1. Schizophrenia and Related Disorders
Psychosis
Schizophrenia and Related Disorders

2. Schizophrenia
A hx of acute psychosis with delusions, hallucinations, disorganized speech, catatonia, grossly disorganized behavior, or flat affect
Chronic deterioration of functioning
Duration more than 6 months
Absence of concurrent mood disorder, substance abuse, or medical condition

3. Schizophrenia Criteria
Two or more for most of at least 1 months time
Delusions-often bizarre and mood-incongruent
Hallucinations
Disorganized speech-incoherence, frequent derailment, loose arrangements, tangentiality, circumstantiality, illogical thinking, poverty of content, unable to filter relevant from irrelevant material, punning without humor, making up words (neologisms)
Disorganized or catatonic behavior
Negative symptoms- what is missing (flat affect or inappropriate, alogia-few or no words or avolition-lack of ability to initiate and persist in goal acted activity)

4. Schizophrenic Presentation
Have difficulties separating what is internal vs. what is external
Magical thinking

5. Course Manifests in adolescents or early adulthood-abruptly or slowly
Promodal- symptoms prior to acute episode
Residual- symptoms following the episode
During both patients seem flat and burnt out
Early on: active symptoms and hospitalizations. Later, less psychotic symptoms, but more apathy, low energy, social withdrawal, and low tolerence for stress

6. Course Can function in the community
May have depression after psychotic episode and this is the most dangerous time for suicide
Decreased sleep, energy and mood tend to precipitate a psychotic break
Recovery is NOT related to severity of psychosis

7. Subtypes
Disorganized-marked incoherence with flat, silly or inappropriate affect. Early onset, poor premorbid functioning, severe social impairment, and chronic course
Catatonic-psychomotor disturbances. Sudden onset, better prognosis, respond to ECT
Paranoid- persecutory or grandiose delusions or hallucinations. Unfocused, angry, argumentative, violent, anxious. Onset later in life, interferes less with social functioning, more stable course. Can be contained delusions

8. Subtypes
Undifferentiated- Don’t fit the other subtypes and are actively psychotic
Residual type-No longer an active episode, but some symptoms continue

9. Specifiers
Episodic with interepisode residual symptoms. Can add with prominent negattive symptoms
Episodic with no interepisode residual symptoms
Continuous. Can add with prominent negative symptoms
Single episode in partial remission
Single episode in full remission
Other or unspecified pattern

10. Etiology Brain chemistry- Dopamine
Biology produces schizophrenia, environment determines if it is expressed and how
Is Genetic

11. Schizophrenic vs Other Disorders
Between psychotic episodes, schizophrenics do not completely recover form the psychosis (may still hear voices) with other conditions like mood disorders people usually have remissions
Anxiety and obsessives know their “delusions” are silly

12. Treatment Not to cure, but to improve quality of life
Minimize symptoms
Prevent suicide
Avert relapse
Improve self-esteem
Improve functioning
Reduce pain of relatives
Educate family

13. Treatment Antipsychotics Tardive Dyskinesia Therapy
Support only, stressing reality testing and reassurance: since poor reality testing, overwhelmed by too much stimuli, and short attention span.
Identify stressors and help avoid and cope better with them
Involve family

14. Treatment Medication Compliance Aftercare compliance
Resources (housing, income, self-care
Increase socialization and support
Help family to provide more supportive environment

15. Schizophreniform Same as Schizophrenia EXCEPT:
Time Frame (at least one month, less than 6 months)
Functional Impairment is not required

16. Schizophreniform Specifiers
With good Prognostic Features
(2) Onset of Psychosis w/in 4 wks of change in B or Func
Confusion at peak of episode
Good premorbid functioning
Absence of flat affect
Without good Prognostic Features
Provisional-If under 6 months and active

17. Schizoaffective Disorder
Schizophrenia with mood disorder (MD-2wks, Mania, or Mixed 1 wk)
and
2 wks of psychosis w/out prominent mood disorder symptoms
Mood is present during most of disorder

18. Schizoaffective Disorder
Bipolar Type
Depressive Type
Prognosis: Better than Schizophrenia, worse than mood disorder (precipitating stress = better prognosis)

19. Delusional Disorder
At least one nonbizarre delusion lasting at least 1 month
Not dx if cl has ever met criteria for Schizophrenia
Hallucinations are not prominent and relate to delusion
Apart from delusions, Psychological functioning is intact
Not due to as mood disorder

20. Delusional Disorder Subtypes-Based on Delusional Theme
Erotomanic- YOU LOVE ME
Grandiose- I’M GREAT
Jealous- YOU’RE CHEATING
Persecutory- YOU’RE OUT TO GET ME
Somatic- I STINK (or other body functions)
Mixed
Unspecified

21. Brief Psychotic Disorder
One day to one month w/ at least one positive psychotic symptom
Subtypes
With Marked Stressors
W/out Marked stressors
With Postpartum Onset (w/in 4 wks)

22. Shared Psychotic Disorder
Catch a delusion (in whole or in part) from another person with a Psychotic Disorder

23. Other Psychotic Disorders
Due to a general medical condition
Substance Induced
NOS