Psychotic disorders Flashcards
Delusional disorder
A. The presence of one or more delusions with a duration of 1 month or longer.
B. Criterion A for schizophrenia has never been met.
Note: Hallucinations, if present, are not prominent and are related to the delusional theme i.e. the sensation of being infested with insects associated with delusions of infestation.
C. Apart from the impact of the delusion(s) or its ramifications, functioning is not markedly impaired, and behavior is not obviously bizarre or the.
D. If manic or major depressive episodes have occurred these have been brief relative to the duration of the delusional periods.
E. The disturbance is not attributable to the physiological effects of a substance or another medical condition and is not better explained by another mental disorder such as body dysmorphic disorder or OCD.
Types: Erotomanic, Grandiose, Jealous, Persecutory, Somatic, Mixed, Unspecified, with bizarre content
Brief psychotic disorder
A. Presence of one or more of the following symptoms. At least 1 of these must be 1, 2, or 3:
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior.
B. Duration of an episode of the disturbance is at least one day but less than 1 month, with eventual full return to premorbid level of functioning.
C. The disturbance is not better explained by major depressive or bipolar disorder with psychotic features or another psychotic disorder such as schizophrenia or catatonia, and is not attributable to the physiological effects of another substance or another medical condition.
Specify years: With or without marked stressors, with postpartum onset, with catatonia
Schizophreniform disorder
A. 2 or more of the following, each present for significant portion of time during a 1 month period, or less if successfully treated. At least 1 of these must be 1, 2, or 3:
1. Delusions
2. Hallucinations
3. Disorganized speech i.e. frequent derailment or incoherence
4. Grossly disorganized or catatonic behavior
5. Negative symptoms i.e. diminished emotional expression or a volition
B. An episode of the disorder last at least 1 month but less than 6 months. When the diagnosis must be made without waiting for recovery, it should be qualified as “provisional”
C. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either 1. No major depressive or manic symptoms have occurred concurrently with the active phase symptoms, or 2. If mood episodes have occurred during active phase symptoms, they have been present for minority of the total duration of the active and residual periods of the illness
D. The disturbance is not attributable to the physiological effects of a substance or another medical condition
Specifiers: With or without good prognostic features, with catatonia
Schizophrenia
A. 2 or more of the following, each present for significant portion of time during a 1 month period, Or less 6 successfully treated. At least 1 of these must be 1, 2, or 3:
1. Delusions
2. Hallucinations
3. Disorganized speech i.e. frequent derailment or incoherence
4. Grossly disorganized or catatonic behavior
5. Negative symptoms i.e. diminished emotional expression or ambulation
B. For significant portion of the time during the onset of the disturbance. Level of functioning in 1 or more major areas, such as work, interpersonal relations, or self-care is markedly below the level achieved prior to the onset, or when onset is in childhood or adolescence there is failure to achieve expected level of interpersonal, academic or occupational functioning
C. Continue signs of the disturbance persist for at least 6 month period. The 6 month period must include at least 1 month of symptoms or less if successfully treated that meet criterion A (active phase symptoms) and may include periods of prodromal or residual symptoms. During these prodrome or residual period the signs of the disturbance may be manifested by only negative symptoms or by 2 or more symptoms we will send criterion a present in an attenuated form (odd believes, unusual perceptual experiences)
D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either 1. No major depressive or manic episodes have occurred concurrently with the active phase symptoms or 2. If mood episodes have occurred during active phase symptoms they have been present for minority of the total duration of the active and residual periods of illness
E. The disturbance is not attributable to the physiological effects of the substance or another medical condition
F. If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia are also present for at least 1 month (or less if successfully treated)
Specifiers: First episode, currently in acute episode; first episode, currently in partial remission; first episode, currently in remission; multiple episodes (same as above); continuous; unspecified; with catatonia
Schizoaffective disorder
A. An uninterrupted period of illness during which there is a major mood episode (major depressive or manic) concurrent with criterion A of schizophrenia
Note: The major depressive episode must include criterion A1: Depressed mood
B. Delusions or hallucinations for 2 or more weeks in the absence of a major mood episode during the lifetime duration of the illness
C. Symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the active and residual portions of the illness
D. Disturbance is not attributable to the effects of a substance or another medical condition
Specifiers: Bipolar type, depressed type, with catatonia, episodes specify as per schizophrenia
Substance/medication-induced psychotic disorder
A. Presence of one or both of the following symptoms:
1. Delusions
2. Hallucinations
B. There is evidence from the history, PE, or lab findings of both 1. and 2.:
1. The symptoms and criteria and a developed during or soon after substance intoxication or withdrawal or after exposure to a medication
2. The involved substance/medication is capable of producing the symptoms and criterion A
C. The disturbance is not better explained by psychotic disorder that is not substance/medication induced. Such evidence of an independent psychotic disorder could include the following:
The symptoms preceded the onset of the substance/medication use; The symptoms persist for a substantial period of time (I.e about 1 month) after the cessation of acute withdrawal or severe intoxication; or there is evidence of an independent non-substance/medication induced psychotic disorder (i.e. a history of recurrent non-substance/medication related episodes)
D. The disturbance does not occur exclusively during the course of a delirium
E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
Psychotic disorder due to another medical condition
A. Prominent hallucinations or delusions
B. There is evidence from the history, physical exam, or lab findings at the disturbance is a direct pathophysiological consequence of another medical condition
C. The disturbance is not better explained by another mental disorder
D. The disturbance does not occur exclusively during the course of a delirium
E. The disturbance causes clinically significant distress or impairment social, occupational, or other important areas of functioning
Specify: With delusions, with hallucinations
Catatonia associated with another mental disorder
A. The clinical picture is dominated by 3 or more of the following symptoms:
- Stupor i.e. no psychomotor activity; and not actively relating to the environment
- Catalepsy i.e. passive induction of a posture held against gravity
- Waxy flexibility i.e. slight or even resistance to positioning by examiner
- Mutism i.e. no or very little verbal response (excluded of known aphasia)
- Negativism i.e. opposition or no response to instructions or external stimuli
- Posturing i.e. spontaneous and active maintenance of the posture against gravity
- Mannerisms i.e. odd, circumstantial caricature of normal actions
- Stereotypy i.e. repetitive or abnormally frequency, non-goal-directed movements
- Agitation, not influenced by external stimuli
- Grimacing
- Echolalia i.e. mimicking another speech
- Echopraxia i.e. mimicking another’s movements
Coding note: Indicate the name of the associated mental disorder when recording the name of the condition i.e. catatonia associated with major depressive disorder
Catatonic disorder due to another medical condition
A. The clinical picture is dominated by 3 or more of the following symptoms:
1. Stupor i.e. no psychomotor activity; and not actively relating to the environment
2. Catalepsy i.e. passive induction of a posture held against gravity
3. Waxy flexibility i.e. slight or even resistance to positioning by examiner
4. Mutism i.e. no or very little verbal response (excluded of known aphasia)
5. Negativism i.e. opposition or no response to instructions or external stimuli
6. Posturing i.e. spontaneous and active maintenance of the posture against gravity
7. Mannerisms i.e. odd, circumstantial caricature of normal actions
8. Stereotypy i.e. repetitive or abnormally frequency, non-goal-directed movements
9. Agitation, not influenced by external stimuli
10. Grimacing
11. Echolalia i.e. mimicking another speech
12. Echopraxia i.e. mimicking another’s movements
B. There is evidence from the history, physical exam, or lab findings at the disturbance is the direct pathophysiological consequence of another medical condition
C. The disturbance is not better explained by another mental disorder
D. The disturbance does not occur exclusively during the course of a delirium
E. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
Coding note: Include the name of the medical condition and the name of the mental disorder i.e. catatonic disorder due to hepatic encephalopathy
Unspecified catatonia
This category applies to presentations in which symptoms characteristic of catatonia because clinically significant distress or impairment in social, occupational or other important areas of functioning but either the nature of the underlying mental disorder or other medical condition is unclear, full criteria of catatonia are not met, or there is insufficient information to make a more specific diagnosis
Other specified schizophrenia spectrum and other psychotic disorder
Applies to presentations in which symptoms characteristic of psychotic disorders 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 schizophrenia spectrum and other psychotic disorders diagnostic class. “The other specified” category is used in situations in which the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for any specific schizophrenia disorder, followed by the specific reason.
Examples of presentations that can be sets specified using the “other specified” designation:
1. Persistent auditory hallucinations, occurring in the absence of any other features
2. Delusions with significant overlapping mood episodes: This includes persistent delusions with periods of overlapping mood episodes that are present for a substantial portion of the delusional disturbance such that the criterion stipulating only brief mood disturbance and delusional disorder is not met
3. Attenuated psychosis syndrome: This syndrome is characterized by psychotic-like symptoms that are below the threshold for full psychosis i.e. the symptoms are less severe and more transient and insight is relatively maintained
4. Delusional symptoms and partner of individual with delusional disorder: In the context of relationship, the delusional material from the dominant partner provides content for delusional belief by the individual who may not otherwise entirely meet criteria for delusional disorder
Unspecified schizophrenia spectrum and other psychotic disorder
Applies to presentations in which symptoms characteristic of a schizophrenia spectrum and other psychotic 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 schizophrenia spectrum class. The unspecified schizophrenia spectrum and other psychotic disorder category is used in situations in which the clinician chooses NOT to specify the reasons that the criteria are not met for specific schizophrenia spectrum and other psychotic disorder, and includes presentations in which there is insufficient info to make more specific diagnosis i.e. in emergency room settings
