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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. SCHIZOPHRENIFORM DISORDER.

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schizophrenia other psychotic disorders
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
schizophreniform disorder
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.

s hizophreniform disorder specifiers
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
treatment planning for schizophreniform disorder
Treatment Planning for Schizophreniform Disorder
  • Psychoeducation
  • Supportive therapy
  • Maintenance antipsychotic medication
  • Better prognosis
diagnostic criteria for schizoaffective disorder
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

diagnostic concerns for schizoaffective disorder
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
treatment planning for schizoaffective disorder
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
delusional disorder
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 month’s 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.
subtypes for delusional disorder
Subtypes for Delusional Disorder

Based on prominent delusional theme:

  • Erotomanic: belief thatanother 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 you’re being treated malevolently, e.g. cheated, conspired against, poisoned, spied on
  • Somatic: belief that you have a physical defect or general medical condition
  • Mixed: >1 of above themes; no 1 theme predominates
  • Unspecified: central theme doesn’t fit other types
diagnostic concerns for delusional disorder
Diagnostic Concerns for Delusional Disorder:
  • Could beliefs be based in reality?
  • Delusional beliefs vs. strongly held beliefs
  • Could beliefs reflect person’s cultural and religious background?
  • Could beliefs be due to the effects of a substance or general medical condition?
treatment planning for delusional disorder
Treatment Planning for Delusional Disorder
  • Use of medication: antipsychotics, antidepressants
  • Psychotherapy: confronting the delusion, reality testing, gentle probing
brief psychotic disorder
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.
specifiers for brief psychotic disorder
Specifiers for Brief Psychotic Disorder:
  • With Marked Stressors: brief reactive psychosis
  • Without Marked Stressors
  • With Postpartum Onset: within 4 weeks postpartum
treatment of brief psychotic disorder
Treatment of Brief Psychotic Disorder:
  • Medication: antipsychotic
  • Psychotherapy: aimed at helping individual cope with or escape from the stressor (if one is present)