SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDERS Flashcards
DELUSIONS
Delusions
Delusions are fixed beliefs that are not amenable to change in light of conflicting evidence. Their content may include a variety ofthemes (e.g., persecutory, referential, somatic, reli-
gious, grandiose). Persecutory delusions (i.e., belief that one is going tobeharmed, harassed, and so forth byan individual, organization, orother group) are most common. Referential
delusions (i.e., belief that certain gestures, comments, environmental cues, and so forth are directed at oneself) are also common. Grandiose delusions (i.e., when an individual believes that he o rshe has exceptional abilities, wealth, orfame) and erotomanic delusions (i.e., when
an individual believes falsely that another person is in love with himor her) are also seen. Nihilistic delusions involve the conviction that a major catastrophe will occur, and somatic
delusions focus on preoccupations regarding health and organ function. Delusions are deemed bizarre if they are clearly implausible and not understandable to
same-culture peers and donot derive from ordinary life experiences. An example ofa bizarre delusion is the belief that an outside force has removed his orher internal organs and
replaced them with someone else’s organs without leaving any wounds or scars. An example of a nonbizarre delusion is the belief that one is under surveillance bythe police, despite a lack ofconvincing evidence. Delusions that express a loss of control over mind or body are generally considered to be bizarre; these include the belief that one’s thoughts
have been “removed” by some outside force (thought withdrawal), that alien thoughts have been putinto one’s mind (thought insertion), or that one’s body oractions are being acted on or manipulated by some outside force (delusions ofcontrol). The distinction between a delusion and a strongly held idea is sometimes difficult to make and depends in part on the degree of conviction with which thebelief is held despite clear or reasonable contradictory
evidence regarding its veracity.
HALLUCINATIONS
Hallucinations
Hallucinations are perception-like experiences that occur without an external stimulus. They are vivid and clear, with the full force and impact of normal perceptions, and not
under voluntary control. They may occur in any sensory modality, but auditory hallucinations are the most common in schizophrenia and related disorders. Auditory hallucina-
tions are usually experienced as voices, whether familiar or unfamiliar, that are perceived as distinct from the individual’s own thoughts. The hallucinations must occur in the con-
text of a clear sensorium; those that occur while falling asleep (hypnagogic) or waking up
SCHIZOAFFECTIVE DISORDER
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 (depressive or manic) 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. The disturbance is not attributable to the effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
Specify whether:
295.70(F25.0) Bipolartype: This subtype applies if a manic episode is part of the presentation. Major depressive episodes may also occur.
295.70 (F25.1) Depressive type: This subtype applies if only major depressive episodes are part of the presentation.
Specify if:
With catatonia (refer to the criteria for catatonia associated with another mental disorder,pp. 119-120, for definition).
Specity if:
The following course specifiers are only to be used after a 1-year duration of the disorder and if they are not in contradiction to the diagnostic course criteria.
-First episode, currently in acute episode:
First manifestation of the disorder meeting the defining diagnostic symptom and time criteria. An acute episode is a time period in which the symptom criteria are fulfilled.
-First episode, currently in partial remission:
is a time period during which an improvement after a previous episode is maintained and in which the defining criteria of the disorder are only partially fulfilled.
-First episode, currently in full remission: Ful! remission is a period of time after a previous episode during which no disorder-specific symptoms are present.
-Multiple episodes, currently an acute episode:
Multiple epiodes may be determined after a minimum of two episodes (i.e., after a first episode, a remission and a
minimum of one relapse).
-Multiple episodes, currently in partial remission
-Multiple episodes, currently in full remission
-Continuous: Symptoms fulfilling the diagnostic symptom criteria of the disorder are remaining for the majority of the illness course, with subthreshold symptom periods be-
ing very brief relative to the overall course.
-Unspecified
-Specify current severity:
Severity is rated by a quantitative assessment of the primary symptoms of psychosis, including delusions, hallucinations, disorganized speech, abnormal psychomotor behavior, and negative symptoms. Each of these symptoms may be rated for its current severity (most severe in the last 7 days) on a 5-point scale ranging from0 (not present) to 4 (present and severe). (See Clinician-Rated Dimensions of Psychosis Symptom
Severity in the chapter “Assessment Measures.”)
Note: Diagnosis of schizoaffective disorder can be made without using this severity
specifier.
SCHIZOPHRENIA
A. Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less ifsuccessfully treated). At least one of these must be (1), (2), or (3):
1. Delusions.
2. Hallucinations.
3. Disorganized speech (e.g., frequent derailment or incoherence).
4. Grossly disorganized or catatonic behavior.
5. Negative symptoms (diminished emotional expression or
avolition).
B. Fora significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is
markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic,
oroccupational functioning).
C. Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may
be manifested by only negative symptomsor by two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, 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 a minority of the
total duration of the active and residual periods of the illness.
E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) 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 delu-
sions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1
month (or less if successfully treated).
Specify if:
The following course specifiers are only to be used after a 1-year duration of the disorder and if they are not in contradiction to the diagnostic course criteria.
-First episode, currently in acute episode: First manifestation of the disorder meeting the defining diagnostic symptom and time criteria. An acute episode is a time pe-
riod in which the symptom criteria are fulfilled.
-First episode, currently in partial remission: Partial remission is a period of time during which an improvement after a previous episode is maintained and in which the
defining criteria of the disorder are only partially fulfilled.
-First episode, currently in full remission: Ful! remission is a period of time after a previous episode during which no disorder-specific symptoms are present.
-Multiple episodes, currently in acute episode: Multiple episodes may be determined after a minimum of two episodes (i.e., after a first episode, a remission and a
minimum of one relapse).
-Multiple episodes, currently in partial remission
-Multiple episodes, currently in full remission
-Continuous: Symptoms fulfilling the diagnostic symptom criteria of the disorder are remaining for the majority of the illness course, with subthreshold symptom periods being very brief relative to the overall course.
-Unspecified
specify if:
With catatonia (refer to the criteria for catatonia associated with another mental disorder, pp. 119-120, for definition).
specify current severity:
-Severity is rated by a quantitative assessment of the primary symptoms of psychosis, including delusions, hallucinations, disorganized speech, abnormal psychomotor behavior, and negative symptoms. Each of these symptoms maybe rated for its current severity (most severe in the last 7 days) on a 5-point scale ranging from 0 (not present) to 4 (present and severe). (See Clinician-Rated Dimensions of Psychosis Symptom
Severity in the chapter “Assessment Measures.”)
Note: Diagnosis of schizophrenia can bemade without using this severity specifier.
SCHIZOPHRENIFORM DISORDER PT 1
Diagnostic Criteria
Schizophreniform Disorder
A. Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3):
1. Delusions.
2. Hallucinations.
3. Disorganized speech (e.g., frequent derailment or incoherence).
4. Grossly disorganized or catatonic behavior.
5. Negative symptoms (i.e., diminished emotional expression or avolition).
B. An episode of the disorder lasts 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. Schitoaffective disorder or depressive or bipolar with psychotic features have been ruled out because either 1) no major depressive or manic epsiodes have occured concurently with the active phase symptoms or 2) if mood episodes have occured during active-phase symptoms they have been present for a minority of the total duration of the active and residual periods of illness
D.The disturbance is not attributable to the physiological affects of a substance (drug of abuse, a medication) or another medical condition
Specity
-With good prognostic features:
-Without good prognostic features:
-with catatonia
Specity current severity:
Severity is rated by a quantitative assessment of the primary symptoms of psychosis, including delusions, hallucinations, disorganized speech, abnormal psychomotor behavior, and negative symptoms. Each ofthese symptoms may be rated for its current surverity
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 (e.g., the sensation of being infested with insects associated with delusions of
infestation).
C. Apart from the impact of the delusion(s) orits ramifications, functioning is not markedly impaired, and behavior is not obviously bizarre or odd.
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 obsessive-compulsive disorder.
Specify whether:
Erotomanic type: This subtype applies when the central theme of the delusion is that another person is in love with the individual.
Grandiose type: This subtype applies when the central theme of the delusion is the conviction of having some great (but unrecognized) talent or insight or having made
some important discovery.
Jealous type: This subtype applies when thecentral theme of the individual’s delusion is that his or her spouse or lover is unfaithful.
Persecutory type: This subtype applies when the central theme of the delusion involves the individual’s belief that he or she is being conspired against, cheated, spied on, followed, poisoned or drugged, maliciously maligned, harassed, or obstructed in
the pursuit of long-term goals.
Somatic type: This subtype applies when the central theme of the delusion involves bodily functions or sensations.
