Differential Diagnosis • Schizoaffective Disorder • Schizophrenia • Schizophreniform Disorder • Major Depressive Disorder (single episode), with mood-incongruent psychotic features • Dysthymic Disorder
Schizoaffective Disorder • a psychotic disorder • both the symptoms of schizophrenia and mood disorders are present • Diagnosis: major depressive episode, manic episode, or both are present during the active phase of Schizophrenia • The patient should also have delusions or hallucinations for at least 2 weeks without mood disorders • Should also not be substance-induced or due to a general medical condition
Schizophrenia • characterized by delusions, hallucinations, disorganized speech, disorganized behavior, and negative symptoms such as alogia, anhedonia, and avolition. • two or more of the said symptoms must be present for at least 6 months • There is decline in the social and occupational functioning of the individual. • the patient’s mood episodes should be shorter than the active and residual periods of schizophrenia OR the major depressive episodes are not concurrent with psychotic symptoms but the duration is more than 6 months
Schizophreniform Disorder • very similar set of manifestations as schizophrenia • its duration must be at least one month but less than 6 months. • at least two or more psychotic symptoms: hallucination, delusions, disorganized speech and behavior or negative symptoms. • Epidemiologic studies: relatives of patients with schizophreniform disorder, in contrast to those with schizophrenia, have a more likely chance to develop mood disorders.
Major Depressive Disorder with mood-incongruent psychotic features • Diagnosis of this disorder requires at least four of the following: • Difficulties in sleeping • Psychomotor agitation/retardation • Poor appetite and weight loss or increased appetite and weight gain • Loss of energy • Feelings of worthlessness • Difficulty concentrating, thinking, or making decisions • Recurrent thoughts of death/suicide
Major Depressive Disorder with mood-incongruent psychotic features • symptoms be present almost everyday for at least 2 weeks and should not be due to normal bereavement • functional impairment • the active and residual periods of schizophrenia are longer than the mood episodes and the hallucinations free of mood episode last for less than 2 weeks
Dysthymic Disorder • chronic long lasting form of depression • Literally means 'bad state of mind' or 'ill humor' • tends to run in families • two to three times more common in women than in men
Dysthymic Disorder • Shares many characteristic symptoms of major depressive disorder • symptoms tend to be less severe but do fluctuate in intensity • Diagnosis: must experience 2 or more of the following symptoms for most of the day, more days than not, for at least 2 year • Feelings of hopelessness • Insomnia or hypersomnia • Poor concentration or difficulty making decisions • Low energy or fatigue • Low self-esteem; • Poor appetite or overeating