Transcript DSM-5 Psychotic Disorders

Schizophrenia and other
Psychotic Disorders
Pascale Jean-Noel, LMSW
[email protected]
[email protected]
Schizophrenia & other Psychotic
Disorders DSM IV
• Schizophrenia: Must have 2 Criterion A symptoms with disorganized
behavior and positive symptoms but can only have one and has five
subtypes (paranoid, disorganized, catatonic, undifferentiated, residual)
• Delusional Disorder: Presence of well systemized, non bizarre delusions
accompanied by affect appropriate to the delusion and occurring in the
presence of a relatively well preserved personality
• Schizoaffective Disorder: An uninterrupted period of illness during which,
at sometime, there is either a major depressive episode, a manic episode,
or mixed episode concurrent with symptoms that meet criterion A
• Shared Psychotic Disorder: Presence of a delusion that develops in the
context of a close relationship with another person, who already has an
established delusion
• Psychotic Disorder NOS: includes psychotic symptomology however
inadequate information to make a specific diagnosis
Schizophrenia & other Psychotic
Disorders DSM IV
• Schizophreniform Disorder: the same
• Brief Psychotic Disorder: the same
• Psychotic Disorder due to Medical conditions: the same
• Substance Induced Psychotic Disorder: the same
Schizophrenia Spectrum and Other
psychotic Disorders- DSM-5
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Schizotypal Personality Disorder
Schizophrenia
Schizoaffective Disorder
Schizophreniform Disorder
Delusional Disorder
Brief Psychotic Disorder
Catatonia Features Specifier
Substance/Medication-Induced Psychotic Disorder
Psychotic Disorder due to another medical condition
Other Specified Schizophrenia Spectrum and Other Psychotic
Disorder
• Unspecified Schizophrenia Spectrum and Other Psychotic Disorder
Schizophrenia- DSM 5
• Must have 2 Criterion A symptoms :delusions,
hallucinations, or disorganized speech
(positive symptoms).
• Subtypes eliminated because of low reliability
and poor validity and now used to provide
further detail to diagnosis
Specifiers of Schizophrenia- DSM 5
Specifiers to be used after year duration of the disorder
First episode, currently in acute episode, First Episode, currently in partial
remission, First Episode, currently in full remission, Multiple Episodes,
currently in acute episode, Multiple Episodes, currently in partial
remission, Multiple Episodes, currently in full remission, Continuous,
Unspecified, Catatonia
Schizoaffective Disorder
• An uninterrupted period of major mood episode (manic or
Depressive) is concurrent with positive symptoms of
schizophrenia (Criteron A)
• Hallucinations or delusions must be present for 2 weeks or
more in the absence of prominent mood symptoms, but
mood symptoms must be present for the total duration of the
illness
• Specifiers: Bipolar type- marked by current or previous manic
syndrome
Depressive type- marked by the absence of any manic
syndromes
Other Specifiers of SchizoeffectiveDSM 5
Specifiers to be used after year duration of the disorder:
First episode, currently in acute episode, First Episode, currently in partial
remission, First Episode, currently in full remission, Multiple Episodes,
currently in acute episode, Multiple Episodes, currently in partial
remission, Multiple Episodes, currently in full remission, Continuous,
Unspecified
Delusional Disorder- DSM 5
• Presence of well systemized, non-bizarre/bizarre
delusions accompanied by affect appropriate to
the delusion and occurring in the presence of a
relatively well preserved personality
• Bizarre content includes delusions that are
implausible, not understandable, and not derived
from ordinary life experiences (ex. belief that
stranger removed his/her organs and replaced
them with someone else’s organs)
Other Specifiers of Delusional
Disorder- DSM 5
Specifiers to be used after year duration of the disorder
First episode, currently in acute episode, First Episode, currently in partial
remission, First Episode, currently in full remission, Multiple Episodes,
currently in acute episode, Multiple Episodes, currently in partial
remission, Multiple Episodes, currently in full remission, Continuous,
Unspecified
Schizophreniform Disorder- DSM 5
• Patients who present with typical
schizophrenia symptoms but who have been
ill for at least 1 month but less than 6 months
Substance/Medication-Induced
Psychotic Disorder- DSM 5
• Substance involved is capable of producing
presence of hallucinations and delusions
• Specify if
• With onset during
intoxification
• With onset during
withdrawal
Psychotic Disorder Due to Another
Medical Condition- DSM 5
Evidence from a physical examinations or labs that distorted perceptions
(hallucinations/delusions) result from a medical condition and cannot be
explained by a mental disorder. Specify if With Delusions, or
Hallucinations
Catatonia Disorder Due to Another
Medical Condition -DSM 5
Dominated by 3 or more of the following:
Catatonic Stupor, Catalepsy, Wavy Flexibility, Mutism, Posturing, Stereotypy,
Mannerism, Echopraxia, Negativism, Agitation, Grimacing
Catatonia Associated with Another Mental
Disorder (Catatonic Specifier) -DSM 5
• dominated by 3 or more of the following
Stupor, Catalepsy, Waxy Flexibility, Mutism, Negativism, Posturing,
Stereotypy , Agitation, not influenced by external stimuli, Grimacing
Other Specified Schizophrenia Spectrum
and other Psychotic Disorder- DSM 5
• Persistent auditory Hallucinations occurs in the absence of any
other features
• Delusions and significant overlapping mood episodes- persistent
delusions with periods of overlapping mood episodes that are
present for a substantial portion of the delusional disturbance
• Attenuated psychosis syndrome- characterized by psychotic like
symptoms that are below a threshold for full psychosis (symptoms
less severe where insight and judgment maintained)
• Delusional symptoms in partner or individual with delusional
disorder- delusional material from dominant partner provides
content for delusional belief by the individual who may not
otherwise entirely meet criteria for delusional disorder
Schizophrenia Paranoid type-DSM 1V
Schizophrenia Multiple episodes, currently in
acute episode–DSM 5
Ms. P a 26 year old single woman was brought in for a consultation
by her parents because of reoccurrence of her psychotic symptoms
and generally poor functioning. She lives at home with her parents
and last worked 5 years ago as administrative assistant. She was
hospitalized 3 times in the past 5 years. Ms. P currently has a
reoccurrence of the delusion that she can control the behaviors of
others through her breathing and that people can read her mind. She
is convinced that she is being watched, followed, complains of being
confused and at times may repeat phrases without meaning to
others. She admits to hearing threatening voices stating that they will
kill her for having the power to hurt others. She lacks motivation and
hesitate to participate in social activities due to increased paranoia
that everyone around her know her thoughts and the power she has
to read minds.
What is the significance of DSM
5 revisions to social work
Practice?