Other Psychotic Disorders

By : Dr SeddighHUMS

Other Psychotic Disorders

Schizophreniform DisorderBrief Psychotic DisorderSchizoaffective Disorder

Delusional DisorderShared Psychotic Disorder

What is a Psychotic Disorder Psychosis

A break from reality Often involves difficulties interacting with and

perceiving the real world Split between thoughts and emotions

Schizophrenia - DSM Diagnostic Criterion “A” Characteristic Sxs (2 + for 1 month)

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

Schizophreniform Disorder

Schizophreniform DisorderA. 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 Essentially, exactly like Schizophrenia,

but the duration is shorter 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

Facts about Schizophreniform Disorder Prevalence: Varies substantially:

Approx. 0.2% in industrialized areasApprox. 1% in non-industrialized

areasMay be explained by higher

functioning and better prognosis for psychotic disorders in non-industrialized

areas Gender: Approx. equal rates Age of Onset: Same as Schizophrenia (keep in

mind gender differences) Course: 1/3 recover within the 6 month

period2/3 progress into Schizophrenia

Brief Psychotic Disorder

Brief Psychotic DisorderA. Presence of one or more of the following

symptoms:1. Delusions2. Hallucinations3. Disorganized speech4. 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/SchizophreniformCriteriaSchizophrenia/Schizophreniform Disorder 2 symptoms needed (there is an exception to this

rule) Can include Negative AffectBrief 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 Prevalence: Unknown (symptoms often do not

persist long enough to come to the attention of mental health

professionals or researchers) Gender: Unknown, can assume to be equal Age of Onset: Late adolescence to early

adulthood Course: By definition, no longer than 1-

month

Schizoaffective Disorder

Schizoaffective DisorderA. 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

B. During the same period of illness, there have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms

C. Symptoms that meet criteria for a mood episode are present for a substantial portion of the total duration of the illness

D. 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

Facts about Schizoaffective Disorder Prevalence: Unknown, but seems to be less

common than Schizophrenia Gender: Equal rates of Bipolar Subtype

Women tend to have higher rates of the Depressive subtype

Age of Onset: Late adolescence to late in lifeAverage age = early adulthood

Bipolar Subtype – more common in younger adults

Depressive Subtype – more common in older adults

Course: Better prognosis than Schizophrenia, worse prognosis than mood disorders

Better prognosis for Bipolar subtype

Delusional Disorder

Delusional DisorderA. Nonbizarre delusions lasting for at least 1 monthB. Criterion A for Schizophrenia have never been

met (However, tactile and olfactory may be present if they are related to the delusional theme)

C. Behavioral functioning is not markedly imparied and behavior is not obviously odd or bizarre

D. If mood episodes have occurred concurrently with delusions, their total duration has been brief relative to the duration of the delusional periods

E. Not due to the direct effects of a GMC or substance

Types of Delusional Disorder 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 Prevalence: 0.03% (community samples)

1-2% of inpatient mental health admissions

Gender: Equal rates, however, rates of specific types of delusional disorder may vary (e.g. Jealous type)

Age of Onset: Can be quite variable – ranging from adolescence to late in life

Course: Can also be quite variableCan be chronic or may remit completelySymptoms may wax and wane or

disappear completely and then reappear

Shared Psychotic Disorder (Folie á Deux)

Shared Psychotic Disorder (Folie á Deux)A. A delusion develops in an individual in

the context of a close relationship with another person(s), who has an already-established delusion

B. The delusion is similar in content to that of the person who already has the established delusion

C. 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

Facts about Shared Psychotic Disorder Prevalence: Unknown, goes unrecognized Gender: Somewhat more common in

women Age of Onset: Seems to vary Course: 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