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Flashcards in Psychotic/Spectrum Disorders Deck (79):
1

What are the diagnostic criteria for schizophreniform disorder?

  1. Criteria A, D, and E of schizophrenia are met
  2. An episode (including prodromal, active, and residual phases) lasts at least one month but less than six months. Diagnosis while still symptomatic must be "provisional."

Specify if "with good prognostic features" or "without good prognostic features."

2

What are the two differences between schizophrenia and schizophreniform disorder?

  1. duration of schizophreniform disorder (all phases) is between one month and six months, and schizophrenia must continue for more than six months
  2. impaired social or occupational functioning is not required for diagnosis

3

The duration for schizophreniform disorder lies between what two similar disorders?

brief psychotic disorder (one day to one month) and schizophrenia (more than six months)

4

Under what conditions would a schizophreniform diagnosis be given?

  • if someone had symptoms lasting 1-6 months but has already recovered
  • if someone is currently experiencing symptoms within the duration timeframe, they are considered "provisional" until symptoms persist for more than six months

5

To have schizophreniform disorder with good prognostic features, what is required?

Two or more of the following:

  • onset of prominent psychotic symptoms within four weeks of first noticeable change in usual behavior or functioning
  • confusion or perplexity at the height of psychotic episode
  • good premorbid social and occupational functioning
  • absence of blunted or flat affect

6

How many people will recover from their initial provisional diagnosis of schizophreniform disorder?

About one third. The rest will progress to diagnoses of schizophrenia or schizoaffective disorder.

7

What is the essential feature if schizoaffective disorder?

an uninterrupted period of illness during which, at some time, there is a major depressive, manic, or mixed episode concurrent with symptoms that meet criterion A for schizophrenia

8

In addition to a major depressive, manic, or mixed episode, what needs to be present for diagnosis of schizoaffective disorder?

  1. delusions or hallucinations for at least two weeks in absence of prominent mood symptoms during the same period of illness
  2. mood symptoms are present for a substantial portion of the total duration of the illness
  3. symptoms not due to substance abuse or general medical condition

All four need to be present within single, uninterrupted period of illness (active or residual symptoms).

9

The phase of the illness with concurrent mood and psychotic symptoms is characterized by the full criteria being met for the active phases of ________, AND either _________, _________,  or ________.

schizophrenia; major depressive episode; manic episode; mixed episode

10

How long must symptoms be present to be considered schizoaffective disorder?

Psychotic symptoms: at least one month, with hallucinations or delusions lasting at least two weeks

Major depressive episode (if present): at least two weeks

Manic or mixed episode (if present): at least one week

(either major depressive or manic/mixed episode must be present)

11

What is the typical symptom pattern for schizoaffective disorder?

  1. pronounced auditory hallucinations or persecutory delusions  for two months 
  2. psychotic symptoms and full major depressive episode together for three months
  3. major depressive episode recovery, but psychotic episodes persist for one month
  4. abatement of symptoms

12

If the total time psychotic symptoms are present is four years, and the total time mood symptoms are present is six weeks, can it be schizoaffective disorder?

no

Mood symptoms must be concurrently present for a substantial portion of the time that psychotic symptoms are present. (This example would be schizophrenia w/additional diagnosis of depressive disorder NOS)

13

What are the subtypes of schizoaffective disorder?

bipolar type and depressive type

14

What would constitute bipolar type schizoaffective disorder?

a manic or mixed episode as part of the symptom presentation (though major depressive episodes may also occur)

15

What would constitute depressive type schizoaffective disorder?

if only major depressive episodes are part of symptom presentation (manic/mixed can't be present)

16

What other features are common with schizoaffective disorder?

  • poor occupational functioning
  • difficulties with self-care
  • increased suicide risk
  • restricted range of social contact
  • anosognosia
  • increased risk for development of pure mood disorder
  • alcohol/substance-related disorders

17

What other diagnoses might be confused with schizoaffective disorder?

  • schizophrenia
  • mood disorder with psychotic features
  • psychotic disorder due to a general medical condition
  • delirium
  • dementia
  • substance-induced psychotic disorder
  • substance-induced delirium
  • delusional disorder
  • psychotic disorder NOS

18

What is the difference between schizoaffective disorder and schizophrenia?

In schizoaffective disorder, a mood episode must be concurrent with active schizophrenic symptoms, mood symptoms must be present for a significant portion of the total duration, and delusions or hallucinations must be present for two or more weeks without mood symptoms.

In schizophrenia, mood symptoms are brief (in relation to duration), do not meet full criteria for mood episodes, or occur only during prodromal or residual phases.

19

What is the essential feature of delusional disorder?

the presence of one or more nonbizarre delusions persisting for at least one month

20

In addition to nonbizarre delusions, what other features must be present in delusional disorder?

  • patient cannot have had symptoms meeting schizophrenia criterion A
  • Auditory or visual hallucinations must not be prominant, but tactile/olfactory hallucinations can be present if related to delusional theme
  • apart from impact of delusions/their ramifications, functioning not markedly impaired and behavior is not obviously odd or bizarre
  • duration of possible mood episodes are brief in relation to total duration of delusional periods
  • not due to direct effects of substances or general medical condition

21

How are delusions typically deemed "bizarre"?

  • clearly implausible
  • not understandable
  • not derived from ordinary life experiences

22

What are some examples of nonbizarre delusions?

  • being followed
  • being poisoned
  • being infected
  • being loved at a distance
  • being deceived by a spouse or lover

23

What are the seven subtypes of delusional disorder?

  1. erotomanic
  2. grandiose
  3. jealous
  4. persecutory
  5. somatic
  6. mixed
  7. unspecified

24

Explain the erotomanic type of delusional disorder.

The central theme of the delusion is that someone is in love with the individual.

  • concerns romantic love/spiritual union rather than sexual attraction
  • "lover" is usually higher status than "lovee" (movie star, boss, etc.)
  • efforts to contact "lover" are common
  • most "lovees" are female in clinics. In forensics, most are male.
  • some people try to rescue "lover" from imagined danger

25

Describe grandiose type delusional disorder.

When central theme of delusion is the conviction of having a great, unrecognized talent or insight, or having made an important discovery.

  • may have delusions of having relationship with person of importance
  • may have delusions of being a prominent person (the real person is seen as an imposter)
  • may have religious content (message from god, etc.)

26

When would the jealous subtype of delusional disorder be applied?

when the central theme of the person's delusion is that a lover is being unfaithful

  • arrived at without due cause
  • based on incorrect inferences supported by perceived "evidence" (clothes on floor, unmade bed)
  • person usually confronts lover or tries to intervene in believed infidelity (following lover, investigating imagined lover, etc.)

27

When does the persecutory type of delusional disorder apply?

when the central theme of the delusion involves a person believing he/she is being:

  • conspired against
  • cheated
  • spied on
  • followed
  • poisoned/drugged
  • maliciously maligned
  • harassed
  • obstructed in the pursuit of long-term goals
  • often believed to be remedied through legal action (querulous paranoia)
  • individuals are often resentful and angry, may resort to violence

28

When would you apply the somatic subtype to delusional disorder?

central theme of delusion involves bodily functions or sensations

Common delusions:

  • they are emitting foul odor from skin, mouth, rectum, or vagina
  • infestation of insects on or in the skin
  • internal parasite
  • body parts are misshapen/ugly
  • organs/body parts are not functioning

29

When does the mixed subtype of delusional disorder apply?

when no delusional theme predominates

30

When does the unspecified subtype apply to delusional disorder?

when the dominant delusional belief cannot be clearly determined or is not otherwise described in the specific types

31

What subtypes of delusional disorder are associated with marked anger and violence?

persecutory and jealous

32

What subtypes of delusional disorder are associated with legal troubles?

jealous and erotomanic

33

What other disorders are associated with delusional disorder?

  • obsessive-compulsive disorder
  • body dysmorphic disorder
  • paranoid, schozoid, or avoidant personality disorders

34

What subtype of delusional disorder is more common in males?

jealous

35

What other disorders might be confused with delusional disorder?

  • delirium
  • dementia
  • psychotic disorder due to a general medical condition (ex. Alzheimer's)
  • substance-induced psychotic disorder
  • schizophrenia
  • schizophreniform disorder
  • mood disorders with psychotic features
  • psychotic disorder NOS
  • depressive disorder NOS
  • bipolar disorder NOS
  • shared psychotic disorder
  • brief psychotic disorder
  • hypochondriasis
  • body dysmorphic disorder
  • paranoid personality disorder

36

How can delusional disorder be differentiated from schizophrenia?

  • delusional disorder is absent other symptoms of active-phase schizophrenia (hallucinations, bizarre delusions, disorganized  or catatonic behavior, negative symptoms)
  • less social/occupational impairment in delusional disorder

37

How can delusional disorder be differentiated from mood disorders with psychotic features?

  • mood disorder w/psych features involve delusions occurring exclusively during mood episodes
  • depressive symptoms are generally mild and remit while delusions persist in delusional disorder

38

How can you differentiate between delusional disorder and psychotic disorder NOS?

If the mood episode symptoms occur for a substantial portion of the delusional disturbance, it is psychotic disorder NOS accompanied by depressive disorder NOS or bipolar disorder NOS

39

How can delusional disorder be differentiated from brief psychotic disorder?

length of symptoms

Delusional symptoms persist longer than one month in delusional disorder

40

Can someone be diagnosed with both delusional disorder, somatic type and body dysmorphic disorder simultaneously?

yes, when he/she holds the belief that the body is distorted with delusional intensity

41

What is the essential feature of brief psychotic disorder?

a disturbance that involves the sudden onset of at least one of the following:

  • delusions
  • hallucinations
  • disorganized speech (frequent derailment or incoherence)
  • grossly disorganized or catatonic behavior

42

In addition to the essential features, what other features must be present in brief psychotic disorder?

  • episode lasts one day to one month, with full return to premorbid functioning
  • not better defined as mood disorder w/psychotic features, schizoaffective disorder, or schizophrenia
  • is not due to direct effects of substance or general medical condition

43

What are the three specifiers of brief psychotic disorder?

  1. with marked stressors
  2. without marked stressors
  3. with postpartum onset

44

When would the specifier "with marked stressor(s)" be used to describe one's brief psychotic disorder?

when symptoms arise shortly after (and in response to) an event that would be stressful to almost anyone in same context

45

When would the diagnosis of brief psychotic disorder without marked stressor be used?

Believe it or not, this would be used when there is no marked stressor to have triggered symptoms, given the context and culture of the individual.

46

When would the specifier "with postpartum onset" be used to describe brief psychotic disorder?

when the onset of symptoms occurs within four weeks of giving birth

47

What are characteristic experiences with brief psychotic disorder?

  • emotional turmoil or overwhelming conclusion
  • rapid shifts in intense affect
  • severe impairment of judgment, cognitive ability
  • supervision may be necessary for nutrition/hygeine and to make sure they don't act on delusions
  • increased risk of mortality/suicide

48

At what time in life does brief psychotic disorder generally appear?

adolescence or early adulthood, with average age of onset in late 20s/early 30s

49

What other disorders may be confused with brief psychotic disorder?

  • psychotic disorder due to a general medical condition
  • delirium
  • substance-induced psychotic disorder
  • substance-induced delirium
  • substance intoxication
  • mood episode
  • schizophreniform disorder
  • delusional disorder
  • mood disorder w/psychotic features
  • psychotic disorders NOS
  • factitious disorder with predominantly psychological signs and symptoms
  • personality disorders

50

Why might there be difficulty in differentiating between brief psychotic disorder and schizophreniform disorder?

If shichophrniform disorder has been successfully treated with medication so that symptoms have abated within one month of onset

51

What is another name for shared psychotic disorder?

folie à deux

52

What is the essential feature of shared psychotic disorder?

a delusion that develops in an individual who is in a close relationship with another person ( called the inducer/primary case) who halready has a psychotic disorder with prominent delusions

53

In addition to the essential feature, what else is necessary for diagnosing shared psychotic disorder?

  • the individual comes to share the delusional beliefs of the inducer in whole or in part
  • the delusion is not better accounted for by another psychotic disorder or mood disorder w/psychotic features
  • is not due to direct effects of substance or general medical condition

54

In shared psychotic disorder, what is the inducer/primary case's typical diagnosis?

schizophrenia, but delusional disorder or mood disorder are also common diagnoses

55

What are common characteristics of shared psychotic delusions?

  • relatively bizarre
  • mood-congruent

nonbizarre delusions characteristic of delusional disorder

56

What are the typical relationships between the primary case/inducer and the second person in shared psychotic disorder?

  • related by blood or marriage
  • have lived together for a long time, sometimes in relative social isolation
  • In families, the parent is typically the primary case

57

What happens if the relationship between the primary case and the second person is disrupted in shared psychotic disorder?

Generally, the second person's delusions diminish or disappear. However, this disorder most commonly occurs in relationships that are long-standing and resistant to change.

58

What are possible differential diagnoses to shared psychotic disorder?

none

Differential diagnosis is rarely a problem in shared psychotic disorder.

59

What are the essential features of substance-induced psychotic disorder?

  1. prominent hallucinations or delusions (do not include hallucinations if person has insight that they are substance induced)
  2. hallucinations are judged to be due to direct physiological effects of a substance

60

What is the technical definition of substance-induced psychotic disorder criterion B?

There is evidence from the history, physical, examination, or laboratory findings of either:

  1. the hallucinations or delusions developed during or within a month of substance intoxication or withdrawal
  2. medication use is etiologically related to the disturbance

61

In addition to the essential features of substance-induced psychotic disorder, what other features must be present?

  • the disturbance is not better diagnosed as a psychotic disorder that is not substance induced
  • psychotic symptoms do not occur exclusively during the course of a delirium

62

What are signs that substance-induced psychotic disorder might be another psychotic disorder instead?

  • psychotic symptoms precede the onset of substance abuse
  • symptoms persist for more than a month after cessation of acute withdrawal or severe intoxication
  • symptoms are substantially in excess of what would be expected given type/amount of substance or duration of use
  • other evidence of independent, non-substance-induced psychotic disorder

63

What are the two subtypes of substance-induced psychotic disorder?

  1. with delusions
  2. with hallucinations

64

What are the two specifiers of substance-induced psychotic disorder?

  1. with onset during intoxication
  2. with onset during withdrawal

65

When would you use the "with onset during intoxication" specifier to substance-induced psychotic disorder?

when criteria for intoxication with the substance are met and the symptoms develop during the intoxication syndrome

66

When would you use the "with onset during withdrawal" specifier to substance-induced psychotic disorder?

when the criteria for withdrawal from the substance are met and the symptoms develop during, or shortly after, a withdrawal syndrome

67

If a patient presented with delusions stemming from alcohol withdrawal, how would you record his disorder?

alcohol-induced psychotic disorder, with delusions, with onset during withdrawal

(drug name-induced psychotic disorder, subtype, specifier)

If two or more substances plays a significant role in psychosis, they must both be listed/recorded separately

68

What classes of substances are associated with the "intoxication" specifier of substance-induced psychotic disorder?

  • alcohol
  • amphetamine and related substances
  • cannabis
  • cocaine
  • hallucinogens
  • inhalants
  • opioids (meperidine)
  • phencyclidine and related substances
  • sedatives, hypnotics, and anxiolytics
  • other or unknown substances

69

What substances are associated with the withdrawal specifier of substance-induced psychotic disorder?

  • alcohol
  • sedatives
  • hypnotics and anxiolytics
  • other or unknown substances

70

What are the hallucinations associated with alcohol-induced psychotic disorder?

usually auditory hallucinations of voices

71

What are common features of the psychotic symptoms from amphetamine or cocaine?

  • persecutory delusions developing shortly after use
  • distortion of body image and misperception of people's faces
  • hallucination of bugs or vermin crawling under skin (formaication)
    • can lead to scratching and skin excoriations

72

What are features of cannabis-induced psychotic disorder?

While rare, features include:

  • persecutory delusions
  • marked anxiety
  • emotional lability
  • depersonalization
  • subsequent amnesia for the episode
  • usually remits within a day

73

Despite removal of the substance and treatment with neuroleptics, what substances might produce extended psychotic symptoms?

  • amphetamines
  • phencyclidine
  • cocaine

74

What medications are known to evoke psychotic symptoms (know at least five)?

  • anesthetics and analgesics
  • anticholinergic agents
  • anticonvulsants
  • antihistamines
  • antihypertensive and cardiovascular medications
  • antimicrobial medications
  • antiparkinsonian medications
  • chemotherapeutic agents
  • corticosteroids
  • gastrointestinal medications
  • muscle relaxants
  • nonsteroidal anti-inflammatory medications
  • other over-the-counter medications
  • antidepressant medication
  • disulfiram

75

What toxins can induce psychotic symptoms?

  • anticholinesterase
  • organophosphate insecticides
  • nerve gases
  • carbon monoxide
  • carbon dioxide
  • volatile substances such as fuel or paint

76

When would you diagnose substance-induced psychotic disorder instead of substance intoxication or substance withdrawal?

  • when the psychotic symptoms are in excess of those usually associated with intoxication or withdrawal syndrome
  • when symptoms are severe enough to warrant clinical attention independently

77

If the person recognizes that their hallucinations are a product of the substance (if reality testing remains intact), can it be diagnosed as substance-induced psychotic disorder?

no

This would be "substance intoxication or withdrawal, with perceptual disturbances."

78

If someone is experiencing flashback hallucinations long after use of hallucinogens has stopped, can substance-induced psychotic disorder be diagnosed?

no

This would be diagnosed as "hallucinogen persisting perception disorder."

79

What other diagnoses might be confused with substance-induced psychotic disorder?

  • primary psychotic disorder
  • psychotic disorder due to a general medical condition
  • psychotic disorder NOS