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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.

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psychiatry course review

Psychiatry Course Review

Dr Mohamed Al Nafaiei

Senior Psychiarist

psychotic disorder
Psychotic Disorder


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.

symptoms of schizophrenia
Symptoms of Schizophrenia

Profound disruption in cognition and emotion, affecting the most fundamental human attributes:





Sense of self

positive symptoms
Positive Symptoms

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.


Disorganized thinking/speech.

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.


Catatonic behavior

Marked decrease in reaction to immediate environment, sometimes just unaware of surroundings, rigid or bizarre postures, aimless motor activity.

summary of positive symptoms
Summary of Positive Symptoms



Disorganized thinking

Disorganized behavior

Catatonic behavior

Inappropriate responses

negative symptoms
Negative Symptoms

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.

Affective flattening

Reduction in the range and intensity of emotional expression, including facial expression, voice tone, eye contact and body language.

negative symptom
Negative Symptom

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.

negative symptom1
Negative Symptom


The reduction, difficulty or inability to initiate and persist in goal-directed behavior. Often mistaken for apparent disinterest.

examples of avolition
Examples of Avolition

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

disorganized symptoms
Disorganized Symptoms

This one is somewhat new and may not be considered valid.

It is thought disorder, confusion, disorientation and memory problems.

summary of negative symptoms
Summary of Negative Symptoms

Lack of emotion

Low energy

Lack of interest in life

Affective flattening


Inappropriate social skills

Inability to make friends

Social isolation

cognitive symptoms
Cognitive Symptoms

Difficulties in concentration and memory:

Disorganized thinking

Slow thinking

Difficulty understanding

Poor concentration

Poor memory

Difficulty expressing thoughts

Difficulty integrating thoughts, feelings, behaviors


Antipsychotic Medication

Psychosocial Approaches

Family Therapy (focus on expressed emotion)

Individual Psychotherapy (coping skills and personal management)

Social-Skills Training

Outcome studies demonstrate around 40% social recoveries with medication use in conjunction with other treatment


Delusional Disorder

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)

mood disorders
Mood Disorders

Episodes and Patterns

Major depressive episode

Manic episode

Mixed episode

Hypomanic episode

Cycling patterns

major depressive episode
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

more depressive symptoms
More depressive symptoms

5. Noticeable change in movement

6. Fatigue

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

manic episode
Manic episode

One week of persistently high, expansive, or irritable mood, and 3 of:

Grandiose self-esteem

Lower sleep need

Overly talkative

Racing thoughts

Easily distracted

Increased activity or agitation

High risk activities

mixed episode
Mixed episode

One week of both manic and major depressive symptoms with rapidly alternating moods

Common symptoms:



Irregular appetite (binge-fast)


Thoughts of suicide

hypomanic episode
Hypomanic episode

Four days of manic episode symptoms

Mood disturbance does not critically impair ability to work or maintain social responsibilities

Response pattern is uncharacteristic

Not euthymia

bipolar disorders
Bipolar disorders

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 disorders1
Bipolar disorders

Bipolar II Disorder

One or more major depressive episodes

One or more hypomanic episodes

NO manic or mixed episode

Cyclothymic Disorder

Two years of alternating hypomanic and depressive symptoms

No remission of more than two months

NO major depressive, manic, or mixed episodes

depressive disorders
Depressive disorders

No history of manic, hypomanic, or mixed episodes

Major Depressive Disorder

Current major depressive episode

Dysthymic Disorder

Two years of chronically depressed mood

Two additional depression symptoms (appetite, sleep, energy, concentration, low self-esteem, hopeless feelings)


Depresive episode:

Anti depressents

:Manic episode

Antipsychotics or/and mood stabilizers