SCHIZOPHRENIA

1
SCHIZOPHRENIA OTHER PSYCHOTIC DISORDERS

• Core Concept
• Distorted perception of reality
• Impaired capacity to reason, speak, and behave
  rationally or spontaneously
• Impaired capacity to respond with appropriate
  affect motivation

2
SCHIZOPHRENIFORM DISORDER

• 2 or more of the following sx are present for at
  least a month delusions, hallucinations,
  disorganized speech, disorganized or catatonic
  behavior, negative sx
• R/O schizoaffective disorder, mood disorders, and
  the effects of a substance or general medical
  condition
• An episode of the disorder (including prodromal,
  active, residual phases) lasts at least a month
  but less than 6 months
• Provisional diagnosis prior to 6 months.

3
Shizophreniform Disorder Specifiers

• Without Good Prognostic Features
• With Good Prognostic Features as evidenced by 2
  or more of the following
• acute onset of Sx
• confusion or perplexity at height of psychotic
  episode
• good premorbid social and occupational
  functioning
• absence of blunted or flat affect

4
Treatment Planning for Schizophreniform Disorder

• Psychoeducation
• Supportive therapy
• Maintenance antipsychotic medication
• Better prognosis

5
Diagnostic Criteria for Schizoaffective Disorder

• Overlap of mood sx psychotic sx
• 2 week period of psychotic sx without mood sx
• Mood sx are prominent enduring part of clinical
  picture
• Specifiers
• Bipolar Type disturbance includes manic or
  mixed episode
• Depressive Type disturbance includes major
  depressive episode

6
Diagnostic Concerns for Schizoaffective Disorder

• Difficult to determine whether mood sx are of
  sufficient severity and duration to warrant dx of
  Schizoaffective (vs. schizophrenia)
• Difficult to determine whether psychotic sx occur
  only in the context of mood disorder (Mood
  Disorder with Psychotic Features)
• Dx applies only to a given episode of the
  disorder, not to lifetime course

7
Treatment Planning for Schizoaffective Disorder

• No clear treatment guidelines
• Acute management antipsychotic medication for
  psychotic sx mood stabilizer for manic or mixed
  sx antidepressant for depressive sx
• Maintenance treatment medication management and
  compliance, psychoeducation, stress reduction

8
DELUSIONAL DISORDER

• Diagnostic Criteria
• Presence of 1 or more nonbizarre delusions
  (involve plausible situations, e.g. being
  followed, poisoned, infected, loved at a
  distance, betrayed by a lover, or having a
  disease) of at least 1 months duration.
• Aside from impact of delusion(s), functioning is
  not markedly impaired and behavior is not
  obviously odd or bizarre.
• Criteria A for Schizophrenia has never been met.

9
Subtypes for Delusional Disorder

• Based on prominent delusional theme
• Erotomanic belief that another person, usually
  of higher status, is in love with you
• Grandiose belief that you have inflated worth,
  power, knowledge, identity, or a special
  relationship to a prominent person
• Jealous belief that lover is unfaithful
• Persecutory belief that youre being treated
  malevolently, e.g. cheated, conspired against,
  poisoned, spied on
• Somatic belief that you have a physical defect
  or general medical condition
• Mixed gt1 of above themes no 1 theme
  predominates
• Unspecified central theme doesnt fit other types

10
Diagnostic Concerns for Delusional Disorder

• Could beliefs be based in reality?
• Delusional beliefs vs. strongly held beliefs
• Could beliefs reflect persons cultural and
  religious background?
• Could beliefs be due to the effects of a
  substance or general medical condition?

11
Treatment Planning for Delusional Disorder

• Use of medication antipsychotics,
  antidepressants
• Psychotherapy confronting the delusion, reality
  testing, gentle probing

12
Brief Psychotic Disorder

• Diagnostic Criteria
• Presence of 1 or more of the following
• Delusions
• Hallucinations
• Disorganized speech
• Grossly disorganized or catatonic behavior
• Duration at least a day, but less than a month
• Diagnosis is given after person has fully
  recovered in less than a month.

13
Specifiers for Brief Psychotic Disorder

• With Marked Stressors brief reactive psychosis
• Without Marked Stressors
• With Postpartum Onset within 4 weeks postpartum

14
Treatment of Brief Psychotic Disorder

• Medication antipsychotic
• Psychotherapy aimed at helping individual cope
  with or escape from the stressor (if one is
  present)