Schizophrenia & Psychotic Disorders

DELUSION - unchanging beliefs despite conflicting evidence

Persecutory (belief that he will be harmed)

Referential (belief that gestures/comments/cues are directed at self)

Grandoise (belief that he has exceptional abilities/wealth/fame)

Erotomanic (belief that someone is in love with him)

Nihilistic (belief that major catastrophe will occur)

Somatic ( preoccupation with health and organ function)

Thought withdrawal (one’s thoughts have been removed)

Thought insertion (alien thoughts put into mind)

Delusions of control (body/actions being manipulated by outside force)

HALLUCINATION – perception-like experiences w/o external stimulus

Sensory

Auditory (most common)

DISORGANIZED SPEECH/THINKING – should impair effective communication

Derailment/loose association (switch from topics)

Tangentiality (unrelated answers to questions)

Incoherence/word salad (incomprehensible)

DISORGANIZED MOTOR BEHAVIOR (including catatonia)

Catatonia (decreased reactivity to environment; resistance to instructions, rigidity, bizarre

posture, mutism and stupor, catatonic excitement, echoing speech, grimacing)

NEGATIVE SYMPTOMS

Diminished emotional expression

Avolition (decrease in motivated self-initiated purposeful activities)

Alogia (decrease in speech output)

Anhedonia ( decrease pleasure from positive stimuli)

Asociality (decreased interest in social interaction)

Delusional Disorder ( 1 month or longer)

- No function impairment
- Specify if Erotomanic, Grandoise, Jealous, Persecutory, Somatic, Mixed, Unspecified type
- Specify if with bizarre content
- Specify if 1st episode currently in acute episode, 1st episode currently in partial remission, 1st
episode currently in full remission, multiple episodes currently in acute/partial/full remission,
unspecified

Brief Psychotic Disorder (1 – 29 days)

- Presence of 1/more of ff: (1 must be 1,2, or 3)

1. Delusions
2. Hallucinations
3. Disorganized speech
4. Disorganized Bx
- Specify if with marker stressors, without marked stressors, with postpartum onset, with
catatonia

Schizophreniform Disorder (1 – less than 6 months)

- Criteria A: 2 or more of ff: (1 must be 1,2, or3)

1. Delusions
2. Hallucinations
3. Disorganized speech
4. Disorganized Bx
5. Negative Symptoms
- No major depressive/manicepisode with actgive phase
- Specify if with good prognostic features, w/o good prognostic features, with catatonia

Schizophrenia (at least 6 months)

- 2 or more of ff: (1 must be 1,2, or3)

1. Delusions
2. Hallucinations
3. Disorganized speech
4. Disorganized Bx
5. Negative Symptoms
- Functional impairment
- Specify if 1st episode currently in acute episode, 1st episode currently in partial remission, 1st
episode currently in full remission, multiple episodes currently in acute/partial/full remission,
unspecified
- Not attributed to physiological effects of drug/medication
- Other features:
 1. Inappropriate affect (laughing)
2. Dysphoric mood
3. Disturbed sleep
4. Food refusal
5. Depresonalization, derealization, somatic concerns
6. Anxiety and phobias
7. Cognitive/sensory deficits
8. Anosognosia (unawareness of symptoms  non-adherence to treatment)
- Emerge in late teens/mid 30
- Peak age for males mid 20; peak age for females late 20
- Strong genetic contribution to risk, greater paternal age, maternal diabetes, season of birth
- Life expectancy reduced because of comorbidity with other conditions

Schizoaffective Disorder (2 or more weeks)

- Major mood episode concurrent with Criterion A of schizophrenia

- Specify if bipolar, depressive type, with catatonia

Substance/Medication-Induced Psychotic Disorder

- Presence of Delusions and/or Hallucinations

- Criterion A developed during medication
- Specify if with onset during intoxication/withdrawal

Catatonia

Bipolar & Related disorders

- MANIC EPISODE- emotional state characterized by a period of at least 1 week where an

elevated, expansive, or unusually irritable mood exists.

3 or more of: inflated self-esteem, less sleep, talkative, flight or ideas, distractibility,
increase in goal-oriented activity, excessive involvement in risky activities

impair functioning with psychotic features

- HYPOMANIC EPISODE (4 days)

3 or more of: inflated self-esteem, less sleep, talkative, flight or ideas, distractibility,
increase in goal-oriented activity, excessive involvement in risky activities

No function impairment

- MAJOR DEPRESSIVE EPISODE (2 weeks)

 5 or more of the ff: (atleast 1 should be 1 or 2)

1. Depressed mood
2. Loss of interest/pleasure
3. Weight loss
4. Insomnia/hypersomnia
5. Psychomotor agitation
6. Fatigue
7. Feeling of worthlessness/guilt
8. Inability to concentrate/decide
9. Suicidal thoughts

Bipolar I

- At least 1 manic episode

Bipolar II

- At least 1 hypomanic episode AND 1 major depressive episode

- Never been a manic episode

Cyclothymic Disorder (2years or 1 yr in children)

- Presence of hypomanic and depressive symptoms that do not meet criteria for diagnosis
- Have not been without symptoms for 2 months at a time

Depressive Disorders

Disruptive Mood Dysregulation Disorder (at least 12 months )

- Temper outburst (verbal and/or behaviorally) at least 3 times per week lasting 3 or more
months
- Present in 2/3 setting
- Diagnosis should be made between 6-18 years old
- Above criteria met before 10 yrs old

Major Depressive Disorder

- 5 or more of the ff: (atleast 1 should be 1 or 2) for 2 weeks

1. Depressed mood
2. Loss of interest/pleasure
3. Weight loss
4. Insomnia/hypersomnia
5. Psychomotor agitation
 6. Fatigue
7. Feeling of worthlessness/guilt
8. Inability to concentrate/decide
9. Suicidal thoughts
- Function impairment

Persistent Depressive Disorder (Dysthymia) – combination of chronic MDD and dysthymic disorder

*mood may shift repidly

*60% manic episodes occurbefore MDE

*strong genetic origin

*comorbid w anxiety disorders & alcohol use

Bipolar II (mid 20)

*hypomanic episode

- change in functioning that is uncharacteristic

-not severe enough to cause impairment

- atleast 1 required

*MDE

- atleast 1 required

*no manic episode

*sypmtoms not better expliad by schizo disorders

*not milder than bipolar 1, bipolar 2 - greater chronicity of illness/more depressive

*impulsive - contribute to higher suicide risk

Anxiety Disorders

---fear: emotional response to real or percieved imminent threat

---anxiety: anticipation of future threat