Transcript Substance Induced Psychotic Disorder

DSM-5 in Action:
™
Diagnostic and Treatment Implications
Section 2, Chapters 5–13
PART 1 of Section 2
Chapters 1–7
by Sophia F. Dziegielewski, PhD, LCSW
© 2014 S. Dziegielewski
After completion of this section, participants will be
able to:
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Identify the major diagnostic categories and the
criteria needed for proper diagnostic assessment.
Utilize the dimensional assessment strategy
outlined in DSM-5 for two disorders.
Utilize this information to complete the diagnostic
assessment.
© 2014 S. Dziegielewski
DSM-5 Chapters
20 Disorder Categories
Neurodevelopmental Disorders
Sleep-Wake Disorders
Schizophrenia Spectrum and the Other
Psychotic Disorders
Sexual Dysfunctions
Bipolar and the Related Disorders
Gender Dysphoria
Depressive Disorders
Disruptive, Impulse Control, and Conduct Disorders
Anxiety Disorders
Substance-Related and Addictive Disorders
Obsessive-Compulsive and the Related
Disorders
Neurocognitive Disorders
Trauma and Stressor-Related Disorders
Personality Disorders
Dissociative Disorders
Paraphilic Disorders
Somatic Symptom and Related Disorders
Other Mental Disorders
Feeding and Eating Disorders
Medication-Induced Movement Disorders and Other
Adverse Effects of Medication
Elimination Disorders
Other Conditions That May Be a Focus of Clinical
Attention
© 2014 S. Dziegielewski
(2 additional categories)
© 2014 S. Dziegielewski
© 2014 S. Dziegielewski
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This section brings together three sections listed separately
in DSM-III-R: Schizophrenia, Delusional Disorder and
Psychotic Disorder: Not Elsewhere Classified.
Active phase has been increased from one week
to one month. Now also includes two new negative
symptoms: alogia (e.g., fluency and productivity of speech)
and volition (goal-directed behavior and drive).
DSM-IV-TR subtypes not clearly supported in research.
Added concept of SCHIZOPHRENIA SPECTRUM: represents the
range of disorders that are more likely to occur in family
members of individuals with schizophrenia (Schizoaffective
Disorder, Schizotypal Personality Disorder, etc.).
© 2014 S. Dziegielewski
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In this condition, individuals suffer from
characteristic psychotic symptoms and
deterioration in adaptive functioning.
The active phase of the disorder must last at
least one month with a time frame of at least
six months in duration.
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Disorganized Type: marked incoherence,
lack of systematized delusions, silly affect
Catatonic Type: stupor, rigidity, bizarre
posturing, waxy flexibility, excessive motor
activity
Paranoid Type: one or more systemized
delusions, or auditory hallucinations with a
similar theme
Undifferentiated Type: "garbage can" bits of
other types
Residual Type: not currently displaying
symptoms displayed in the past
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Brief Reactive Psychosis: AKA 3-day schizophrenia. Symptoms
have existed no longer than a month, last at least a few
hours), sudden onset. No direct link to a severe psychosocial
stressor required.
Schizophreniform Disorder: Less than six months.
Schizoaffective Disorder: Mood disorder and schizophrenia.
Focuses on an uninterrupted phase of illness rather than a
lifetime pattern of symptoms. In this disorder the
schizophrenia is described with periods of major depressive,
manic or mixed episodes.
Substance Induced Psychotic Disorder: Includes both organic
delusional disorder and organic hallucinosis.
© 2014 S. Dziegielewski
Could symptoms be culturally related?
Latinos may first confer with indigenous
healers, curanderos or espiritistas, or Catholic
leaders, or both before discussing mental
health symptoms with mental health
practitioners.
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African American— controversy continues
about the relevance of culture as related to the
diagnosis of schizophrenia.
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Belief there is a biological component to
schizophrenia when psychotropic
medication showed a decrease in symptoms
related to the disorder.
Although the exact relationship is unknown
a clear connection exists with the
neurochemical dopamine.
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Genetics may be a necessary, but not a
sufficient, cause for schizophrenia.
Schizophrenia spectrum represents the
range of mental disorders that are more
likely to occur in family members of
individuals with schizophrenia such as
schizoaffective disorder and schizotypal
personality disorder.
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Schizophrenia is probably not a single disorder.
Clients do not clearly and concisely fit perfectly
into an identified diagnostic category.
Multiple problems require a multifaceted
approach to intervention.
Some of these problems can easily overlap with
other mental health conditions such as the
affective disorders (bipolar and depression) or
the dementia- or delirium-based disorders.
© 2014 S. Dziegielewski
© 2014 S. Dziegielewski
Criterion A : Must have at least ONE of
these THREE symptoms
 Delusions
 Hallucinations
 Disorganized Speech
© 2014 S. Dziegielewski
Types of Delusions
 Persecutory delusions,
 Grandiose delusions,
 Erotomania (believes falsely another person
loves them),
 Bizarre,
 Thought withdrawal (thoughts are removed),
thought insertion,
 Nihilistic (major catastrophe will occur)
© 2014 S. Dziegielewski
Disorganized Thinking and
Disorganized Behavior:
 Derailment or loose associations;
 Catatonian
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Hallucinations:
 Auditory,
 Visual,
 Tactile,
 Olfactory,
 Gustatory.
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Diminished emotional expression
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Avolition
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Anhedonia (decreased ability to experience
pleasure)
Asociality (lack of interest in social
interactions)
Alogia
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Difference between mood and
affect:
 Mood = the general feeling (e.g.,
depressed) (climate)
 Affect = how you show it (e.g.,
flat or blunted) (weather)
© 2014 S. Dziegielewski
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Clinician-Rated Dimensions of Psychosis
Symptom Severity (Included in Section 3, p. 743)
Is the scale for the dimensional assessment and
addresses the primary positive and negative
symptoms.
This is an eight-item measure that addresses
symptom severity over the last seven days and is
completed by the clinician. Uses a five-point scale
from no symptoms = 0 to severe = 4.
Can be done regularly to measure progress, and
clinical judgment guides the decisions.
© 2014 S. Dziegielewski
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Schizotypal Personality Disorder;
Delusional Disorder;
Brief Psychotic Disorder;
Schizophreniform Disorder;
Schizophrenia;
Schizoaffective Disorder;
Substance/Medication-Induced Psychotic
Disorder;
Psychotic Disorder Due to Another Medical
Condition.
© 2014 S. Dziegielewski
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Catatonia—
Catatonia Associated With Another Medical
Disorder;
Catatonia Due to Another Medical Condition;
Unspecified Catatonia;
 Other Specified Schizophrenia Spectrum and
Other Psychotic Disorder (Replaced Shared
Psychotic Disorder);
 Unspecified Schizophrenia Spectrum and
Other Psychotic Disorder.
© 2014 S. Dziegielewski
In Section 3 for further study:
Attenuated Psychosis Syndrome
◦ Delusions, hallucinations, and
disorganized speech—but not as intense
as in a psychotic episode
◦ Occur once per week and appear to
worsen
◦ Symptoms cause distress or disability
© 2014 S. Dziegielewski
New Name for this category
 Reorganization of the disorders within
this category to reflect a gradient of
psychopathology, from least to most
severe
 Minor changes to criteria for
schizoaffective disorder
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© 2014 S. Dziegielewski
 Schizotypal
personality
disorder listed in
schizophrenia spectrum but
described in the PD section.
© 2014 S. Dziegielewski
Subtype categories are eliminated
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Specifiers will be utilized
(e.g., catatonia—marked by motor inability and
stupor will be used as a specifier)
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© 2014 S. Dziegielewski
© 2014 S. Dziegielewski