Schizophrenia and Other Psychotic Disorders
Schizophrenia
Duration of symptoms for at least 6 months with a least one month of 2 or
more active-phase symptoms
Onset – late teens & mid 30s (Late Onset: after 45)
Etiology – Genetic component; dopamine hypothesis; brain abnormalities
(enlarged ventricles; hypo-frontality)
Familial Pattern: 1st degree relatives: 10x >
Treatment – Antipsychotic drugs; skills training (social, self-care,
cognitive); family intervention (ie. improved communication and reduce
negative expressed emotion).
Better prognosis correlates with a precipitating event; acute (brief
duration), late onset, female gender, no family history and good pre-morbid
adjustment.
Positive v.s. Negative Symptoms
Positive Symptoms:
Delusions – false beliefs that they firmly held despite the existence of
evidence that suggests the contrary.
Hallucinations – auditory (most common); visual; olfactory; tactile
Disorganized Speech – loosening of association; incoherence
Grossly Disorganized– (appearance is disheveled; agitated; displaying
inappropriate sexual behavior) or Catatonic Behavior – decrease flow of
psychomotor activity; reduced reactivity to environmental stimuli.
Negative Symptoms:
* affective flattening, blunted; avolition – restricted initiation of goal-directed
behavior.
Catatonia
• Catatonia will be expanded as a specifier and likely to be used for the
following disorders:
• Brief Psychotic Disorder
• Schizophreniform Disorder
• Schizoaffective Disorder
• Substance-induced Psychotic Disorder
• Depressive Disorders
• Bipolar Disorders
• Catatonia Associated with Another Mental Disorder (Catatonia
Specifier)
• Catatonia Disorder Due to Another Medical Condition
• Unspecified Catatonia
Delusional Disorder
• Criterion A for delusional disorder no longer requires that the delusions
must be non-bizarre.
• One or more delusions for 1 month or longer
• Hallucinations are not prominent, associated with delusions
• Not due to substance use or another general medical condition
• DSM-5 no longer separates delusional disorder from shared delusional
disorder.
• Other Specified Schizophrenia Spectrum
Delusional Disorder
• Specify:
• Erotomanic, Grandiose, Jealous, Persecutory, Somatic
• Specify: Mixed or Unspecfiied
• Specify:
• Episode (e.g., first, multiple)
• Current Functioning (e.g., acute, partial, full remission)
Brief Psychotic Disorder
• Presence of (1) or more of the following symptoms. At lease one must be out
of the first three:
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized
1. Duration: 1 day but less than 1 month
2. Disturbance is not better explained by major depressive or bipolar disorder
with psychotic features or another psychotic disorder such as Schizophrenia
or catatonia and not attributable to the physiological effects of a substance.
3. Specify (1):
-with/out marked stressors (brief reactive psychosis)
- with postpartum (during or within 4 weeks post)
- With catatonia
Specify (2): Severity: (Optional)
Schizophreniform Disorder
• Presence of (2) or more of the following symptoms. At lease (1) must be out
of the first (3)
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized
5. Negative symptoms
• Duration: 1 month but less than 6 months
• Schizoaffective disorder and depressive or bipolar disorder with psychotic
features have been ruled out
• Disturbance is not attributable to the physiological effects of a substance
• Specify:
- with/out good prognostic features
- with catatonia
Schizoaffective Disorder
• A. An uninterrupted period of illness during which there is a major Mood
episode concurrent with Schizophrenia.
• B. Delusions or hallucinations for 2 or more weeks in the absence of a major
mood episode
• C. Symptoms that meet criteria for a major mood episode are present for the
majority of the total duration of the active and residual portions of the
illness.
• D Disturbance is not attributed to the effects of a substance or another
medical condition.
• Specify: Bipolar or Depressive
• [increased risk]
• Specify: Episode and Current Functioning
Schizophrenia
• Presence of (2) or more of the following symptoms, each present for a
significant portion of time during (1) month period (or less if successfully
treated). At lease (1) must be out of the first (3)
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized
5. Negative symptoms
• Duration: minimum 6 months
• Schizoaffective disorder and depressive or bipolar disorder with psychotic
features have been ruled out
• Disturbance is not attributable to the physiological effects of a substance
• Specify:
- Episode and current functioning
- with catatonia
Differential Diagnosis
• Schizophreniform Disorder – symptoms present for at least one month but
less than 6 months.
• Schizoaffective Disorder – an uninterrupted period of disturbance in which
a mood episode and active phase symptoms occur concurrently & during
which hallucinations and/or delusions have occurred for at least 2 weeks in
the absence of mood symptoms (e.g. can be disorganized, flat affect,
catatonic behavior)
• Delusional Disorder – non-bizarre delusions ; behavior is not bizarre;
however, may depict tactile and olfactory hallucinations related to the
delusion; for a period of 1 month (ie. I can smell my wife has been with
another man).
• Brief Psychotic Disorder – delusions; hallucinations; disorganized speech
and/or behavior for at least 1 day but less than 1 month returning to pre-
morbid level of functioning.
Schizophrenias
• Brief Psychotic Disorder – 1 day < 1 month
• Schizophreniform Disorder - 1 month > 6 months
• Schizophrenia – 6 months w/ 2 month of active symptoms
• Schizoaffective Disorder – mood & schizophrenia occur together w/ 2
Weeks of hallucinations/delusions w/o mood
• Unspecified Schizophrenia Spectrum and Other Psychotic Disorder
(Folie a Deux) – a delusion that develops in an individual who is involved in
a close relationship with another person who already has a Psychotic
Disorder with prominent delusions whereby the individual shares either in
whole or in part the delusion of the primary case
• Psychotic Disorder due to Another [General Medical Condition] – a
transient or recurrent condition, which cycles with exacerbation and
remission of the underlying medical condition, that may involve delusions or
hallucinations. There must be a evidence of a physiological consequence
subsequent to a physical exam or lab result.
• Specify: with delusions or hallucinations
• Substance/Medication-Induced Psychotic Disorder – prominent
hallucinations or delusions with evidence of a physical exam or lab result
indicating that the symptoms developed within 1 month of substance
intoxication or withdrawal and does not occur during the course of delirium.
• Specify:
-with onset during intoxication
-with onset during withdrawal
