Schizophrenia Spectrum Disorders: DSM-5 Flashcards
Schizoaffective Disorder
A:
Uninterrupted period of illness during which there is a major mood episode (major depressive or manic) concurrent with Criterion A schizophrenia
*MDE must include A1. Depressed Mood
B:
Delusions or hallucinations for 2 or more weeks in the absence of the major mood episode during the lifetime duration of the illness
C:
Symptoms that meet criteria for major mood episode are present for the majority of the total duration of the active and residual portions of the illness
Schizoaffective: Diagnostic Features
Diagnosis is usually, but not necessarily, made during the period of psychotic illness
MDE must include pervasive depressed mood
*Presence of markedly diminished interest or pleasure is not sufficient
Schizoaffective: Associated Features
Occupational functioning is frequently impaired
*However, not a defining criterion (unlike SZ)
Anosognosia is common, but deficits in insight may be less severe and pervasive
Increased risk for MDD or BP if mood symptoms continue following remission SZ symptoms
Schizoaffective: Prevalence
1/3 as common as SZ
Lifetime prevalence 0.3%
More common in females, due to an increased incidence of the depressive type among females
Schizoaffective: Onset
Anywhere from adolescence to late in life
Typically early adulthood
Many initially diagnosed with another psychotic illness will later receive schizoaffective dx when pattern of mood episodes becomes more apparent
Schizoaffective: Course
Typical pattern:
2 months of auditory hallucinations and persecutory delusions for two months before a MDE
3 months of psychotic symptoms and full MDE
Complete recovery from MDE, but psychotic symptoms persist for another month before they also disappear
Schizoaffective Differential Diagnosis: Bipolar, and depressive disorders
Presence of prominent delusions and/or hallucinations for at least 2 weeks in the absence of a major mood episode
In depressive or bipolar disorder with psychotic features, the psychotic features primarily occurred during the mood episode
As proportion of mood to psychotic symptoms changes, dx may change from and to schizoaffective disorder
Delusional Disorder
A:
Presence of 1 or more delusions with a duration of 1 month or longer
B:
Criteria for schizophrenia has never been met
*hallucinations, if present, are not prominent and are related to the delusional theme
C:
Apart from the impact of the delusion(s) or its 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
Delusional Disorder Subtypes
Erotomanic
Grandiose
Jealous
Persecutory
Somatic
Mixed
Unspecified
Delusional Disorder Differential Diagnosis: SZ
Delusion(s) only
Absence of the other characteristic symptoms of the active phase of schizophrenia
Delusional Disorder Differential Diagnosis: Depressive, Bipolar, Schizoaffective
Total duration of all mood episodes remains brief relative to the total duration of the delusional disturbance
If delusions occur exclusively during mood episodes, the diagnosis is depressive or bipolar disorder with psychotic features
Brief Psychotic Disorder
A:
Presence of one or more of the following symptoms (at least one must be A1, A2 or A3):
1. Delusions
2. Hallucinations
3. Disorganized speech (frequent derailment or incoherence)
4. Grossly disorganized or catatonic behavior
B:
Duration of an episode of the disturbance is at least 1 day but less than 1 month, with eventual full return to premorbid level of functioning
Specifiers:
*With marked stressor(s)- (brief reactive psychosis)
Without marked stressors
With postpartum onset
With catatonia
Brief psychotic disorder prevalence
Brief psychotic disorder may account for 9% of cases of first-onset psychosis
Brief psychotic disorder: Onset
Brief psychotic disorder may appear in adolescence or early adulthood, and onset can occur across the lifespan
Average age at onset being the mid-30s
Brief psychotic disorder: Course
Dx of brief psychotic disorder requires a full remission of all symptoms and an eventual full return to the premorbid level of functioning within 1 month of onset
In some individuals, the duration of psychotic symptoms may be quite brief – e.g. a few days
Brief psychotic disorder: Risk Factors
Pre-existing personality disorders and traits:
Schizotypal personality disorder
Borderline personality disorder
Traits in the psychoticism domain such as perceptual dysregulation
Traits in the negative affectivity domain such as suspiciousness
Brief psychotic disorder: functional consequences
Despite high rates of relapse, for most individuals, outcome is excellent in terms of social functioning and symptomatology
Schizophreniform Disorder
Same Criterion A as Schizophrenia, but DURATION is at least 1 month but less than 6 months
When dx is made without waiting for recovery, it should be qualified as “provisional”
Rule out Schizoaffective and Bipolar with psychotic features if:
1. No Manic or MDE have occurred during 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
Specifiers:
With / Without good prognostic features
With Catatonia
Schizophreniform Disorder: Diagnostic Features
Characteristic symptoms are identical to those of schizophrenia Criterion A
Difference in duration: at least 1 month but less than 6 months
(Intermediate between that for brief psychotic disorder)
Diagnosis of schizophreniform disorder is made under two conditions:
- Episode of illness last between 1 and 6 months and the individual has already recovered
- When an individual is symptomatic for less than the six months duration required for the diagnosis schizophrenia but has not yet recovered
“schizophreniform disorder (provisional)”
Schizophreniform Disorder: Prevalence
5x less than schizophrenia
Schizophreniform Disorder: Course
1/3 of individuals with an initial diagnosis of schizophreniform disorder (provisional) recover within the 6-month period
2/3 will eventually receive a diagnosis of schizophrenia or schizoaffective disorder
Schizotypal Personality Disorder: General
Pervasive pattern of social and interpersonal deficits
Acute discomfort and reduced capacity for close relationships
Cognitive or perceptual distortions
Eccentricities of behavior
Beginning by early adulthood
Schizotypal Personality Disorder: DSM-Criteria
5 or more of the following:
- Ideas of reference (excluding delusions of reference)
- Odd beliefs or magical thinking that influences behavior and is consistent with subcultural norms
e. g. superstitious mess, belief in clairvoyance, telepathy, or “sixth sense”
* in children and adolescents – bizarre fantasies or preoccupations - Unusual perceptual experiences, including bodily illusions
- Odd thinking and speech
e. g. vague, circumstantial, metaphorical, over elaborate, or stereotyped - Suspiciousness or paranoid ideation
- Inappropriate were constricted affect
- Behavior or appearance that is odd, eccentric, or peculiar
- Lack of close friends or confidants other than first-degree relatives
- Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self
Schizotypal Personality Disorder: Ideas of reference
Incorrect interpretations of casual incidents and external events as having a particular an unusual meaning specifically for the person
- Different from delusions of reference, in which the beliefs are held with delusional conviction
Schizotypal Personality Disorder: Associated Features
Individuals with schizotypal personality disorder often seek treatment for the associated symptoms of anxiety or depression rather than for the personality disorder features per se
In response to stress, individuals may experience transient psychotic episodes (lasting minutes to hours)
*usually insufficient integration to warrant an additional diagnosis such as brief psychotic disorder or schizophreniform disorder
Over half may have a history of at least one major depressive episode
30% to 50% have a concurrent diagnosis of major depressive disorder one admitted to a clinical setting
Considerable co-ocurrence with schizoid, paranoid, avoid ant, and borderline personality disorders
Schizotypal Personality Disorder: Prevalence
Clinical populations: 0% – 1.9%
Estimated prevalence in general population: 3.9%
Schizotypal Personality Disorder: Onset and Course
Schizotypal personality disorder has a relatively stable course
*Only a small proportion of individuals go on to develop schizophrenia or another psychotic disorder
It may first be apparent in childhood and adolescence with:
- solitariness
- poor peer relationships
- social anxiety
- underachievement in school
- hypersensitivity
- peculiar thoughts and language
- bizarre fantasies
*Children may appear odd or eccentric and may attract teasing
Schizotypal vs. Paranoid and Schizoid Diagonsis
Paranoid and schizoid personality disorders may also be characterized by social detachment and restricted affect
Schizotypal personality disorder can be distinguished by the presence of cognitive perceptual distortions and marked eccentricity or oddness
Schizotypal vs. Narcissistic and Borderline Diagnosis
More likely to have enduring psychotic-like symptoms that may worsen under stress
*Though less likely to be invariably associated with pronounced affective symptoms
Schizotypal and Borderline Personality Disorders
Don’t usually demonstrate the impulsive or manipulative behaviors associated with BPD
High rate of co-occurrence between the two disorders *making such distinctions is not always feasible
Schizoid Personality Disorder
Pervasive pattern of detachment from social relationships
Restricted emotional expression
No desire or enjoyment in close relationships (including family)
Chooses solitary activities
Little to no interest in sexual experiences
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Indifferent to praise or criticism of others
Shows emotional coldness, detachment, or flattened affectivity
