Schizophrenia Spectrum and other Psychotic Disorders

Question 1

Criterion A (active phase symptoms)

Answer 1

1. Delusions
2. Hallucinations
3. Disorganised Speech
4. Grossly disorganised or catatonic behaviour
5. Negative symptoms (eg diminished emotional expression)

At least (1,2 or 3) must be present in a diagnosis for schizophrenia

Question 2

Criterion B

Answer 2

Impaired functioning, although not deterioration, be present during the active phase of the illness.

Functioning is markedly below the level achieved prior to the onset of the illness

Question 3

Criterion C

Answer 3

Continuous signs of the disturbance persist for at least 6 months

Question 4

Criterion D

Answer 4

Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out

Ruled out if

1) no major depressive or manic episodes happen concurrently with active-phase symptoms
2) if mood disorders have occurred during active phase symptoms, they are present for a minority of the time.

Question 5

Criterion E

Answer 5

The disturbances is not attributable to the physiological effects of a substance (eg drug abuse or medication).

Question 6

Criterion F

Answer 6

if there is history of Austism or communication disorder if childhood onset, the additional diagnosis of Schizophrenia is made ONLY if there are prominent delusions or hallucinations for at least 1 month

Question 7

3 Important Clinical Features of Schizophrenia

Answer 7

1) no clinical sign or symptom is specifically characteristic for schizophrenia. A patients historys is essential for the diagnosis of schizophrenia.
2) A patients symptoms change with time.
3) Clinicians must take into consideration education level, intellectual ability and cultural/subcultural membership.

Question 8

3 disorders of Thought

Answer 8

Thought Content
Form of Thought
Thought Process

Question 9

Thought Content

Answer 9

Disorders of thought content reflect the patients ideas, beliefs, interpretations of stimuli.

Delusions are the most obvious example of a disorder of thought content.

Loss of ego boundaries
ideas of reference
cosmic Identity

Question 10

Form of Thought

Answer 10

Objectively observable in patients’ spoken and written language.
Includes - looseness of associations, derailment, incoherance, tangentiality (tangents), circumstantiality (unnecessary info), neologisms (making up new words) , echolalia (meaningless repetition of words), verbigeration (obsessive repetition of random words), word salad and mutism.

Question 11

Thought Process

Answer 11

Concerns the way ideas and languages are formulated

The examiner may asses the patients thought process by observing his or her behavior in carrying out discrete tasks.

Thought Control - outside forces controlling what they think
Thought Broadcasting - they think others can read their mind

Question 12

Other Psychotic disorders

Answer 12

Schizoaffective
Schizophreniform
Brief Psychotic Disorder
Delusional Disorder

Question 13

Schizophreniform Disorder

Answer 13

Differs from Schizophrenia, in that the symptoms have a duration of AT LEAST one month but LESS than 6 months

Question 14

Brief Psychotic Disorder

Answer 14

It is appropriate for this diagnosis when symptoms have lasted at least 1 day but less than 1 month

Question 15

Schizoaffective Disorder

Answer 15

Schizoaffective disorder is a combination of symptoms of schizophrenia and mood disorder, such as depression or bipolar disorder. Symptoms may occur at the same time or at different times.

In current diagnostic systems, patients can receive the diagnosis of schizoaffective disorder if they fit into one of the following six categories:

(1) patients with schizophrenia who have mood symptoms,
(2) patients with mood disorder who have symptoms of schizophrenia,
(3) patients with both mood disorder and schizophrenia,
(4) patients with a third psychosis unrelated to schizophrenia and mood disorder,
(5) patients whose disorder is on a continuum between schizophrenia and mood disorder, and
(6) patients with some combination of the above

Question 16

Delusional Disorder

Answer 16

Nonbizarre Delusions present for at least month without other symptoms of schizophrenia or mood disorder.

• Nonbizarre means that the delusions must be about situations that can occur in real life, such as being followed, infected, loved at a distance, and so on

Question 17

Schizophrenia

Answer 17

Symptoms must be present for at least 6 months. Diagnosis of schizoaffective or a mood disorder but be absent.

The disorder is diagnosed as Schizophrenia when the patient exhibits two of the symptoms listed in the Criterion A (Active phase).
Criterion B requires impaired functioning, although not deteriorations, be present during the active phase of the illness.

Question 18

Differential Diagnosis - How does Delusional Disorder Differ from Schizophrenia

Answer 18

• By the absence of schizophrenic Symptoms
• By the nonbizzare quality of the delusions
• Delusional disorder patients also lack the impaired functioning seen in schizophrenia

Question 19

Paranoid personality disorder vs Delusional Disorder

Answer 19

• Sometimes a difficult clinical distinction between extreme delusion and frank delusion
• in general, if there is doubt that a symptom is not a delusion, the diagnosis of delusional disorder should not be made.

Question 20

Brief Psychotic Disorder

Answer 20

A psychotic condition that involves the sudden onset of psychotic symptoms, which lasts 1 day or more but less than 1 month.
Remission is full, and returned to the premorbid level of functioning.

Question 21

Clinical Features of Brief Psychotic Disorder

Answer 21

At least one major symptom of psychosis - such as, hallucinations, delusions, and disorganised thoughts usually with an abrupt onset.

Characteristics include: emotional volatility, strange or bizarre behaviour, screaming or muteness, and impaired memory of recent events.

Lasts 1 day or more but less than 1 month. Remission is full.

Question 22

Negative signs in schizophrenia

Answer 22

Flat affect
Alogia (is the inability to speak )
Abulia (an absence of willpower or an inability to act decisively)
Apathy (lack of interest, enthusiasm, or concern.)

Question 23

Positive signs in schizophrenia

Answer 23

Hallucinations
Delusions
Thought disorder