1. Other Psychotic Disorders
By : Dr Seddigh
HUMS

2. Other Psychotic Disorders
Schizophreniform Disorder
Brief Psychotic Disorder
Schizoaffective Disorder
Delusional Disorder
Shared Psychotic Disorder

3. What is a Psychotic Disorder
Psychosis
A break from reality
Often involves difficulties interacting with and perceiving the real world
Split between thoughts and emotions

4. Schizophrenia - DSM Diagnostic Criterion “A”
Characteristic Sxs (2 + for 1 month)
delusions
hallucinations
disorganized speech
grossly disorganized or catatonic behavior
negative Sxs (flat affect, alogia, avolition)
(Only one element required if delusions bizarre,
or hallucinations commentary 2 voices conversing )

5. Schizophrenia - DSM Diagnostic Criteria B - F
B: Social/occupational dysfunction (decline)
C: Duration - 6 months total, 1 month “A” Sxs
D: Exclusion - SAFD, mood d/o
E :Exclusion - sub abuse, gen med condition
F: PDD/Autism - at least 1 month delusions or hallucinations

6. Schizophreniform Disorder

7. Schizophreniform Disorder
Criteria A, D, and E of Schizophrenia are met
(To help you remember:
Criteria A: 2+ characteristic symptoms (delusions, hallucinations, disorganized speech, disorganized/catatonic behavior, negative affect) present for significant part of month
Criteria D: Schizoaffective Disorder and Mood Disorder with Psychotic Features have been ruled out
Criteria E: Not due to a GMC or substance)
An episode of the disorder (including the prodromal, active, and residual phases) lasts at least 1 month but less than 6 months

8. Schizophreniform Disorder
Essentially, exactly like Schizophrenia, but the duration is shorter
Schizophrenia: 6 months or longer
Schizophreniform: 1-6 months
Often used as a provisional diagnosis during the first months of a psychotic illness
Thus, this diagnosis not infrequently changes to Schizophrenia after 6 months have passed without complete recovery

9. Facts about Schizophreniform Disorder
Prevalence: Varies substantially:
Approx. 0.2% in industrialized areas
Approx. 1% in non-industrialized areas
May be explained by higher functioning and better prognosis for psychotic disorders in non-industrialized areas
Gender: Approx. equal rates
Age of Onset: Same as Schizophrenia (keep in mind gender differences)
Course: 1/3 recover within the 6 month period
2/3 progress into Schizophrenia

10. Brief Psychotic Disorder

11. Brief Psychotic Disorder
A. Presence of one or more of the following symptoms:
Delusions
Hallucinations
Disorganized speech
Grossly disorganized or catatonic behavior
B. Duration of an episode of the disturbance is at least 1 day but less than 1 month, with eventual full return to premorbid levels of functioning
C. Disturbance is not better accounted for by another mental disorder and is not due to a GMC or substance

12. Brief Psychotic Disorder vs. Schizophrenia/Schizophreniform
Criteria
Schizophrenia/Schizophreniform Disorder
2 symptoms needed (there is an exception to this rule)
Can include Negative Affect
Brief Psychotic Disorder
Only 1 symptom needed
Cannot be Negative affect
Duration
Schizophrenia: 6+ months
Schizophreniform Disorder: 1 – 6 months
Brief Psychotic Disorder: 1 day – 1 month

13. Facts about Brief Psychotic Disorder
Prevalence: Unknown (symptoms often do not persist long enough to come to the attention of mental health professionals or researchers)
Gender: Unknown, can assume to be equal
Age of Onset: Late adolescence to early adulthood
Course: By definition, no longer than 1-month

14. Schizoaffective Disorder

15. Schizoaffective Disorder
An uninterrupted period of illness during which, at some time, there is either a Major Depressive Episode, a Manic Episode, or a Mixed Episode concurrent with symptoms that meet Criterion A for Schizophrenia
During the same period of illness, there have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms
Symptoms that meet criteria for a mood episode are present for a substantial portion of the total duration of the illness
Not due to a GMC or substance

16. Subtypes of Schizoaffective Disorder
Bipolar Type: if the disturbance includes a Manic or a Mixed episode
Depressive Type: if the disturbance only includes Major Depressive Episodes

17. Facts about Schizoaffective Disorder
Prevalence: Unknown, but seems to be less common than Schizophrenia
Gender: Equal rates of Bipolar Subtype
Women tend to have higher rates of the Depressive subtype
Age of Onset: Late adolescence to late in life
Average age = early adulthood
Bipolar Subtype – more common in younger adults
Depressive Subtype – more common in older adults
Course: Better prognosis than Schizophrenia, worse prognosis than mood disorders
Better prognosis for Bipolar subtype

18. Delusional Disorder

19. Delusional Disorder Nonbizarre delusions lasting for at least 1 month
Criterion A for Schizophrenia have never been met (However, tactile and olfactory may be present if they are related to the delusional theme)
Behavioral functioning is not markedly imparied and behavior is not obviously odd or bizarre
If mood episodes have occurred concurrently with delusions, their total duration has been brief relative to the duration of the delusional periods
Not due to the direct effects of a GMC or substance

20. Types of Delusional Disorder
Erotomanic – delusions that another person, usually of higher status, is in love with the individual
Grandiose – delusions of inflated worth, power, knowledge, identity, or special relationship to a deity or famous person
Jealous – delusions that the individual’s partner is unfaithful
Persecutory – delusions that the person (or someone who is close to the person) is being malevolently treated in some way (most common)
Somatic – delusions that the person has some physical defect or general medical connection
Mixed – delusions characteristic of more than one of the above types but no one theme predominates
Unspecified – no information provided

21. Facts about Delusional Disorder
Prevalence: 0.03% (community samples)
1-2% of inpatient mental health admissions
Gender: Equal rates, however, rates of specific types of delusional disorder may vary (e.g. Jealous type)
Age of Onset: Can be quite variable – ranging from adolescence to late in life
Course: Can also be quite variable
Can be chronic or may remit completely
Symptoms may wax and wane or disappear completely and then reappear

22. Shared Psychotic Disorder (Folie á Deux)

23. Shared Psychotic Disorder (Folie á Deux)
A delusion develops in an individual in the context of a close relationship with another person(s), who has an already-established delusion
The delusion is similar in content to that of the person who already has the established delusion
The disturbance is not better accounted for by another psychotic disorder or is due to a GMC or substance

24. Shared Psychotic Disorder
The delusions are shared between two people are in a close relationship (husband and wife, parent and child, siblings, etc.)
Typically, the person with the original delusion is the more dominant personality in the relationship
Generally the delusions are only shared by two people, but can be shared among large groups of people as well

25. Facts about Shared Psychotic Disorder
Prevalence: Unknown, goes unrecognized
Gender: Somewhat more common in women
Age of Onset: Seems to vary
Course: Tends to be chronic, because the disorder tends to afflict people in extremely close, long-lasting relationships
However, if separated from the person with the original delusions, the delusions usually dissipate