 specificall common in schizo)
1. Diminished emotional expression: which includes reductions in the expression of emotions in the face, eye contact, intonation of speech (prosody) and movements of the hand, head, and face that normally give an emotional emphasis to speech.
2. Avolition:
This is a decrease in motivated self- initiated purposeful activities.
73
Other negative symptoms include
Alogia— manifested by
diminished speech output.
Anhedonia—the decreased ability to experience pleasure from positive stimuli or a degradation in the recollection of pleasure previously experienced.
Asociality—the apparent lack of interest in social interactions and may be associated with avolition, but can also be the manifestation of limited opportunities for social interactions.
74
Schizotypal (Personality) Disorder
Schizotypal personality disorder is a pervasive pattern of social and interpersonal deficits marked by acute discomfort with, a reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts.
75
Does schizotypal personality disorder fall into two diffferent classes?
Yes!
76
What is schizotypal personality disorder
Ideas of reference i.e. incorrect interpretations of casual incidents and external events as having a particular and unusual meaning specifically for the person.
* Odd beliefs or magical thinking (e.g. superstitiousness, telepathy, ‘sixth sense’)
* Unusual perceptual experiences, including bodily illusions.
* Odd thinking and speech (e.g. vague, metaphorical, stereotyped)
* Suspiciousness or paranoid idealation ( e.g. believing that colleagues are intent on undermining their reputation with the boss)
* Behavior or appearance that is odd, eccentric, or peculiar.
* Lack of close friends or confidants other than 1st degree
relatives.
* Excessive social anxiety that does not diminish with familiarity
77
Ddelusional Disorder
Delusional disorder is characterized by the presence of one or more delusions that persist for at least 1 month.
Whenhallucinationsarepresent in the delusional type, they are not be prominent or related to the delusional theme.
*
Ones’ functioning is not markedly impaired and behavior is not obviously bizarre or odd.
78
Associated features supporting diagnosis of Delusional disorder
Social, marital, or work problems resulting from the delusional beliefs.
* Individuals with delusional disorder may be able to factually describe that others view their beliefs as irrational but are unable to accept this themselves.
Many develop irritable or dysphoric mood. Anger and violent behavior can occur with persecutory, jealous, and erotomanic types.
* They may engage in litigious or antagonistic behavior e.g. sending hundreds of letters of protest to the government
79
Brief Psychotic Disorder
This is a disturbance that involves the sudden onset of at least one of the following positive psychotic symptoms:
1. Delusions
2. Hallucinations
3. Disorganized speech (e.g.
frequent derailment or incoherence)
4. Or grossly abnormal
psychomotor behavior, including catatonia.
5. Negative Symptoms
The episode lasts at
least 1 day but less than a month with eventual full return to premorbid level of functioning.
80
Prevealence of Brief Psychotic Disorder & when can they occur
Prevalence: More in females 2:1 than males
Note: Brief psychotic disorder can occur:
m kos
With marked stressor(s)—
symptoms occurring in response to events that are very stressful
Without marked stressor(s)— symptoms occurring without particularly very stressful events
With postpartum onset—onset is during pregnancy or within 4 weeks postpartum
81
Associated features supporting diagnosis for brief psychotic disorder
Associated features supporting diagnosis
* Individuals experience brief but intense
emotional turmoil or overwhelming confusion and severity.
* The severity may require their supervision in order to meet nutritional and hygiene needs or protect them from consequences of poor judgment, cognitive impairments, or acting on delusions.
82
Differential diagnosis for brief psychotic disorder
Differential diagnosis: other medical conditions, substance-related disorders, depressive and bipolar disorders, other psychotic disorders, malingering and factitious disorders, personality disorders.
83
Schizophreniform Disorder
Symptoms of schizophreniform disorder are identical to those of schizophrenia. The difference is in duration.
* The patient must have 2 or more of the following, each for a significant portion of time during a 1-month period:
Delusions
* Hallucination
* Disorganized speech
* Grossly disorganized or catatonic behavior
* Negative symptoms (diminished emotional expression)
84
If someone has brief psychotic disorder less than a month but it continues what does it become
Schizophreniform disorder
85
Schizophreniform disorder then becomes what?
Schizophrenia after it has been over 6 months
86
Schizophreniform Disorder
The total duration of the illness, including prodromal, active, and residual phases, is at least 1 month but less than 6 months.
Note that the duration required for schizophreniform disorder is intermediate between that for brief psychotic disorder, which lasts more than 1 day and remits by 1 month and that of schizophrenia which lasts for at least 6 months.
❖ Another distinguishing feature of schizophreniform disorder is the lack of a criterion requiring impaired social and occupational functioning.
87
Schizophrenia
Characteristic symptoms of schizophrenia involve a range of cognitive, behavioral, and emotional dysfunctions, but no single symptom is pathognomonic of the disorder.
- stress, drugs, alcohol, smoking
- earlier the diagnosis the worse the prognosis
Two or more of the following must be present, each for a significant time during a 1-month period:
Delusions
▪ Hallucinations
▪ Disorganized speech
▪ Grossly disorganized or catatonic behavior
▪ Negative symptoms—like diminished emotional expression
88
Course and development for schizophrenia
Peak on-set is early-to mid-20s for males and late
20s for females.
The earlier the onset, the worse the prognosis.
Season of birth has been linked to incidences of
in some locations and summer for the deficit form
of the disease.
Higher incidences seen in children growing in urban environment.
5%-6% die by suicide. About 20% attempt suicide.
the continuous signs of disturbance persist for at least 6 months
89
Associated features supporting diagnosis for schizophrenia
- The presence of inappropriate affect (e.g. laughing in absence of appropriate stimuli)
- A dysphoric mood that takes the form of depression, anxiety, or anger. angry depression
- A disturbed sleep pattern e.g. day time sleeping and night time activity.
- Depersonalization, de-realization, and somatic concerns with delusional proportions. (ie. you know whats going on but you do not want to be associated to it)
- Cognitive deficits that are linked vocational and functional impairments—these may include: declarative memory, working memory, language function, and slower processing speed.
- Lack of insight which includes unawareness of symptoms of schizophrenia, illness, neurological deficits following brain damage (anosognosia). Anosognosia is the most common predictor of non-adherence to treatments and it predicts higher relapse rates, increased number of involuntary treatments, poorer psychosocial functioning, aggression, and poorer course of illness.
- Hostility and aggression. Spontaneous or random assault is uncommon. Aggression is common for younger males, those with a history of violence, non-adherence with treatments, substance abuse, and impulsivity.
- There is no positive radiological, laboratory, or psychometric test for the disorder.
- Reduced overall brain volume has been observed, as well as increased brain volume reduction with age.
- Neurological soft signs which include impairment in motor coordination, sensory integration, and motor sequencing of complex movements; left- right confusion; and dis-inhibition of associated movements.
- Minor physical abnormalities of the face and limbs may occur—e.g. high riding palate.
90
Differential Diagnosis
Major depressive or bipolar disorder with psychotic or catatonic features
* Schizoaffective disorder
* Schizophreniform disorder
* Brief psychotic disorder
* Delusional disorder
* Schizotypal personality disorder
* Obsessive-compulsive disorder and body dysmorphic disorder
* Posttraumatic stress disorder
* Autism spectrum Communication disorder.
91
Schizoaffective disorder
schizophrenia and depression .... (bipolar 1 or bipolar 2)
This is an uninterrupted period of illness during which the individual continues to display active or residual symptoms of psychotic illness.
* There is a major mood episode (major depressive or manic) and disordered thought process (psychosis).
Schizoaffective disorder is a serious mental illness that has features of two different conditions, schizophrenia and an affective (mood) disorder, either major depression or bipolar disorder
92
Substance/Medcation indusced psychotic disorder
These are prominent delusions and / hallucinations that are judged to be due to the physiological effects of a substance/medications.
❖Substance/medication-induced psychotic disorder is distinguished from a primary psychotic disorder by considering the onset, course, and evidence of drug of abuse in history, physical examination, or laboratory findings.
