Schizophrenia and other Psychotic Disorders Flashcards
Schizophrenia and other Psychotic Disorders Defined by:
are defined by abnormalities in one or more of the following 5 key domains:
Delusions Hallucinations Disorganized thinking (speech) Grossly disorganized or abnormal motor behavior (including catatonia) Negative symptoms
Delusions
fixed beliefs not amenable to change in light of conflicting evidence
Types:
Persecutory delusions - belief that others intend harm
Grandiose delusions - belief that one is special, famous, or important
Referential delusions - belief that certain gestures, comments, environmental cues and the like are directed to the person
Erotomanic delusions - the erroneous belief that someone is in love with the person
Nihilistic delusions - or the conviction that a major catastrophe will happen
Somatic delusions - a preoccupation with one’s health.
Delusions that are implausible/ bizarre
There are a number of delusions that are clearly implausible and thus seen as bizarre and include: thought withdrawal (belief that the person’s thoughts have been removed from them by some kind of outside force, thought insertion (the belief that thoughts have been put into the person’s mind), and delusions of control (where the person believes his or her body is being affected by some outside force)
Hallucinations
perception-like experiences that occur without an external stimulus
Types:
Auditory – or hearing voices
Somatic (or tactile) – experiencing sensations similar to electrical tingling or burning
Disorganized thinking
seen in echolalia, derailment, tangentiality, loose associations, neologisms, perseveration, clanging or incoherence
Disorganized behavior
catatonic behavior
Negative symptoms
diminished emotional expression, avolition (lack of goal directed behavior), flat affect, alogia (poverty of speech), anhedonia (lack of pleasure), asociality (lack of interest in social interactions)
Schizophrenia
Seen as a complicated and variable condition best thought of as a syndrome or a cluster of symptoms that may or may not have related causes
Three Phases of Schizophrenia
Specific patterns or features that tend to appear together which generally includes:
Prodromal - refers to the period before the features of schizophrenia become very apparent and a person’s functioning deteriorates
Active phase – where the disorder persists for at least 6 months with impaired functioning and the individual is exhibiting 2 symptoms for one month with at least one of the following psychotic features - delusions, hallucinations, and/or grossly disorganized speech and behavior – a second symptom could be from the negative symptoms
Residual phase – a person no longer has enough features for the practitioner to ascertain the presence of schizophrenia
Specifiers for Schizophrenia
Episodes and remission status
Catatonia (note that catatonia can occur in the context of several disorders or unspecified)
Clinician-rated assessment of primary symptoms of psychosis – including delusions, hallucinations, disorganized speech, abnormal psychomotor behavior and negative symptoms – on a 5-point scale (detailed in the DSM-5 Assessment Measures)
Currently the diagnosis of schizophrenia can be made without using this specifier
Schizophrenia Criteria
A. Two or more, each present for significant time (6 months): Delusions
Hallucinations
Disorganized thinking (speech)
Grossly disorganized or abnormal motor behavior (including catatonia)
Negative symptoms
B. Significant impairment for much of length of time in functioning area
C. Continuous signs for 6 months of symptom from A
D. Schizoaffective Disorder and depressive or bipolar disorder with psychotic features ruled out. (p. 99)
E: Not attributed to substance use.
Assessment Level p. 743
Diagnostic Features P. 100
Exclude schizoaffective disorder and mood disorders; not due to medication or substance use or medical condition
Delusional Disorder p. 90
Refers to the person’s persistent belief about something that is contrary to reality The main feature is the presence of delusions lasting for at least one month or longer Types (assigned based on the delusion): Erotomanic Grandiose Jealous Persecutory Somatic Mixed Unspecified onset is 40-49 if longer than 1 year consider specifiers
Delusional Disorder specifiers
if longer than 1 year consider specifiers
first episode
specified as an acute episode
currently in partial or full remission
Rule out substance use
Rule out neurocognitive disorder
Brief Psychotic Disorder
Also known as brief reactive psychosis, and seldom assessed in clinical practice
Differentiated from the other related psychotic disorders by its sudden onset, its relatively short duration, and the individual’s full return to functioning
Specifically lasts more than one day, but less than 30 days
Must always include at least one major psychotic symptom of delusions, hallucinations, disorganized speech
Grossly disorganized or catatonic behavior may also be present and considered to support the diagnosis, as appropriate
3 Forms – with marked stressors, without marked stressors, and with peripartum onset
Schizophreniform Disorder
The symptom picture is akin to schizophrenia, but not at the same level as those found in full-blown schizophrenia
Psychotic features must last less than 6 months
Features must include a prodromal, active, and residual phase
It appears as if the person has schizophrenia, but he or she subsequently recovers completely with no residual effects
