Schizophrenia Other Psychotic Disorders

1. Schizophrenia & Other Psychotic Disorders 7.19.2007

2. Schizophrenia Two or more of the following, each present for a significant portion of the time during a 1-month period** Delusions Hallucinations Disorganized speech Grossly disorganized or catatonic behavior Negative symptoms **Exception to the 2+ symptom requirement: only 1 psychotic symptom required if: Delusion is bizarre Hallucination consists of

3. Delusions (Positive Symptom) Fixed, false beliefs Types Bizarre � Thought insertion � Thought withdrawal � Thought broadcast � Reference �

4. Delusions (positive symptom) Types, continued Control � Somatic � Nihilistic � Grandiose � Religious � Persecutory �

5. Hallucinations (Positive Symptom) False sense perception Types Auditory � Tactile � Visual � Olfactory/Gustatory � Somatic �

6. Disorganized Speech (Positive Symptom) Speech that is hard to understand or follow, impairs communication Types Loose associations � Incoherence � Frequent derailment �

7. Disorganized Speech (Positive Symptom) Types Circumlocution � Tangential � Clang � Neologisms �

8. Disorganized Speech:Geometric Analogy

9. Grossly Disorganized or Catatonic Behavior (Positive Symptom) Grossly Disorganized Behavior

10. Grossly Disorganized or Catatonic Behavior (Positive Symptom) Catatonic Behavior

11. Negative Affect (Negative Symptom) Flat affect No emotional expression in speech Restricted fluency of thought and speech

12. Schizophrenia **Exception to the 2+ symptom requirement: only 1 psychotic symptom required if: 1. Delusion is bizarre OR 2. Hallucination consists of either: a. voice keeps up a running commentary on the person�s thoughts or behavior OR b. two or more voices conversing with each other

13. Schizophrenia Impairment in functioning Signs of the disturbance for at least 6 months, that includes at least 1 month of symptoms described by Criterion A Symptoms are not better accounted for Schizoaffective Disorder or Mood Disorder with Psychotic Features Not due to a GMC or substance If there is a developmental disorder present, there are prominent delusions or hallucinations present for at least one month

14. Facts about Schizophrenia Prevalence: Gender: Age of Onset: Course:

15. Facts about Schizophrenia Course: Onset may be acute or gradual Many sufferers experience three phases Prodromal � beginning of deterioration Active � meet criteria for Schizophrenia Residual � return to prodromal levels

16. Facts about Schizophrenia Course, continued

17. Schizophrenia: Course

18. Facts about Schizophrenia Outcome Approximately 15% Approximately 85% Approximately 50% 90% or more 75% or more Approximately 10%

19. Facts about Schizophrenia Culture: Prevalence seems to be higher in lower SES communities �Downward drift� � direction of causality?

20. Facts about Schizophrenia Culture, continued Prevalence doesn�t vary Prevalence doesn�t vary Cross cultural variation

21. Factors associated with better prognosis Good premorbid functioning Acute onset Later age at onset Being female Mood disturbance Family history of Mood Disturbance

22. Factors associated with better prognosis Treatment with antipsychotic medication Compliance with medication Brief duration of symptoms Good interepisode functioning No family history of Schizophrenia Insight

23. Subtypes of Schizophrenia Paranoid Disorganized Catatonic Undifferentiated Residual

24. Paranoid Schizophrenia Preoccupation with one or more delusions or auditory hallucinations (usually persecutory, grandiose, or both) None of the following is prominent: Disorganized speech, Disorganized behavior Catatonic behavior Flat/inappropriate affect

25. Disorganized Schizophrenia All of the following are prominent Disorganized speech Disorganized behavior Flat/Inappropriate affect There is no catatonic behavior

26. Catatonic Schizophrenia A type of Schizophrenia in which the clinical picture is dominated by at least 2 or more catatonic behaviors Motoric immobility as evidenced by stupor, catalepsy, or waxy flexibility Excessive motor activity that is apparently purposeless and not influenced by external stimuli Extreme negativism or mutism Peculiarities of movement (posturing, stereotyped movements, prominent mannerisms, or prominent grimacing Repeating whatever is said or done

27. Undifferentiated Schizophrenia Characterized by symptoms which fit do not fit the paranoid, disorganized, or catatonic subtypes Vague, �catch-all� category

28. Residual Schizophrenia Characterized by symptoms that have lessoned in strength and number Person may continue to display blunted or inappropriate emotions

29. Schizophrenia: Risk Factors Being born in winter or early spring Family history of Schizophrenia Risk of developing Schizophrenia 6% chance 10% chance 13% chance 42% chance 50% chance If one MZ twin has Schizophrenia and the other one doesn�t, the one who doesn�t have it often isn�t completely asymptomatic (e.g. may have a personality disorder)

30. Schizophrenia: Biology Dopamine Hypothesis Schizophrenia has been linked to excessive dopamine activity Effective antipsychotics are dopamine antagonists Bind to dopamine receptors Decreasing dopamine too far can result in Tardive Dyskinesia Problem with the Dopamine hypothesis

31. Other Psychotic Disorders Schizophreniform Disorder Brief Psychotic Disorder Schizoaffective Disorder Delusional Disorder Shared Psychotic Disorder

32. What is a Psychotic Disorder Psychosis A break from reality Often involves difficulties interacting with and perceiving the real world Split between thoughts and emotions

33. Schizophreniform Disorder Criteria A, D, and E of Schizophrenia are met An episode of the disorder (including the prodromal, active, and residual phases) lasts at least 1 month but less than 6 months

34. Schizophreniform Disorder Essentially, exactly like Schizophrenia, but the duration is shorter Schizophrenia: Schizophreniform: Often used as a provisional diagnosis during the first months of a psychotic illness Thus, this diagnosis can change to Schizophrenia after 6 months have passed without complete recovery

35. Facts about Schizophreniform Disorder Prevalence**: Varies substantially: Industrialized areas: Non-industrialized areas:

36. Facts about Schizophreniform Disorder Gender: Age of Onset: Course: 1/3 - 2/3 -

37. Brief Psychotic Disorder A. Presence of one or more of the following symptoms: Delusions Hallucinations Disorganized speech Grossly disorganized or catatonic behavior B. Duration of an episode of the disturbance is at least 1 day but less than 1 month, with eventual full return to premorbid levels of functioning C. Disturbance is not better accounted for by another mental disorder and is not due to a GMC or substance

38. Brief Psychotic Disorder vs. Schizophrenia/Schizophreniform Criteria Schizophrenia/Schizophreniform Disorder Brief Psychotic Disorder Duration Schizophrenia: Schizophreniform Disorder: Brief Psychotic Disorder:

39. Facts about Brief Psychotic Disorder Prevalence: Gender: Age of Onset: Course:

40. Schizoaffective Disorder An uninterrupted period of illness during which, at some time, there is either a Major Depressive Episode, a Manic Episode, or a Mixed Episode concurrent with symptoms that meet Criterion A for Schizophrenia During the same period of illness, there have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms

41. Schizoaffective Disorder D. Symptoms that meet criteria for a mood episode are present for a substantial portion of the total duration of the illness E. Not due to a GMC or substance

42. Subtypes of Schizoaffective Disorder Bipolar Type: Depressive Type:

43. Facts about Schizoaffective Disorder Prevalence: Gender:

44. Facts about Schizoaffective Disorder Age of Onset: Bipolar Subtype � Depressive Subtype � Course: Better prognosis than Worse prognosis than Better prognosis

45. Delusional Disorder Nonbizarre delusions lasting for at least 1 month Criterion A for Schizophrenia have never been met (However, tactile and olfactory may be present if they are related to the delusional theme) Behavioral functioning is not markedly imparied and behavior is not obviously odd or bizarre

46. Delusional Disorder D. If mood episodes have occurred concurrently with delusions, their total duration has been brief relative to the duration of the delusional periods E. Not due to the direct effects of a GMC or substance

47. Types of Delusional Disorder Erotomanic � Grandiose � Jealous �

48. Types of Delusional Disorder Persecutory � Somatic � Mixed � Unspecified �

49. Facts about Delusional Disorder Prevalence: 0.03% - 1-2% - Gender: Age of Onset: Course:

50. Shared Psychotic Disorder (Folie � Deux) A delusion develops in an individual in the context of a close relationship with another person(s), who has an already-established delusion The delusion is similar in content to that of the person who already has the established delusion The disturbance is not better accounted for by another psychotic disorder or is due to a GMC or substance

51. Shared Psychotic Disorder The delusions are shared between two people are in a close relationship (husband and wife, parent and child, siblings, etc.) Typically, the person with the original delusion is the more dominant personality in the relationship Generally the delusions are only shared by two people, but can be shared among large groups of people as well

52. Facts about Shared Psychotic Disorder Prevalence: Gender: Age of Onset: Course: