Schizophrenia Spectrum and Other Psychotic Disorders Flashcards
Delusion Disorder Criteria
A. The presence of one (or more) delusions with duration of 1 mo or longer
B. Criterion A for schizophrenia has never been met (hallucinations are not present or if so are related to the delusion)
C. Functioning not markedly impaired
D. Episodes of mania or major depression are brief in comparison to the delusional period
E. Disturbance isn’t attributable to the physiological effects of a substance or another medical condition
What kind of delusion is a belief that one is going to be harmed or harassed by an individual, organization, or other group. It is also the most common type of delusion.
Persecutory.
What is the definition of a jealous type delusion?
The belief that the person’s spouse or lover is unfaithful
What type of delusion is defined as an individual believing he or she has exceptional abilities, wealth, or fame?
Grandiose.
What is an erotomanic delusion?
The false belief that another person is in love with him or her.
What type of delusion involves the belief that the person is being conspired against, cheated, spied on, followed, poisoned or drugged, maliciously maligned, etc.
Persecutory Type
Which delusion focuses on preoccupations regarding health and organ function?
Somatic delusions.
What is a mixed type delusion?
When no delusional theme predominates
What is an unspecified type delusion?
This applies when the dominant delusional belief cannot be clearly determined or is not described in the specific types.
Brief Psychotic Disorder Criteria
A. Presence of one or more of the following symptoms. 1 must be either 1, 2, or 3:
- Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganized or catatonic behavior
- DO NOT INCLUDE A SYMPTOM IF IT IS A CULTURALLY SANCTIONED RESPONSE
B. Duration of an episode is at least 1 day but less than 1 month
C. Disturbance is not better explained by a major depressive or bipolar disorder with psychotic features
Delusional Disorder Specifiers:
Bizarre
Bizarre: a bizarre delusion is clearly implausible, not understandable, and not derived from ordinary life experiences
Differential Diagnosis for Delusional Disorder
- OCD*
- Delirium/Major Neurocog Disorder/Psychotic Disorder due to Another Med Condition*
- Schizophrenia and Schizophreniform Disorder*
- Depressive and Bipolar Related Disorders*
OCD: If someone is completely convinced of their OCD beliefs then dx OCD with absent insight/delusional beliefs
Delirium, etc.: Simple persecutory delusions in the context of neurocog disorder would be dx as Major Neurocog Disorder with Behavioral Disturbance. Differential between whether onset of delusions occurred with substance use
Schizophrenia and Schizophreniform Disorder: Differentiated by the absence of other symptoms of the active phase of schizophrenia
Depressive and bipolar and schizoaffective disorders: These have a temporal relationship between mood disturbance and delusions and by the severity of mood symptoms. IF delusions occur exclusively in mood episodes, dx Depressive/Bipolar Disorder w/ Psychotic Features.
Brief Psychotic Disorder Specifiers
- With Marked Stressor(s)*
- Without Marked Stressor(s)*
- With Peripartum Onset*
- With Current Severity*
Marked Stressor(s): if symptoms occur in response to events that singly or together would be markedly stressful to almost anyone
Without Marked Stressor(s): Sxs do not occur in response to events that singly or together would be markedly stressful.
With Peripartum Onset: onset is during pregnancy or within 4 weeks postpartum
With Current Severity: Severity is based on quantitative assessment of primary symptoms of psychosis including delusions, hallucinations, disorganized speech, abnormal psychomotor behavior and negative sxs. 5 point scale of severity 0=not present 4=present and severe
Brief Psychotic Disorder Differential Diagnoses
- Other Medical Conditions*
- Substance Related Disorders*
- Depressive and Bipolar Disorders*
- Other Psychotic Disorders*
- Malingering and Factitious Disorders*
- Personality Disorders*
- Other Medical Conditions: a variety of med conditions can manifest with psychotic symptoms. Diagnose Psychotic Disorder due to Another Medical Condition or a Delirium if medical delusions are a direct consequence of a medical condition
- Substance Related Disorders: Substance is the cause of psychotic symptoms, diagnose: Substance/Medication-Induced Psychotic Disorder
- Depressive and bipolar disorders: if psychotic symptoms are better explained by a mood disorder, do not diagnose brief psychotic disorder
- Other Psychotic Disorders: if psychotic symptoms last longer than a month then diagnose another psychotic disorder (schizophreniform spectrum, delusional disorder, etc.)
- Malingering and Factitious Disorders: Factitious disorders and malingering can look like psychotic disorder but these maybe intentionally produced for a goal in malingering.
- Personality Disorders: psychotic symptoms may be a result of psychosocial stressors in those with personality disorders. A separate dx is not warranted unless symptoms last for more than a day.
Catatonia Specifier:
Specifier for: Brief Psychotic Disorder, Schizophreniform Disorder, Schizophrenia, Schizoaffective Disorder,
Clinical picture is dominated by 3 or more of the following:
- Stupor (i.e., no psychomotor activity, not actively relating to the environment)
- Catalepsy (i.e., passive induction of a posture held against gravity) rigid muscular presentation
- Waxy flexibility (i.e., slight, even resistance to positioning by examiner)
- Mutism (i.e., no, or very little, verbal response [exclude if known if aphasia])
- Negativism (i.e., opposition or no response to instructions or external stimuli)
- Posturing (i.e., spontaneous and active maintenance of posture against gravity)
- Mannerism (i.e,. odd, circumstantial caricature of normal actions).
- Stereotypy (i.e., repetitive, abnormally frequent, non-goal-directed movements)
- Agitation, not influenced by external stimuli
- Grimacing
- Echolalia (i.e., mimicking another’s speech)
- Echopraxia (i.e., mimicking another’s movements).
What is the definition of a hallucination?
A hallucination is a perception like experience that occurs without an external stimulus.
Hallucinations can occur in any sensory modality but what type of hallucination is the most common in schizophrenia and related disorders?
Auditory hallucinations.
In terms of disorganized thinking and speech what is the derailment?
Switching from one topic to another.
In terms of disorganized thinking and speech what is tangentiality considered?
Answers to questions may be obliquely related or completely unrelated.
What is the rarest type of disorganized thinking or speech in schizophrenia spectrum disorders?
Incoherence or “word salad”.
