Psychosis

Schizophrenia and Related Disorders

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

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)

Schizophrenic Presentation

• • Have difficulties separating what is internal vs. what is external Magical thinking

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

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

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

Subtypes

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

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

Etiology

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

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

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

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

Treatment

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

Schizophreniform

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

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

Schizoaffective Disorder

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

Schizoaffective Disorder

• • • Bipolar Type Depressive Type Prognosis: Better than Schizophrenia, worse than mood disorder (precipitating stress = better prognosis)

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

• • • • • • •

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

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)

Shared Psychotic Disorder

• Catch a delusion (in whole or in part) from another person with a Psychotic Disorder

Other Psychotic Disorders

• • • Due to a general medical condition Substance Induced NOS