ASSIGNMENT

Schizophrenia Spectrum and Other Psychotic Disorder

Submitted to:
Imran Haider Zaidi

Submitted by:
Rabia Azhar
(1599)

M.Sc.
2nd Semester (Eve)

Department of Applied Psychology

Government College University Faisalabad
Table of Content

No Title Page No.

1. Delusional Disorder
2. Brief Psychotic Disorder
3. Schizophreniform Disorder
4. Schizophrenia
5. Schizoaffective Disorder 5
6. Substance / Medication-Induced Psychotic Disorder 6
7. Psychotic Disorder Due to Another Medical Condition 7
8. Catatonia Associated with Another Mental Disorder 8
9. Catatonic Disorder Due to Another Medical Condition 9
10. Unspecified Catatonia 9
11. Other Specified Schizophrenia Spectrum and Other Psychotic
Disorder 10
12. Unspecified Schizophrenia Spectrum and Other Psychotic Disorder
13. Clinical Case 13
14. References 14
1) Delusional Disorder
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). Persecutory delusions (i.e., belief that one is going to be harmed,
harassed, and so forth by an individual, organization, or other group) are most common.
Referential delusions (i.e., belief that certain gestures, comments, environmental cues, and
so forth are directed at oneself) are also common. Grandiose delusions (i.e., when an
individual believes that he or she has exceptional abilities, wealth, or fame) and erotomania
delusions (i.e., when an individual believes falsely that another person is in love with him or
her) are also seen. Nihilistic delusions involve the conviction that a major catastrophe will
occur, and somatic delusions focus on preoccupations regarding health and organ function.

Delusions are deemed bizarre if they are clearly implausible and not understandable to
same-culture peers and do not derive from ordinary life experiences. An example of a
bizarre delusion is the belief that an outside force has removed his or her internal organs
and replaced them with someone else's organs without leaving any wounds or scars. An
example of a no bizarre delusion is the belief that one is under surveillance by the police,
despite a lack of convincing evidence. Delusions that express a loss of control over mind or
body are generally considered to be bizarre; these include the belief that one's thoughts
have been "removed" by some outside force {thought withdrawal), that alien thoughts have
been put into one's mind (thought insertion), or that one's body or actions are being acted
on or manipulated by some outside force (delusions of control). The distinction between a
delusion and a strongly held idea is sometimes difficult to make and depends in part on the
degree of conviction with which the belief is held despite clear or reasonable contradictory
evidence regarding its veracity.

Symptoms:
 Diminished emotional expression
 Avolition
 Reductions in the expression of emotions
in the face
 Reductions in the expression of eye contact
 Alogia
 Anhedonia
 Asociality

Etiology:

 Genetic influences
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 Biological
 Environmental
 Psychological
 Alcohol or drug abuse
Differential Diagnosis:
 X-rays
 Blood tests
 Specially designed interview and assessment tools

Prevalence
The lifetime prevalence of delusional disorder has been estimated at around 0.2%, and
the most frequent subtype is persecutory. Delusional disorder, jealous type, is
probably more common in males than in females, but there are no major gender
differences in the overall frequency of delusional disorder.
Bio Psychosocial Model Causes
An individual's cultural and religious background must be taken into account in evaluating
the possible presence of delusional disorder. The content of delusions also varies across
cultural contexts. The functional impairment is usually more circumscribed than that seen
with other psychotic disorders, although in some cases, the impairment may be substantial
and include poor occupational functioning and social isolation. When poor psychosocial
functioning is present, delusional beliefs themselves often play a significant role. A common
characteristic of individuals with delusional disorder is the apparent normality of their
behavior and appearance when their delusional ideas are not being discussed or acted on.

2) Brief Psychotic Disorder:

Symptoms:
 Delusions

 Hallucinations

 Disorganized speech
 Grossly disorganized or catatonic behavior

Etiology:

 Genetic influences
 Stressful life events
 trauma

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 neurological Components
 environmental component
Differential Diagnosis:
 Pharmacotherapy
 Psychotherapy
 Lurasidone
 Loperidone
 Asenapine
 Paliperidone
Prevalence
In the United States, brief psychotic disorder may account for 9% of cases of first-
onset psychosis. Psychotic disturbances that meet Criteria A and C, but not Criterion
B, for brief psychotic disorder (i.e., duration of active symptoms is 1-6 months as
opposed to remission within 1 month) are more common in developing countries than
in developed countries. Brief psychotic disorder is twofold more common in females
than in males.
Bio Psychosocial Model Causes
Temperamental. Preexisting personality disorders and traits (e.g., schizotypal
personality disorder; borderline personality disorder; or traits in the psychoticism
domain, such as perceptual dysregulation, and the negative affectivity domain, such as
suspiciousness) may predispose the individual to the development of the disorder.
It is important to distinguish symptoms of brief psychotic disorder from culturally
sanctioned response patterns. For example, in some religious ceremonies, an
individual may report hearing voices, but these do not generally persist and are not
perceived as abnormal by most members of the individual's community. In addition,
cultural and religious background must be taken into account when considering
whether beliefs are delusional.

3) Schizophreniform Disorder

Symptoms:

 Delusions

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 Hallucinations
 Disorganized speech
 Disorganized or catatonic behavior
 Social withdrawal
 Flat affect
 Anhedonia
 Aphasia
 Asociality
 Avolition

Etiology:

 Genetic
 Brain chemistry
 Environmental factors

Differential Diagnosis:

 Pharmacotherapy
 Psychotherapy
 Medication
 cognitive behavioral therapy
 interpersonal psychotherapy

Prevalence:

Incidence of schizophreniform disorder across sociocultural settings is likely similar to that

observed in schizophrenia. In the United States and other developed countries, the incidence
is low, possibly fivefold less than that of schizophrenia. In developing countries, the
incidence may be higher, especially for the specifier ''with good prognostic features"; in some
of these settings schizophreniform disorder may be as common as schizophrenia.

4) Schizophrenia

Symptoms:

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 Delusions
 Hallucinations
 disorganized speech
 disorganized behavior

Etiology:

 Genetic causes
 Environmental causes
 Abnormal brain structure

Differential Diagnosis:

 Medications
 Second-generation antipsychotics
 First-generation antipsychotics
 Long-acting injectable antipsychotics
 Psychosocial interventions
 Hospitalization


Prevalence:

Incidence of schizophreniform disorder across sociocultural settings is likely similar to that

observed in schizophrenia. In the United States and other developed countries, the incidence
is low, possibly fivefold less than that of schizophrenia. In developing countries, the
incidence may be higher, especially for the specifier ''with good prognostic features"; in some
of these settings schizophreniform disorder may be as common as schizophrenia.

Bio Psychosocial Model Causes

A holistic approach, the biopsychosocial model, is the most rational and effective way for
both understanding the causation and the treatment of an illness. This should be the model for
the brief inpatient treatment of the schizophrenic syndrome. In establishing a focus of
treatment, particularly in brief inpatient treatment, it is necessary to determine the role and
magnitude of each of the three, the biological, the psychological and social, factors in
precipitating a disequilibrium or breakdown. Only through careful history taking can one

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ascertain the degree of significance of the three factors, to make a prognosis as to recovery,
and to establish a realistic therapeutic plan. Discharge planning must begin almost the very
same day the patient enters the unit. Observation of the patient on the unit to structure, to
other patients and staff, and reactions of staff to the patient usually mirrors the adaptation in
the outer world, and is thus a valuable guide to treatment approach. The team leader, the
psychiatrist, whose understanding of the biological, genetic and constitutional element,
should formulate the treatment plan in conjunction with the input and assessments offered by
members of other disciplines.

5) Schizoaffective Disorder

Symptoms:
• Paranoid thoughts.
• Delusions.
• Hallucinations.
• Confusion.
• Disorganized thoughts or behaviors.
• Catatonia, which is an inability to move normally.
• Speaking too quickly.
• Depression or irritability

Etiology:
• Environmental factors
• Exposure to viruses or toxins while in the womb
• Birth defects
Differential Diagnosis:
• Physical exam
• Psychiatric evaluation
• Antipsychotics
• Antidepressants
• Mood stabilizers
Prevalence:

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Schizoaffective disorder appears to be about one-third as common as schizophrenia. Lifetime
prevalence of schizoaffective disorder is estimated to be 0.3%. The incidence of
schizoaffective disorder is higher in females than in males, mainly due to an increased
incidence of the depressive type among females.

6) Substance/Medication-Induced Depressive Disorder

Symptoms:

 Oversleeping
 Listlessness
 Social and emotional disengagement
 Sadness
 Suicidal thoughts
 Fatigue

Etiology:

  Improper use of a medication

  Person’s decision to abuse an illegal substance

Differential Diagnosis:

 Physical Examination

 Medication

Prevalence:

In a nationally representative U.S. adult population, the lifetime prevalence of substance/

medication-induced depressive disorder is 0.26%.

7) Depressive Disorder Due to Another Medical Condition:

Symptoms:

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Symptoms of depressive disorder due to another medical condition are contingent on the
medical complication that the individual has. Broadly speaking, however, the depression
symptoms are similar to those found in other depressive disorders, such as bipolar and major
depressive disorder. In seeking for symptoms of depressive disorder, the crucial step is to
determine if the individual has a non-neuropsychiatric medical condition.

As one of the symptoms that follow from this disorder, the DSM-5 notes that individuals with
depressive disorder are not likely to find interest in many activities that were previously
enjoyed. Additionally, if the mood disorders occur when the patient does not have delirium,
then a diagnosis of depressive disorder due to another medical condition may be warranted.

Etiology:

 hypothyroidism

 disruption of normal activities

Differential Diagnosis:

 cognitive-behavioral therapy

 psychological interventions

 Rule out medication-caused depressive disorder

8) Other Specified Depressive Disorder:

Symptoms:

This category applies to presentations in which symptoms characteristic of a depressive

disorder 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 any of
the disorders in the depressive disorders diagnostic class. The other specified depressive
disorder category is used in situations in which the clinician chooses to communicate the

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specific reason that the presentation does not meet the criteria for any specific depressive
disorder. This is done by recording “other specified depressive disorder” followed by the
specific reason (e.g., “short-duration depressive episode”).

Etiology:

 Clinically significant distress

 Impairment in social, occupational, or other important areas of functioning

predominate

Differential Diagnosis:

 Psychotherapy

 Pharmacotherapy 

9) Unspecified Depressive Disorder

Symptoms:

This category applies to presentations in which symptoms characteristic of a depressive

disorder 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 any of
the disorders in the depressive disorders diagnostic class. The unspecified depressive disorder
category is used in situations in which the clinician chooses not to specify the reason that the
criteria are not met for a specific depressive disorder, and includes presentations for which
there is insufficient information to make a more specific diagnosis (e.g., in emergency room
settings).

Etiology:

 Distress due to medical conditions

 Environmental effects and situations

Differential Diagnosis:

 Psychotherapy

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 Pharmacotherapy 
10) Bipolar and Related Disorders

Bipolar disorder, formerly called manic depression, is a mental health condition that causes
extreme mood swings that include emotional highs (mania or hypomania) and lows
(depression). When you become depressed, you may feel sad or hopeless and lose interest or
pleasure in most activities. When your mood shifts to mania or hypomania (less extreme than
mania), you may feel euphoric, full of energy or unusually irritable. These mood swings can
affect sleep, energy, activity, judgment, behavior and the ability to think clearly. Episodes of
mood swings may occur rarely or multiple times a year. While most people will experience
some emotional symptoms between episodes, some may not experience any. Although
bipolar disorder is a lifelong condition, you can manage your mood swings and other
symptoms by following a treatment plan. In most cases, bipolar disorder is treated with
medications and psychological counseling (psychotherapy).

11) Bipolar I, Bipolar II Disorder

Mania and Hypomania:

Mania and hypomania are two distinct types of episodes, but they have the same symptoms.
Mania (lasting at least 1 week) is more severe than hypomania (lasting at least 4 consecutive
days).
While they vary in intensity, most of the symptoms of mania and hypomania are the same.
Three (or more) of the following symptoms (four if the mood is only irritable) are present to
diagnose.
 Grandiosity or overblown self-esteem
 Reduced sleep need
 Increased talkativeness, or drive to continue talking
 Rapidly shifting ideas or the sense that one’s thoughts are moving very fast
 Attention pulled in many directions
 Heightened activity or agitated movements

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 Excessive pursuit of risky and potentially problematic activities.
Bipolar I Disorder:
1. Occurrence of a manic episode.
2. Hypomanic or major depressive episodes may precede or follow the manic episode.
Bipolar II Disorder:
1. Presence or history of major depressive episode(s).
2. Presence or history of hypomanic episode(s).
3. No history of a manic episode
Etiology:
 Low serotonin activity accompanied by high norepinephrine activity.
 Abnormal functioning in the proteins.
 Abnormal brain structures.
 Genetic abnormalities.

Differential Diagnosis:
 Adjunctive Psychotherapy
 Lithium and Other Mood Stabilizers
Bipolar I Prevalence:
The 12-month prevalence estimate in the continental United States was 0.6% for bipolar
disorder as defined in DSM-IV. Twelve-month prevalence of bipolar I disorder across 11
countries ranged from 0.0% to 0.6%. The lifetime male-to-female prevalence ratio is
approximately 1.1:1.
Bipolar II Prevalence:
The 12-month prevalence of bipolar II disorder, internationally, is 0.3%. In the United
States, 12-month prevalence is 0.8%. The prevalence rate of pediatric bipolar II disorder is
difficult to establish. DSM-IV bipolar I, bipolar II, and bipolar disorder not otherwise
specified yield a combined prevalence rate of 1.8% in U.S. and non-U.S. community
samples, with higher rates (2.7% inclusive) in youths age 12 years or older.

12) Cyclothymia:

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Symptoms:
 Mood changes less severe than the mood swings seen in bipolar disorder.
 Persist for at least 2 years.
 In depressed phase:
 Distinct loss of interest
 Low energy,
 Feelings of inadequacy, social withdrawal, and a pessimistic,
 Brooding attitude
 In Hypomanic phase:
 Increased physical and mental energy.
 Overblown self-esteem
Etiology:
 Heredity, as cyclothymia tends to run in families
 Differences in the way the brain works, such as changes in the brain's
neurobiology
 Environment, such as traumatic experiences or prolonged periods of
stress
Differential Diagnosis:
Same as for bipolar I&II
Prevalence:
The lifetime prevalence of cyclothymic disorder is approximately 0.4%-l%. Prevalence in
mood disorders clinics may range from 3% to 5%. In the general population, cyclothymic
disorder is apparently equally common in males and females. In clinical settings, females
with cyclothymic disorder may be more likely to present for treatment than males.

13) Substance / Medication-Induced Bipolar and

Related Disorder
Symptoms:
A prominent and persistent disturbance in mood that predominates in the
clinical picture and is characterized by depressed mood or markedly
diminished interest or pleasure in all, or almost all, activities.

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Etiology:

 Alcohol
 Alpha-2-adrenergic agonists
 Amphotericin
 Anabolic steroids
 Beta-blockers
 Bismuth
 Carbamazepine
 Cis-retinoic acid
 Corticosteroids
 Cyclosporin
 Digitalis

Differential Diagnosis:
 Eliminate instigating agent.
 If ongoing symptoms, treat with antidepressant agent.
Prevalence:
There are no epidemiological studies of substance/medication-induced mania or bipolar
disorder. Each etiological substance may have its own individual risk of inducing a bipolar
(manic/hypomania) disorder.

14) Bipolar and Related Order Due to Another Medical

Condition
Symptoms:
 Abnormally elevated, expansive, or irritable mood
 Abnormally increased activity
 Energy that predominates in the clinical picture
Etiology:
 Medical condition
Differential Diagnosis:
 Medication
 Clinical Judgment

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15) Clinical Case: Myles

Myles was a 20-year-old man who was brought to the emergency room by the campus police
of the college from which he had been suspended several months ago. A professor had called
and reported that Myles had walked into his classroom, accused him of taking his tuition
money and refused to leave.

Although Myles had much academic success as a teenager, his behavior had become
increasingly odd during the past year. He quit seeing his friends and no longer seemed to care
about his appearance or social pursuits. He began wearing the same clothes each day and
seldom bathed. He lived with several family members but rarely spoke to any of them. When
he did talk to them, he said he had found clues that his college was just a front for an
organized crime operation. He had been suspended from college because of missing many
classes. His sister said that she had often seen him mumbling quietly to himself and at times
he seemed to be talking to people who were not there. He would emerge from his room and
ask his family to be quiet even when they were not making any noise.

Myles began talking about organized crime so often that his father and sister brought him to
the emergency room. On exam there, Myles was found to be a poorly groomed young man
who seemed inattentive and preoccupied. His family said that they had never known him to
use drugs or alcohol, and his drug screening results were negative. He did not want to eat the
meal offered by the hospital staff and voiced concern that they might be trying to hide drugs
in his food.

His father and sister told the staff that Myles’ great-grandmother had had a serious illness and
had lived for 30 years in a state hospital, which they believed was a mental hospital. Myles’
mother left the family when Myles was very young. She has been out of touch with them, and
they thought she might have been treated for mental health problems.
Myles agreed to sign himself into the psychiatric unit for treatment. His story reflects a
common case, in which a high-functioning young adult goes through a major decline in day-
to-day skills. Although family and friends may feel this is a loss of the person they knew, the
illness can be treated and a good outcome is possible. In the case of Myles, he was having
persecutory delusions, auditory hallucinations and negative symptoms that had lasted for at

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least one year. All of these symptoms fit with a diagnosis of schizophrenia. It is key for the
treating doctor to quickly rule out other causes of the problem, such as substance use, a head
injury or a medical illness. Treatment for these conditions differs from that for schizophrenia
and may be lifesaving.

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References
 https://www.ncbi.nlm.nih.gov/books/NBK539912/
 Barlow, D. H., & Durand, V. M. (2016). Abnormal psychology: An integrated
approach. Cengage Learning.
 Butcher, J. N., Mineka, S., & Hooley, J. M. (2017). Abnormal psychology.
Pearson Education India.
 https://www.merckmanuals.com/professional/psychiatric-disorders/mood-
disorders/depressive-disorders
 American Psychiatric Association. (2013). Diagnostic and statistical manual of
mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  "Depressive Disorders 3rd Edition". John Wiley & Sons. 2009.

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