Schizophrenia Spectrum & Other Psychotic Disorders

Question 1

Delusions

Answer 1

fixed beliefs that aren’t amenable to change in light of conflicting evidence
(Persecutory, Referential, Grandiose, Erotomanic, Nihilistic, Somatic)

Question 2

Hallucinations

Answer 2

perception-like experiences that occur w/o an external stimulus

Question 3

Disorganized Thinking or Speech

Answer 3

switch from one topic to the next (derailment/loose association), tangential speech

Question 4

Grossly Disorganized/Abnormal Motor Behavior

Answer 4

can range from childlike silliness to unpredictable agitation

Question 5

Catatonic Behavior

Answer 5

marked decrease in reactivity to environment. Can range from resistance to instructions, maintaining rigid, inappropriate or bizarre posture, to a complete lack of verbal and motor responses (mutism or stupor)

Question 6

Catatonic Excitement

Answer 6

Purposeless & and excessive motor activity w/o obvious cause

Question 7

Negative Sx

Answer 7

Diminished Emotional Expression: reduction in the expression of emotions in the face, eye contact, intonation of speech & movements of the hand, head and face
Avolition: a decrease in motivated self-initiated purposeful activities. Individual may sit for long periods of time and show little interest in participating in activities
Algoia: diminished speech output
Anhedonia: decreased ability to experience pleasure

Question 8

Delusional Disorder

Answer 8

A: Presence of one or more delusions w/ a duration of 1 month or longer
B: Criterion A for schizophrenia has never been met. Hallucinations, if present, are not prominent are and are related to the delusional themes
C: Apart from the impact of the delusions or its ramifications, functioning is not markedly impaired & behavior is not obviously bizarre or odd
D: If manic or major depressive episodes have occur, they have been brief relative to the duration of the delusional of the delusional periods
E: The disturbance is not attributable to physiological effects of a substance or other medical condition

Question 9

Delusional Disorder-Specify Whether

Answer 9

Erotomaniac Type: Theme is that another person is in love w/ the individual
Grandiose Type: Theme is the conviction of having some great talent or insight or having made an important discovery
Jealous Type: Theme is that their spouse or lover is unfaithful
Persecutory: Theme is that they are being conspired against
Somatic: Theme of involves bodily functions or sensations
Mixed Type: When no delusional theme predominates
Unspecified Type: The dominate delusional belief can’t be clearly determined or isn’t described in the specific types)

Question 10

Delusional Disorder: Specify IF

Answer 10

With bizarre content: Delusions are deemed bizarre if they are clearly implausible, not understandable and not derived from ordinary life experiences

Question 11

Delusional Disorder: Specify If (After a 1 year duration)

Answer 11

First episode, currently in acute: first manifestation of the disorder meeting the defined diagnostic sx and time critera. Acute episode is a time period in which the sx criteria are fulfilled
First episode, currently in partial remission: a time period during which an improvement after a previous episode is maintained & the criteria is partially fulfilled
First episode, currently in full remission: a period of time after a previous episode during which no disorder-specific sx are present
Multiple episodes, currently in acute episode
Multiple episodes, currently in partial remission
Multiple episodes, currently in full remission
Continuous: Sx fulfilling the diagnostic sx criteria are of the disorder are remaining for the majority of the illness, relief of sx are brief

Question 12

Brief Psychotic Disorder

Answer 12

A: Presence of one or more of the following sx. At least one must be 1,2 or 3:
1. Delusions 2. Hallucinations 3. Disorganized Speech 4. Grossly disorganized or catatonic behavior
(Don’t include a sx if it’s a culturally sanctioned response)
B: Duration of an episode of the disturbance is at least 1 day but less than 1 month w eventual return to functioning
C: Disturbance is not better explained by MDD or Bipolar Disorder w/ psychotic features or another psychotic disorder

Question 13

Brief Psychotic Disorder: Specify If

Answer 13

With marked stressors: if sx occur in response to events that would be stressful to anyone is a similar circumstance
W/O Marked Stressors: if sx don’t occur in response to events that would be stressful to anyone
W/ post partum onset: during pregnancy or within 4 weeks postpartum
With catatonia:

Question 14

Brief Psychotic Disorder: Specify Severity

Answer 14

Rated by the primary sx of psychosis including delusions, hallucinations, disorganized speech, abnormal psychomotor behavior, & negative sx. Each sx must be rated for its current severity on a 5-point scale ranging from 0-4

Question 15

Schizophreniform Disorder

Answer 15

A: Two or more of the following, each present for a significant portion of time during a 1 month period. At least one must be 1, 2 or 3
1. Delusions 2. Hallucinations 3. Disorganized speech 4. Grossly disorganized or a catatonic behavior
5. Negative sx
B: An episode lasts at least 1 month but less than 6 months. If a dx must be made w/o waiting for recovery it should be provisional
C: Schizoaffective disorder & depressive or bipolar disorder w/ psychotic features have been ruled out bc either no major depressive or manic episodes have occurred concurrently or mood episodes have occurred during active phase sx, they have been presents for a minority of the total durations of the active & residual periods of the illness
D: Disturbance is not attributable to the physiological effects of a substance

Question 16

Schizophreniform Disorder: Specify If

Answer 16

With good prognostic features: Requires the presence of at least 2 of the following features: onset of prominent psychotic sx within 4 weeks, confusion or perplexity, good premorbid social & occupational functioning & absence of blunted or flat affect
W/O good prognostic features: Is applied to 2 or more of the above features have not been present
W/ catatonia:

Question 17

Schizophreniform Disorder: Current Severity

Answer 17

Rated by quantitative assessment of primary sx of: psychosis (including delusions, hallucinations, disorganized speech, abnormal psychomotor behavior & negative sx. Each sx may be rated for it’s current severity (last 7 days) on a 5-point scale ranging from 0-4

Question 18

Schizophrenia

Answer 18

A: Two or more of the following sx are present for a significant portion of time during a 1 month period, at least one must be 1, 2 or 3:
1. Delusions 2. Hallucinations 3. Disorganized speech 4. Grossly disorganized 5. Negative sx
B: Significant portion of time since onset, level of functioning in one or more areas is below level achieved prior to onset, failure to achieve expected level of interpersonal, academic or occupational functioning
C: Continuous signs of disturbance persist for at least 6 mos. Must include at least 1 month of sx that meet Criterion A & may include periods or prodroma or residual sx-signs of disturbance may be manifested by only negative sx or 2 or more sx in Criterion A
D: Schizoaffective Disorder & depressive or bipolar disorder w/ psychotic features have been ruled out b/c of 1) No MDD or manic episodes have occurred concurrently 2) if mood episodes have occurred during active-phase sx it has been for a minority of the total duration
E: Disturbance isn’t due to physiological effects of a substance or other medical condition
F: If there’s a dx of autism or communication disorder in childhood onset, dx of schizophrenia is made only if prominent delusions or hallucinations-present for at least 1 month

Question 19

Schizophrenia: Specify If

Answer 19

First episode, currently in acute episode: first manifestation meet defining diagnostic sx & time criteria. Acute episode is time period in which the sx criteria are fulfilled
First episode, currently in partial remission: Improvement after a previous episode is maintained & criteria is only partially fulfilled
First episode, currently in full remission: Period of time after a previous episode during which no disorder sx are present
Multiple episodes, currently acute episode: multiple episodes determined after 2 episodes
Multiple episodes, currently in partial remission
Multiple episodes, currently in full remission
Continuous: Sx remaining for majority of the illness,
Catatonia

Question 20

Schizophrenia: Current Severity

Answer 20

Rated by a quantitative assessment of the primary sx of : psychosis (including delusions, hallucinations, disorganized speech, abnormal psychomotor behavior & negative sx) Each sx rated for current severity (last 7 days) on a 5-point scale ranging from 0-4

Question 21

Schizoaffective Disorder

Answer 21

A: Uninterrupted period of illness during which there is major mood episode (MDD or manic) concurrent w/ Criterion A of schizophrenia (MDD episode must include Criterion A1: Depressed mood
B: Delusions or hallucinations for 2 or more weeks in the absence of major mood episode ( depressive or manic) during lifetime duration of illness
C: Sx that meet criteria for a major mood disorder are present for the majority of the total duration of the active & residual portions of the illness
D: Disturbance not due to effects of a substance or other medical condition

Question 22

Schizoaffective Disorder: Specify Whether

Answer 22

Bipolar Type: If a manic episode is a part of the presentation. MDD episode may also occur
Depressive Type: If only major depressive episodes are part of the presentation

Question 23

Psychotic Disorder Due to Another Medical Condition

Answer 23

A: Prominent hallucinations or delusions
B: Evidence from history, physical examination or lab that the disturbance is the direct pathophysiological consequence of another medical condition
C: Disturbance not better explained by another mental disorder
D: Disturbance doesn’t occur exclusively during the course of delirium
E: Disturbance causes clinically significant distress or impairment in important areas of functioning

Question 24

Psychotic Disorder Due to Another Medical Condition: Specify Whether

Answer 24

W/ Delusions or W/ Hallucinations

Question 25

Catatonia Associated W/ A Mental Disorder (Catatonia Specifier)

Answer 25

A: The clinical picture is dominated by 3 or more of the following sx:
1. Stupor (no psychomotor activity, not actively relating to environment)
2. Catalepsy (passive induction of a posture held against gravity, rigidity of body, limbs stay however they’re placed)
3. Waxy flexibility (slight, even resistance to positioning by examiner)
4. Mutism (no or very little verbal response-exclude for aphasia)
5. Negativism (no or very little response to instructions or external stimuli)
6. Posturing (spontaneous & active maintenance of a posture against gravity)-holds a specific position unlike catalepsy position isn’t due to someone placing them like that)
7. Mannerism (odd, circumstantial caricature of normal actions)
8. Stereotypy (repetitive, abnormally frequent, non-goal directed movements)
9. Agitation, not influenced by external stimuli
10. Grimacing
11. Echolalia (mimicking another’s speech)
12. Echopraxia (mimicking another’s movements)
Coding note: indicate the name of the associated mental disorder

Question 26

Catatonic Disorder Due to Another Medical Condition

Answer 26

Coding Note: include the name of the medical condition in the name of the mental disorder

Question 27

Unspecified Catatonia

Answer 27

Applies to presentation in which sx characteristics of catatonia cause clinically significant distress or impairment, but either the nature of the underlying mental disorder or other medical condition is unclear, full criteria of catatonia are not met or there is insufficient information to make a more specific diagnosis (Ex: Emergency Department)

Question 28

Unspecified Schizophrenia Spectrum & Other Psychotic Disorder

Answer 28

Applies to presentation in which sx are characteristics of a schizophrenia spectrum & other psychotic disorder that causes clinically significant distress or impairments of functioning predominate but do not meet full criteria for any of the disorders in the schizophrenia spectrum and other psychotic disorders. Used in situations in which clinician chooses NOT to specify the reason that the criteria are not met for a specific schizophrenia spectrum & other psychotic disorder & includes presentations in where there’s insufficient information to make a specific dx