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SCHIZOPHRENIA & OTHER PSYCHOTIC DISORDERS

SCHIZOPHRENIA & OTHER PSYCHOTIC DISORDERS. Core Concept: Distorted perception of reality Impaired capacity to reason, speak, and behave rationally or spontaneously Impaired capacity to respond with appropriate affect & motivation. SCHIZOPHRENIFORM DISORDER.

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SCHIZOPHRENIA & OTHER PSYCHOTIC DISORDERS

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  1. SCHIZOPHRENIA & OTHER PSYCHOTIC DISORDERS Core Concept: • Distorted perception of reality • Impaired capacity to reason, speak, and behave rationally or spontaneously • Impaired capacity to respond with appropriate affect & motivation

  2. SCHIZOPHRENIFORM DISORDER • 2 or more of the following sx are present for at least a month: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, negative sx • R/O schizoaffective disorder, mood disorders, and the effects of a substance or general medical condition • An episode of the disorder (including prodromal, active, & residual phases) lasts at least a month but less than 6 months Provisional diagnosis prior to 6 months.

  3. Shizophreniform Disorder: Specifiers • Without Good Prognostic Features • With Good Prognostic Features – as evidenced by 2 or more of the following: • acute onset of Sx • confusion or perplexity at height of psychotic episode • good premorbid social and occupational functioning • absence of blunted or flat affect

  4. Treatment Planning for Schizophreniform Disorder • Psychoeducation • Supportive therapy • Maintenance antipsychotic medication • Better prognosis

  5. Diagnostic Criteria for Schizoaffective Disorder • Overlap of mood sx & psychotic sx • 2 week period of psychotic sx without mood sx • Mood sx are prominent & enduring part of clinical picture Specifiers: Bipolar Type – disturbance includes manic or mixed episode Depressive Type – disturbance includes major depressive episode

  6. Diagnostic Concerns for Schizoaffective Disorder • Difficult to determine whether mood sx are of sufficient severity and duration to warrant dx of Schizoaffective (vs. schizophrenia) • Difficult to determine whether psychotic sx occur only in the context of mood disorder (Mood Disorder with Psychotic Features) • Dx applies only to a given episode of the disorder, not to lifetime course

  7. Treatment Planning for Schizoaffective Disorder • No clear treatment guidelines • Acute management: antipsychotic medication for psychotic sx; mood stabilizer for manic or mixed sx; antidepressant for depressive sx • Maintenance treatment: medication management and compliance, psychoeducation, stress reduction

  8. DELUSIONAL DISORDER Diagnostic Criteria: • Presence of 1 or more nonbizarre delusions (involve plausible situations, e.g. being followed, poisoned, infected, loved at a distance, betrayed by a lover, or having a disease) of at least 1 month’s duration. • Aside from impact of delusion(s), functioning is not markedly impaired and behavior is not obviously odd or bizarre. • Criteria A for Schizophrenia has never been met.

  9. Subtypes for Delusional Disorder Based on prominent delusional theme: • Erotomanic: belief thatanother person, usually of higher status, is in love with you • Grandiose: belief that you have inflated worth, power, knowledge, identity, or a special relationship to a prominent person • Jealous: belief that lover is unfaithful • Persecutory: belief that you’re being treated malevolently, e.g. cheated, conspired against, poisoned, spied on • Somatic: belief that you have a physical defect or general medical condition • Mixed: >1 of above themes; no 1 theme predominates • Unspecified: central theme doesn’t fit other types

  10. Diagnostic Concerns for Delusional Disorder: • Could beliefs be based in reality? • Delusional beliefs vs. strongly held beliefs • Could beliefs reflect person’s cultural and religious background? • Could beliefs be due to the effects of a substance or general medical condition?

  11. Treatment Planning for Delusional Disorder • Use of medication: antipsychotics, antidepressants • Psychotherapy: confronting the delusion, reality testing, gentle probing

  12. Brief Psychotic Disorder Diagnostic Criteria: Presence of 1 or more of the following: • Delusions • Hallucinations • Disorganized speech • Grossly disorganized or catatonic behavior Duration: at least a day, but less than a month • Diagnosis is given after person has fully recovered in less than a month.

  13. Specifiers for Brief Psychotic Disorder: • With Marked Stressors: brief reactive psychosis • Without Marked Stressors • With Postpartum Onset: within 4 weeks postpartum

  14. Treatment of Brief Psychotic Disorder: • Medication: antipsychotic • Psychotherapy: aimed at helping individual cope with or escape from the stressor (if one is present)

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