Schizophrenia Spectrum and Other Psychotic Disorders

Question 1

Schizophrenia

Answer 1

A. 2+ of the following present for a significant portion of time during a 1 month period (less if treated) with at least one being one of the first 3 listed symptoms
▪ Delusions
▪ Hallucinations
▪ Disorganized speech
▪ Grossly disorganized or catatonic
▪ Negative symptoms
B. For significant portion of time, level of functioning in life is low to level achieved prior
C. Continuous signs of the disturbance persist for at least 6 months with at least 1 month of active symptoms; prodromal phases can be manifested by negative symptoms
D. Schizoaffective disorder and depressive or bipolar disorders with psychotic features are ruled out
E. Not attributable to substance/other medical condition
F. If history of ASD or communication disorder of childhood onset, additional

Question 2

Schizophrenia Specifiers

Answer 2

▪ First episode, currently in acute episode – full criteria
▪ First episode, currently in partial remission – some symptoms met
▪ First episode, currently in full remission – no symptoms
▪ Multiple episodes, currently in acute
▪ Multiple episodes currently in partial remission
▪ Multiple episodes currently in full remission
▪ Continuous
▪ Unspecified

Question 3

Schizophreniform

Answer 3

full schizophrenia symptoms present only for 1-6 months; preliminary diagnosis – can be given when a client as not yet had symptoms for 6 months and is often accompanied by a provisional schizophrenia diagnosis; good premorbid functioning then good prognosis; fewer negative symptoms equals better prognosis

Question 4

Schizoaffective

Answer 4

schizophrenia criteria and criteria for mood disorder that is secondary to the psychosis are met; periods of psychosis happen without mood problems rather than the other way around; if mood disorder symptoms occur without psychotic symptoms it is not schizoaffective; need to specify whether bipolar or depressed and whether there is catatonia

Question 5

Delusional Disorder

Answer 5

1+ months of delusions without other active phase symptoms of schizophrenia; delusions can be bizarre or non-bizarre, no history of schizophrenia

Question 6

Brief Psychotic Disorder

Answer 6

Less than 1 month with full return to premorbid functioning

Question 7

Methods for Assessment of Schizophrenia and Related Disorders

Answer 7

o Unstructured clinical interview
o Corroborative data from relatives, etc.
o MSE
o SCID-5 Psychotic and related disorders module
o MMPI-2-RF (if the person can take it), elevations on TXD (thought dysfunction), RCd (demoralization), RC3 (Cynicism), RC6 (ideas of persecution), RC7 Sometimes (dysfunctional negative emotions), RC8 (aberrant experiences), SUI (suicidal ideation), DSF (disaffiliativeness), PSYC-r (psychoticism)
o PAI
o TOMM

Question 8

Treatment for Schizophrenia and Related Disorders

Answer 8

o Antipsychotic medication for sure (it is difficult to complete psychotherapy with a person who is actively psychotic)
▪ Neuroleptics (first line antipsychotics) – cause tardive dyskinesia; Haldol, Thorazine
▪ Atypical antipsychotics: serotonin-dopamine antagonists; reduce psychosis, motor dysfunction, and helps with negative symptoms; Geodon, Abilify
▪ Community and family support strengthening
▪ Inpatient care in more severe cases
▪ Monitor for suicidality

Question 9

Key Concerns for Schizophrenia and Related Disorders

Answer 9

o etiology, neurobiology
o Good prognostic factors:
▪ abrupt and later onset
▪ shorter episodes with minimal negative symptoms
▪ Shorter psychotic episode and minimal negative symptoms
▪ Normal neuropsych performance
▪ No family history
▪ Evidence of more mood problems than psychosis
▪ Lower expressed emotion at home (less expressed negativity)
▪ Acute onset vs. insidious onset
o Variance in prognosis
▪ Complete remission between acute episodes
▪ Recurrent acute psychotic episodes against chronic residual symptoms
▪ Degenerating functioning
o More early negative symptoms = worse prognosis
o Equally represented in men and women
▪ Men have an earlier onset and tend to be hospitalized for longer
▪ Schizoaffective is more common in women
▪ Women have a better prognosis
o Onset: early adulthood (18-30); late onset (over 40) is rare and has a better prognosis
o More common in lower SES, in population dense areas
o High suicide rates

Question 10

Catatonia

Answer 10

3 or more of the following symptoms:
-stupor (no psychomotor activity)
-catalepsy (passive induction of a posture help against gravity)
-waxy flexibility
-mutism
-negativism
-posturing
-mannerism
-stereotypy
-agitation
-grimacing
-echolalia
-echopraxia (mimicking movements)