Schizophrenia Spectrum & Psychotic Other Disorders - Answers Characterized by abnormalities
of one or more: delusions,hallucinations, disorganized thinking (speech), disorganized or
abnormal motor (including catatonia) & negative symptoms. Severity is rated by assessing the
primary symptoms of psychosis on a 5point scale for each so based on presence & strength of
the screen from 0 (not present) to 4 (present & severe). Disorders presented in order of severity.
Delusions (thinking) - Answers Fixed, false beliefs that are unchangeable. Content varies and
can be bizarre or non-bizarre. Non-bizarre are situations that are possible and bizarre are those
that are clearly implausible
Hallucinations (perception) - Answers Vivid & clear perceptions that occur w/out external stimuli.
May occur in any sensory modality. Auditory experiences are the most common and tend to be
experienced as voices that are distinct from one's own thoughts
Disorganized Thinking - Answers Usually inferred from speech - person switches from topic to
topic (derailment or loose associations) or provides answers that diverge from questions asked
(tangentiality)
Grossly Disorganized or Abnormal Motor Behavior (including catatonia) - Answers May range
from childlike silliness to unexpected agitation, typically interfering with goal-directed behaviors
and activities of daily living. Catatonia is a marked decrease in reactivity that ranges from
resistance to instructions (negativism), to maintaining odd posture,to lack of verbal or motor
response (mutism and stupor). Can also involve excessive motor activity (catatonic excitement)
repeated stereotype movement, grimacing, and echoing of speech.
Negative Symptoms - Answers Include diminished emotional expression and avolition
(decrease in self-initiated purposeful activities), alogia (reduced speech output), anhedonia
(diminished pleasure) & asociality (lack of interest in social interactions)
Specifier w/catatonia - Answers Can be coded for any of the disorders. Criteria involve a clinical
picture that is dominated by 3 or more: stupor (no psychomotor activity), catalepsy (posture is
held passively, against gravity), waxy flexibility (resistance to positioning by another), mutism
(no verbal response), negativism (no response instructions or external stimuli), posturing
(actively maintaining a posture against gravity), mannerism (caricature of normal actions),
stereo to be repetitive non-goal directed movements, agitation, grimacing, echolalia (mimicking
another's speech) or echopraxia (imitating another's movement)
Schizotypal Personality Disorder - Answers Is considered part of the schizophrenia spectrum
and is also in the personality disorders.
Delusional Disorder - Answers One or more delusions for at least one month with no additional
symptoms found in schizophrenia. The person's behavior is relatively unimpaired and is not
obviously. If manic or major depressive episodes occur concur with the delusions, the duration
,of the moon episode is brief relative to the duration of the delusion. Specifiers include
erotomanic type, grandiose type, jealous type, persecutory type, somatic type, mixed type, and
unspecified type. Specifier with bizarre content if bizarre. Onset is typically in middle to late
adulthood & the most common subtype is persecutory
Erotomanic type - Answers Involves delusions and which another person, usually of higher
status, is in love with the individual
Grandiose type - Answers Characterized by delusions of inflated self-worth, power, knowledge,
or a special relationship to a deity or famous person
Jealous type - Answers Involves delusions in which the person believes that a sexual partner is
being unfaithful
Persecutory type - Answers Characterized by delusions in which the person is being persecuted
or ill treated, which may trigger violent behavior
Somatic type - Answers Involved illusion relating to body functions and sensations
Mixed type - Answers Involves characteristics of more than one of the types of without any
single theme predominating
Unspecified type - Answers Delusions who's themes are not characteristic of any of the types
Brief Psychotic Disorder - Answers Characterized by one or more: delusions, hallucinations,
disorganized speech, or grossly disorganized or catatonic behavior. The episode lasts from one
day to one month with eventual return to premorbid level of functioning. Specifiers: with Mark
stressor, without marked stressor, or with postpartum onset. With catatonia is also used.
Schizophreniform Disorder - Answers Symptoms are identical to schizophrenia and
distinguished only by duration. Diagnosis is made when the duration of the illness is at least one
month but less than six. If person has not recovered after onset "provisional" is added to the dx
and will be changed to schizophrenia after 6 months. Specifiers include with good prognostic
features & without good prognostic features. catatonia is also used if present
Good prognostic features - Answers Include two or more: onset of prominent psychotic
symptoms within four weeks of the first noticeable change in behavior (acute onset), confusion
or perplexity, good premorbid social and occupational functioning, and absence of flat or
blunted affect.
Schizophrenia - Answers Diagnostic criteria require the presence of two or more sx of psychosis
each for a significant time during a 1 month period. At least one sx must be hallucinations,
disorganized speech, or delusions. Since onset the person must be functioning at a level
markedly below previous functioning for a significant portion of time in areas such as work,
personal relations or self-care. Signs must persist for at least 6 months with at least 1 month of
,active sx. During prodromal or residual periods, the signs of disturbance May include only
negative symptoms or two or more symptoms in attenuated (weakened) forms.
Schizophrenia onset & course - Answers Typically occurs between late teens and early 30s with
onset prior to adolescence rarely occurring. Median age is early to mid 20s for men and late 20s
for women. It may be abrupt or gradual and in most cases involve a prodromal phase which is
characterized by deterioration in overall functioning in the beginning. The course is variable but
full remission is rather uncommon, some individuals have a course characterized by
exacerbations and remissions while other show progressive deterioration
Schizophrenia prognosis - Answers Prognosis is best with good prior functioning, abrupt onset,
fewer negative symptoms, minimal cognitive impairment & female gender (females tend to have
fewer negative symptoms). Later on that has been associated with better prognosis however
the effect of age on onset on prognosis is likely related to gender as females have a later age of
onset. Suicide risk is high.
Schizophrenia & genes - Answers First-degree relatives have a concordance rate of 10% and
have a greater risk of developing schizophrenia than the general population. Identical twins have
a 50% concordance rate, the risk of developing schizophrenia when both parents have the
disorder is about 45%. Relatives of individuals with schizophrenia havoc increased risk of
developing other schizophrenia spectrum disorders including schizotypal and paranoid
personality disorders and delusional disorder
Schizophrenia & brain - Answers MRI of the brain the persons with schizophrenia showing
enlargement of the lateral and third ventricles, a smaller cerebral cortex, and a smaller thalamus
(the filter for sensory input). PET scans indicate decreased frontal lobe activity which have been
associated with the negative symptoms
Treatment for Schizophrenia - Answers Medication management is a key component and
typically life long. Most common are antipsychotics. Psychosocial interventions such as CBT
and family psychoeducation. Expressed emotion by family members has been shown to predict
relapse many family approaches work to decrease expressed emotion and focus on strength
and resiliency. Social skills training teach skills related to communication, service, disease
management and independent living.
Schizoaffective Disorder - Answers Uninterrupted period of illness during which there has been
a major mood episode concurrent with the sxs of schizophrenia and delusions or hallucinations
for at least 2 weeks w/out prominent mood sxs. Mood symptoms are present for the majority of
the course of the disorder but the schizophrenia symptoms are prominent. With Catatonia is
used if sxs are present
Schizoaffective Dis Bipolar type - Answers Used if a manic episode is part of the presentation,
whether or not a major depressive episode occurs
, Schizoaffective Dis Depressive type - Answers Used only if major depressive episodes are part
of the presentation
Substance/medication induced psychotic disorder - Answers Substances that can induce a
psychotic disorder include alcohol, cannabis, hallucinogens (including PCP), inhalants, sedatives,
hypnotics, anxiolytics and stimulants including (cocaine)
Psychotic disorder due to another medical condition - Answers Medical conditions that are
known to manifest with delusions or hallucinations include neurological conditions, in the
kindest orders, and metabolic condition. Specifiers include with delusions or with hallucinations
Catatonic disorder due to another medical condition - Answers Medical conditions that are
known to manifest with catatonia including neurological conditions and metabolic conditions
Other specified/unspecified schizophrenia spectrum and other psychotic disorder - Answers
Psychotic like symptoms below threshold for full psychosis
Bipolar and related disorders - Answers Three types of mood episodes: manic, depressive,
hypomanic. episodes should be specified as mild moderate or severe. Full criteria not met it
should be specified as in partial remission or in full remission. Other specifiers include: with
anxious distress, with mixed features, with rapid cycling, with mood congruent or mood
incongruent psychotic features, with catatonia, with peripartum onset, and with seasonal
pattern.
Manic episode - Answers An abnormally elevated, expensive, or irritable mood with increased
goal directed activity or energy that lasts at least one week and is present most of the day
nearly every day. Three or more symptoms: inflated self-esteem or grandiosity, decreased need
for sleep, pressured speech, flight of ideas or racing thoughts, distractibility, increased goal
directed activity, psychomotor agitation and excessive involvement in activities that have a high
likelihood of adverse consequences. Either causes significant impairment in functioning or
necessitates hospitalization (no minimum duration of symptoms required when hospitalization
is necessary)
Hypomanic episode - Answers A period of elevated, expensive, or irritable mood as well as
increased activity or energy that lasts at least four days and is present most days nearly every
day. Three or more of the following symptoms: inflated self-esteem or grandiosity, decreased
need for sleep, pressured speech, flight of ideas or racing thoughts, distractibility, increased go
directed activity or psycho motor agitation and involvement in activities that have a high
likelihood of adverse consequences. Distinct from a manic episode in that it is not severe
enough to impaired functioning or require hospitalization
Major depressive episode - Answers Requires at least 5 sxs during a 2 week period represented
change from previous functioning. At least one symptom must be either depressed mood or
loss of interest or pleasure (anhedonia). Other sxs: unintentional weight loss or gain or change