DSM-5-TR - Schizophrenia Spectrum & Other Psychotic Disorders

Question 1

Schizophrenia | Psychotic Disorders
Key Concepts*

Answer 1

positive sx
negative sx
specifier - w/ catatonia (3 or more sx)

Question 2

Schizophrenia

Answer 2

3 Basic Conditions REQUIRED
- Active psychotic sx; at least 1m
- Disturbance continuous; at least 6m
- Decline in overall fxn
(ADD)

Presence of 2 or more REQUIRED:
- delusions, hallucinations, disorganized speech, grossly disorganized/cataotnic bx or negaitve sx

AT LEAST 1 must be delusions, hallucinations, disorganized speech

[prodromal vs. residual]

Onset
* typical b/w late teens - early 30s
* median age mid-20s Males; late-20s Female
* abrupt or gradual
* Most involve ‘prodromal phase’ - overall fxn deterioration
* Characterized by exacerbations/remissions, or progressive deterioration

Prevalence/Prognosis
* Prevalence of .3% - .7%
* M:F - equal
* Prognosis best when - good prior fxn, abrupt onset, less neg sx, minimal cog impairment. —- Being F, later onset

Risks | Heritability
* High for SI; 5% dying by, 20% attempting
* Fraternal Twins/Sibs - 10%
* Identical Twins - 50%
* Both Parents - 45%
* Relatives of - also other disorders of the spectrum

Measured by
* MRI - enlarged 3rd ventricle, smaller cerebral cortex, smaller thalamus
* PET - decreased frontal lobe activity (neg sx)

Medications | Key Component *
* Novel/Atypical Antipsychotics
* Traditional Antipsychotics

Interventions
* CBT, Family Psychoeducation (FP)
* (EE) by family predicts relapse
* Family works to decrease EE and focus on client’s strengths and resilience
* (SST) - teaches skills of communication, assertiveness, disease management, independent living
* [research in support] cognitive remediation, supported employment, social learning/token economy programs

Question 3

Delusional Disorder

Answer 3

Involves:
* 1+ delusions for AT LEAST 1m — absence of additional schizophrenic sx
* Behavior relatively unimpaired
* Not ‘obviously’ odd, except for those impacted (can be substantial regardless)

Onset
* typical mid-late adulthood
* persecutory most common

Specifiers of - erotomanic (higher status), grandiose (self or rx to diety/famous person), jealous (partner being unfaithful), persecutory (ill-treated, may trigger violence), somatic (body fxns/sensations), mixed, unspecified, w/ bizarre content

Question 4

Brief Psychotic Disorder

Answer 4

• 1 or more positive sx
• episodes last 1day - 1m
• eventual return to premorbidity
• specificied as – with/without marked stressor OR with postpartum onset

Question 5

Schizophreniform

Answer 5

• Only difference from Schizophrenia is the duration — at least 1m | less than 6m
• Specifiers of with or without ‘good prognostic features’
• 1/3 of recover w/in 6m
• 2/3 Dx of Schizophrenia OR Schizoaffective

Question 6

Schizoaffective Disorder

Answer 6

• Major Mood Episode (major depressive or manic CONCURRENT with Sx of Schizophrenia
• AND AT LEAST 2 wks w/o the mood Sx

Question 7

Additonal

Answer 7

Induced Psychotic Disorder | triggered by

Other Specified Schizophrenia | Psychotic Disorder
* attenuated psychosis syndrome (-like symptoms, or just below full)
* delusional symptoms in the context of relationship with an individual w/ prominent delusions. [??]