Psychiatry Course Review. Dr Mohamed Al Nafaiei Senior Psychiarist. Psychotic Disorder. Schizophrenia: A chronic severe brain disorder; often they hear voices, believe media are broadcasting their thoughts to the world or may believe someone is trying to harm them.
Dr Mohamed Al Nafaiei
A chronic severe brain disorder; often they hear voices, believe media are broadcasting their thoughts to the world or may believe someone is trying to harm them.
In men it usually develops in teen years and early 20s; in women it usually develops in 20s and 30s.
Profound disruption in cognition and emotion, affecting the most fundamental human attributes:
Sense of self
Those that appear to reflect an excess or distortion of normal functions.
Delusions. Those where the patient thinks he is being followed or watched are common; also the belief that people on TV, radio are directing special messages to him/her.
Hallucinations. Distortions or exaggerations of perception in any of the senses.
loose associations; speech is tangential, loosely associated or incoherent enough to impair
Grossly disorganized behavior.
Difficulty in goal directed behavior, unpredictable agitation or silliness, social disinhibition, or bizarre behavior.
There is a purposelessness to behavior.
Marked decrease in reaction to immediate environment, sometimes just unaware of surroundings, rigid or bizarre postures, aimless motor activity.
Those that appear to reflect a diminution or loss of normal functions.
May be difficult to evaluate because they are not as grossly abnormal as positive symptoms.
Reduction in the range and intensity of emotional expression, including facial expression, voice tone, eye contact and body language.
Alogia (poverty of speech)
Lessening of speech fluency and productivity, thought to reflect slowing or blocked thoughts; often manifested as short, empty replies to questions.
The reduction, difficulty or inability to initiate and persist in goal-directed behavior. Often mistaken for apparent disinterest.
No longer interested in going out with friends
No longer interested in activities that the person used to show enthusiasm
No longer interested in anything
Sitting in the house for hours or days doing nothing
This one is somewhat new and may not be considered valid.
It is thought disorder, confusion, disorientation and memory problems.
Lack of emotion
Lack of interest in life
Inappropriate social skills
Inability to make friends
Difficulties in concentration and memory:
Difficulty expressing thoughts
Difficulty integrating thoughts, feelings, behaviors
Family Therapy (focus on expressed emotion)
Individual Psychotherapy (coping skills and personal management)
Outcome studies demonstrate around 40% social recoveries with medication use in conjunction with other treatment
Individual feels singled out and taken advantage of, mistreated, plotted against, stolen from, spied on, ignored or otherwise mistreated
Hold a delusional system usually centered on one theme
Aside from delusional system such individuals may appear perfectly normal in conversation, emotionality, and conduct
A. Nonbizarre delusions (i.e., involving situations that occur in real life, such as being followed, poisoned, loved at a distance, or deceived by spouse or lover, or having a disease) of at least 1 month's duration.
B. Criterion A for Schizophrenia has never been met.
Note: Tactile and olfactory hallucinations may be present if they 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 odd or bizarre.
D. If mood episodes have occurred concurrently with delusions, their total duration has been brief relative to the duration of the delusional periods.
E. The disturbance is not due to the direct physiological effects of a substance (drug abuse, medication or a medical condition)
Episodes and Patterns
Major depressive episode
Five or more of the following, most of the day and/or nearly every day for at least 2 weeks, including at least symptom 1 or 2:
1. Depressed mood
Sad, empty, weepy; irritable, angry
2. Loss of interest or pleasure in previously enjoyable activities
3. Change in weight or appetite
4. Sleep changes
5. Noticeable change in movement
7. Feelings of worthlessness or guilt
8. Impaired cognition or volition
9. Repeated thoughts of death or suicide, or planned or attempted suicide
The five symptoms must occur in the same two weeks
One week of persistently high, expansive, or irritable mood, and 3 of:
Lower sleep need
Increased activity or agitation
High risk activities
One week of both manic and major depressive symptoms with rapidly alternating moods
Irregular appetite (binge-fast)
Thoughts of suicide
Four days of manic episode symptoms
Mood disturbance does not critically impair ability to work or maintain social responsibilities
Response pattern is uncharacteristic
Bipolar I Disorder
One or more manic or mixed episodes
Usually one or more major depressive episodes
Subcategorized based on the character of the most recent episode
Most recent episode depressed
Most recent episode manic
Most recent episode mixed
Bipolar II Disorder
One or more major depressive episodes
One or more hypomanic episodes
NO manic or mixed episode
Two years of alternating hypomanic and depressive symptoms
No remission of more than two months
NO major depressive, manic, or mixed episodes
No history of manic, hypomanic, or mixed episodes
Major Depressive Disorder
Current major depressive episode
Two years of chronically depressed mood
Two additional depression symptoms (appetite, sleep, energy, concentration, low self-esteem, hopeless feelings)
Antipsychotics or/and mood stabilizers