Schizophrenia & Psychotic Disorders
DELUSION - unchanging beliefs despite conflicting evidence
Persecutory (belief that he will be harmed)
Referential (belief that gestures/comments/cues are directed at self)
Grandoise (belief that he has exceptional abilities/wealth/fame)
Erotomanic (belief that someone is in love with him)
Nihilistic (belief that major catastrophe will occur)
Somatic ( preoccupation with health and organ function)
Thought withdrawal (one’s thoughts have been removed)
Thought insertion (alien thoughts put into mind)
Delusions of control (body/actions being manipulated by outside force)
HALLUCINATION – perception-like experiences w/o external stimulus
Sensory
Auditory (most common)
DISORGANIZED SPEECH/THINKING – should impair effective communication
Derailment/loose association (switch from topics)
Tangentiality (unrelated answers to questions)
Incoherence/word salad (incomprehensible)
DISORGANIZED MOTOR BEHAVIOR (including catatonia)
Catatonia (decreased reactivity to environment; resistance to instructions, rigidity, bizarre
posture, mutism and stupor, catatonic excitement, echoing speech, grimacing)
NEGATIVE SYMPTOMS
Diminished emotional expression
Avolition (decrease in motivated self-initiated purposeful activities)
Alogia (decrease in speech output)
Anhedonia ( decrease pleasure from positive stimuli)
Asociality (decreased interest in social interaction)
Delusional Disorder ( 1 month or longer)
- No function impairment
- Specify if Erotomanic, Grandoise, Jealous, Persecutory, Somatic, Mixed, Unspecified type
- Specify if with bizarre content
- Specify if 1st episode currently in acute episode, 1st episode currently in partial remission, 1st
episode currently in full remission, multiple episodes currently in acute/partial/full remission,
unspecified
Brief Psychotic Disorder (1 – 29 days)
- Presence of 1/more of ff: (1 must be 1,2, or 3)
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Disorganized Bx
- Specify if with marker stressors, without marked stressors, with postpartum onset, with
catatonia
Schizophreniform Disorder (1 – less than 6 months)
- Criteria A: 2 or more of ff: (1 must be 1,2, or3)
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Disorganized Bx
5. Negative Symptoms
- No major depressive/manicepisode with actgive phase
- Specify if with good prognostic features, w/o good prognostic features, with catatonia
Schizophrenia (at least 6 months)
- 2 or more of ff: (1 must be 1,2, or3)
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Disorganized Bx
5. Negative Symptoms
- Functional impairment
- Specify if 1st episode currently in acute episode, 1st episode currently in partial remission, 1st
episode currently in full remission, multiple episodes currently in acute/partial/full remission,
unspecified
- Not attributed to physiological effects of drug/medication
- Other features:
1. Inappropriate affect (laughing)
2. Dysphoric mood
3. Disturbed sleep
4. Food refusal
5. Depresonalization, derealization, somatic concerns
6. Anxiety and phobias
7. Cognitive/sensory deficits
8. Anosognosia (unawareness of symptoms non-adherence to treatment)
- Emerge in late teens/mid 30
- Peak age for males mid 20; peak age for females late 20
- Strong genetic contribution to risk, greater paternal age, maternal diabetes, season of birth
- Life expectancy reduced because of comorbidity with other conditions
Schizoaffective Disorder (2 or more weeks)
- Major mood episode concurrent with Criterion A of schizophrenia
- Specify if bipolar, depressive type, with catatonia
Substance/Medication-Induced Psychotic Disorder
- Presence of Delusions and/or Hallucinations
- Criterion A developed during medication
- Specify if with onset during intoxication/withdrawal
Catatonia
Bipolar & Related disorders
- MANIC EPISODE- emotional state characterized by a period of at least 1 week where an
elevated, expansive, or unusually irritable mood exists.
3 or more of: inflated self-esteem, less sleep, talkative, flight or ideas, distractibility,
increase in goal-oriented activity, excessive involvement in risky activities
impair functioning with psychotic features
- HYPOMANIC EPISODE (4 days)
3 or more of: inflated self-esteem, less sleep, talkative, flight or ideas, distractibility,
increase in goal-oriented activity, excessive involvement in risky activities
No function impairment
- MAJOR DEPRESSIVE EPISODE (2 weeks)
5 or more of the ff: (atleast 1 should be 1 or 2)
1. Depressed mood
2. Loss of interest/pleasure
3. Weight loss
4. Insomnia/hypersomnia
5. Psychomotor agitation
6. Fatigue
7. Feeling of worthlessness/guilt
8. Inability to concentrate/decide
9. Suicidal thoughts
Bipolar I
- At least 1 manic episode
Bipolar II
- At least 1 hypomanic episode AND 1 major depressive episode
- Never been a manic episode
Cyclothymic Disorder (2years or 1 yr in children)
- Presence of hypomanic and depressive symptoms that do not meet criteria for diagnosis
- Have not been without symptoms for 2 months at a time
Depressive Disorders
Disruptive Mood Dysregulation Disorder (at least 12 months )
- Temper outburst (verbal and/or behaviorally) at least 3 times per week lasting 3 or more
months
- Present in 2/3 setting
- Diagnosis should be made between 6-18 years old
- Above criteria met before 10 yrs old
Major Depressive Disorder
- 5 or more of the ff: (atleast 1 should be 1 or 2) for 2 weeks
1. Depressed mood
2. Loss of interest/pleasure
3. Weight loss
4. Insomnia/hypersomnia
5. Psychomotor agitation
6. Fatigue
7. Feeling of worthlessness/guilt
8. Inability to concentrate/decide
9. Suicidal thoughts
- Function impairment
Persistent Depressive Disorder (Dysthymia) – combination of chronic MDD and dysthymic disorder
*mood may shift repidly
*60% manic episodes occurbefore MDE
*strong genetic origin
*comorbid w anxiety disorders & alcohol use
Bipolar II (mid 20)
*hypomanic episode
- change in functioning that is uncharacteristic
-not severe enough to cause impairment
- atleast 1 required
*MDE
- atleast 1 required
*no manic episode
*sypmtoms not better expliad by schizo disorders
*not milder than bipolar 1, bipolar 2 - greater chronicity of illness/more depressive
*impulsive - contribute to higher suicide risk
Anxiety Disorders
---fear: emotional response to real or percieved imminent threat
---anxiety: anticipation of future threat
