Schizophrenia Spectrum and Other Psychotic Disorders Flashcards
Delusion definition; types of delusions
Fixed beliefs that are not amenable to change in light of conflicting evidence.
Types:
* Persecutory: Belief that one is going to be harmed/harassed by an individual, organization, or group
* Referential: Belief that certain gestures, comments, environmental cues, etc. are directed at oneself
* Gradiose: Belief that one has exceptional abilities, wealth, or fame
* Erotomanic: Belief that another person is inlove with the individual
* Nihilistic: Conviction that a major catastrophe will happen
* Somatic: Preoccupations regarding health and organ function
* Jealous: Belief that spouse or lover in unfaithful
* Mixed: When no one delusional theme predominates
* Unspecified type: When the delusional belief cannot be clearly determined or isn’t captured by one of the other types
“Bizarre” delusions
Delusions that are clearly implausible and not understandable to same-culture peers. Do not derive from ordinary life experiences.
E.g., belief that one’s organs have been replaced with someone else’s without any scars being left; thought insertion and withdrawals, mind/body control delusions
Hallucination definition
Perception-like experience that occurs without an external stimulus; vivid and clear, with the full force of normal perceptions; involuntary.
May occur in any modality, but auditory is the most common in schizophrenia.
Disorganized thinking definition
Normally inferred from speech. Rapid switching between topics; tangential responses to questions.
Not to be confused with glossolalia (“speaking in tongues” as a religious experience)
Delusional Disorder Diagnostic Criteria
A. The presence of ≥1 delusion(s) with a duration of ≥1 month(s).
B. Criterion A for schizophrenia has never been met.
C. Apart from the impact of the delusion(s) or its ramificaitons, functioning is not markedly impaired, behaviour is not obviously bizarre or odd.
D. If manic episodes or MDEs have occurred, they are short compared to the periods of delusion.
E. Not attributable to substances/medication/another medical condition.
Delusional Disorder specifiers
Type of delusion:
* Erotomanic type
* Grandiose type
* Jealous type
* Persecutory type
* Somatic type
* Mixed type
* Unspecified type
Presence of bizarre content:
* With bizarre content
After 1-year duration of the disorder:
* First episode, curently in acute episode
* First episode, currently in partial remission: period after an episode in which criteria are only partially fulfilled
* First episode, currently in full remission: period after an episode during which no disorder-specific symptoms are present
* Multiple episodes, currently in acute episode
* Multiple episodes, currently in partial remission
* Multiple episodes, currently in full remission
* Continuous: Diagnostic criteria have been met for the majority of illness course, with short periods of subthreshold symptoms present in between
* Unspecified
Severity: (based on Clinican-Rated Dimensions of Psychosis Symptom Severity)
Differentiation of Delusional Disorder from OCD and related disorders
- If an individual with OCD is completely convinced of their OCD belief, then OCD, with absent insight/delusional belief specifier should be given
Differentiation of Delusional Disorder from Schizophrenia and Schizophreniform Disorder
- Delusional Disorder does not have characteristic symptoms of active phase of schizophrenia
- In schizoprhenia, delusions show greater disorganization (less internally consistent)
- In delusional disorder, there is greater conviction, greater extension (i.e., the delusion is more tied to areas of the individual’s life) and greater pressure (i.e., preoccupation/concern)
Differentiation of Delusional Disorder from Mood Disorders and Schizoaffective Disorder
- If delusions occur exclusively during a major mood episode, then it’s likely not delusional disorder
- Mood symptoms may be present, but only relatively briefly compared to the delusions for delusional disorder to be appropriate (otherwise it would be other specified/unspecified schizophrenia spectrum and other psychotic disorder, accomparnied by other specified/unspecified depressive/bipolar disorder)
Brief Psychotic Disorder Diagnostic Criteria
A. Presence of ≥1 of the followning. ≥1 must be 1-3:
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behaviour
B. Duration ≥1 day but <1 month, with eventual return to premorbid functioning.
C. Not better explaind by MDD/bipolar with psychotic features and not attributable to substances/medication/other medical condition
Brief Psychotic Disorder Specifiers
Conditions at onset:
* With marked stressor(s) (brief reactive psychosis)
* Without marked stressor(s)
* With peripartum onset: If onset is during pregnancy or ≤4 weeks postpartum
Additional features:
* With catatonia
Severity (based on Clinician-Rated Dimensions of Psychosis Symptom Severity
Diagnosis can be made without a severity specifier
Differentiation of Brief Psychotic Disorder from other psychotic disorders
- If symptoms persist ≥1 monthm diagnosis is either schizophreniform disorder, delusional disorder, MDD/bipolar with psychotic features, or other specified/unspecified schizophrenia spectrum and other psychotic disrder
- Differentiation is challenging when symptoms have remitted in less than a month with successful treatment
Schizophreniform Disorder Diagnostic Criteria
A. ≥2 of hte following, present for a significant portion during a 1-month period (or less if successfully treated). ≥1 must be 1-3:
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behaviour
5. Negative symptoms
B. An episode of the disorder lasts ≥1 month but < 6 months. When the diagnosis must be made without waiting for recovery, it should be qualified as “provisional”.
C. Schizoaffective disorder or depressive/bipolar disorder with psychotic features have been ruled out either because:
1. No MDE or manic episodes have occurred concurrently with active-phase symptoms
2. If mood episodes have occurred with active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of illness
D. Not attributable to substances/medication/other medical condition.
Schizophreniform Disorder specifiers
Prognostic features:
* With good prognostic features: Requires the presence or ≥2 of the following:
1. Onset of prominent psychotic symptoms within 4 weeks of first noticeable change in behaviour
2. Confusion or perplexity
3. Good premorbid functioning
4. Absence of blunted/flat affect
* Without good prognostic features
Other features:
* With catatonia
Severity
Diagnosis can be made without severity specifier
Schizophrenia Diagnostic Criteria
A. ≥2 of the following, present for a significant portion during a 1-month period (or less if successfully treated). ≥1 must be 1-3:
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behaviour
5. Negative symptoms
B. For a significant portion of time sine onset, functioning in ≥1 major areas is markedly below baseline
C. Continuous signs of disturbance for >6 months; must include ≥1 month of symptoms (less if successfully treated) that meet criterion A and may include prodromal or residual symptoms (during this time, signs may only be manifested or attenuated versions of symptoms in A).
D. Schizoaffective and mood disorders with psychotic features have been ruled out because either:
1. No mood episodes have occurred concurrently with active-phase symptoms
2. If mood episodes have occurred with active-phase symptoms, they have been presen for a minority of the total duration of the active and residual portions of the illness
E. Not attributable to substances/medication/other medical condition
F. If history of ASD or communication disorder with childhood onset, additional diagnosis of schizophrenia is made only if prominent hallucinations/delusions are present for ≥1 month (less if treated successfully)
