Transcript Other Psychotic Disorders

Other Psychotic Disorders
By : Dr Seddigh
HUMS
Other Psychotic
Disorders
Schizophreniform Disorder
Brief Psychotic Disorder
Schizoaffective Disorder
Delusional Disorder
Shared Psychotic Disorder
What is a Psychotic Disorder
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Psychosis
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A break from reality
Often involves difficulties interacting with and perceiving the
real world
Split between thoughts and emotions
Schizophrenia - DSM Diagnostic
Criterion “A”
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Characteristic Sxs (2 + for 1 month)
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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 )
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
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Schizophreniform Disorder
Schizophreniform Disorder
A.
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)
B.
An episode of the disorder (including the prodromal,
active, and residual phases) lasts at least 1 month but
less than 6 months
Schizophreniform Disorder
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Essentially, exactly like Schizophrenia, but the duration
is shorter
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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
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Facts about Schizophreniform Disorder
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Prevalence:
Gender:
 Age of Onset:
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Course:
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
Approx. equal rates
Same as Schizophrenia (keep in mind
gender differences)
1/3 recover within the 6 month period
2/3 progress into Schizophrenia
 Brief
Psychotic Disorder
Brief Psychotic Disorder
A. Presence of one or more of the following symptoms:
1.
2.
3.
4.
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
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
Facts about Brief Psychotic Disorder
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Prevalence:
Gender:
 Age of Onset:
 Course:
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Unknown (symptoms often do not
persist long enough to come to the
attention of mental health
professionals or researchers)
Unknown, can assume to be equal
Late adolescence to early adulthood
By definition, no longer than 1-month
Schizoaffective
Disorder
Schizoaffective Disorder
A.
B.
C.
D.
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
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
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Facts about Schizoaffective Disorder
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Prevalence:
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Gender:
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Age of Onset:
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Course:
Unknown, but seems to be less common than
Schizophrenia
Equal rates of Bipolar Subtype
Women tend to have higher rates of the
Depressive subtype
Late adolescence to late in life
Average age = early adulthood
Bipolar Subtype – more common in younger
adults
Depressive Subtype – more common in older
adults
Better prognosis than Schizophrenia, worse
prognosis than mood disorders
Better prognosis for Bipolar subtype
Delusional
Disorder
Delusional Disorder
A.
B.
C.
D.
E.
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
Types of Delusional Disorder
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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
Facts about Delusional Disorder
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Prevalence:
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Gender:
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Age of Onset:
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Course:
0.03% (community samples)
1-2% of inpatient mental health admissions
Equal rates, however, rates of specific types
of delusional disorder may vary (e.g. Jealous
type)
Can be quite variable – ranging from
adolescence to late in life
Can also be quite variable
Can be chronic or may remit completely
Symptoms may wax and wane or disappear
completely and then reappear
Shared Psychotic Disorder
(Folie á Deux)
Shared Psychotic Disorder
(Folie á Deux)
A.
B.
C.
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
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
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Facts about Shared Psychotic Disorder
Prevalence:
 Gender:
 Age of Onset:
 Course:
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Unknown, goes unrecognized
Somewhat more common in women
Seems to vary
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