schizophrenia spectrum & other psychotic disorders for ncmhce study
TRANSCRIPT
Review of DSM5 Mental Disorders for NCMHCE Study
Key FeaturesDelusionsHallucinationsDisorganized Thinking (speech)Grossly Disorganized or Abnormal Motor Behavior (Including Catatonia)Negative Symptoms
1. Brief Psychotic Disorder2. Delusional Disorder3. (Schizotypal Personality Disorder)4. Schizophreniform Disorder5. Schizoaffective Disorder6. Schizophrenia7. Catatonia8. Substance/Medication-Induced Psychotic Disorder9. Psychotic Disorder Due to Another Medical Condition10. Other Specified Schizophrenia Spectrum and Other Psychotic
Disorder11. Unspecified Schizophrenia Spectrum and Other Psychotic
Disorder
Brief Psychotic1-30 days No mood disorderNo negative symptoms
SchizophreniformNo negative symptoms1-6 months
SchizophreniaNegative symptoms, unmotivated1 month period of psychosisPersisting 6 months
Schizoaffective Mood disorder
All have positive psychotic symptoms
S4. Assess & ReferTestsPNSS Positive & Negative Syndrome ScalesStructured Interview for Psychotic Symptoms
S4. TreatmentMedicationsAntipsychotics
TherapyBehavior TherapiesPsychosocial Therapies
Diagnosis IKey: Discomfort in close relationships, distorted thinking and perceptions, and eccentric behavior
Requires at least 5:1) Senses others are thinking of them2) Belief in superstitions and magical thinking and powers3) Odd perceptions4) Odd thinking and speech5) Suspiciousness and paranoia6) Constricted, inappropriate affect7) Odd behavior8) Lacks close friends9) Social anxiety related to paranoia
Diagnosis IICo-occurring:Delusional disorderSchizophreniform disordersSchizophrenia
Rule out:Autism Spectrum DisorderDisturbance is only part of a psychotic disorderBipolar or depressive disorder with psychotic featuresResult of medical problem
Diagnosis1. Presence of one or more of the following symptoms:DelusionsHallucinations Disorganized speech Grossly disorganized or catatonic behavior2. Lasts at least one day but less than one month Full return to premorbid level of functioningOften in response to a very stressful event, such as a death in the family
Rule OutMajor depressive or bipolar disorder with psychotic features Other psychotic disorder
S1. Find OutMedical historyAffective functioningCognitive functioningDevelopment of symptoms, duration and frequencyFamily historyPast traumaSubstance use history
S2. Refer or AssessMedical evaluation (heart, thyroid)Psychiatric evaluationTestsPNSS Positive & Negative Symptom ScalesStructured Interview for Psychotic SymptomsMental status exam
S4. TreatmentMedicationsAnti-psychotic
TherapyPsychoeducationHospitalization until positive symptoms under controlNAMI for community support
S5. MonitoringCompletion of homework assignmentsFrequency and severity of symptoms check list Medication compliance
S6. TerminationContinued medicationAnxiety support group
Diagnosis1. Presence of delusion only Non bizarre, plausible Internally consistent2. Long lasting, held strongly3. Specifiers Erotomanic Grandiose Jealous Persecutory Somatic Mixed Unspecified
Rule OutMajor depressive or bipolar disorder with psychotic features Other psychotic disorder
S1. Find OutMedical historyAffective functioningCognitive functioningDevelopment of symptoms, duration and frequencyFamily historyPast traumaSubstance use history
S2. Refer or AssessPsychiatric evaluationTestsStructured Interview for Psychotic SymptomsMental status exam
S4. TreatmentVery challenging since the patient sees no problemNon judgmental, empathetic stance
TherapyCBTMedicationsAnti-psychotics (for agitation)
Diagnosis1. Two or more of the following during 1 month period:
Delusions Hallucinations Disorganized speech Grossly disorganized/ catatonic
behavior Negative symptoms Symptoms similar to Schizophrenia
but duration is less2. Episode lasts at least 1 month but less than 6 months
Rule OutSchizoaffective disorderDepressive/Bipolar disorders with psychotic features Not attributed to substance use or medical condition
S1. Find OutMedical historyAffective functioningCognitive functioningDevelopment of symptoms, duration and frequencyFamily historyPast traumaSubstance use history
S2. Refer or AssessMedical evaluation (heart, thyroid)Psychiatric evaluationTestsPNSS Positive & Negative Symptom ScalesStructured Interview for Psychotic SymptomsMental status exam
S4. TreatmentMedicationsAntipsychotics
TherapyPsychoeducationBehavior TherapySocial Skills TrainingHospitalization until positive symptoms under controlNAMI for community support
Diagnosis I1. Requires 2 or more of the following for a significant time
during a 1 month period: Delusions, Hallucinations, Disorganized speech (frequent derailment or incoherence), Grossly disorganized or catatonic behavior, Negative symptoms2. Since onset of disturbance, level of functioning in work,
social relations, or self care is below what it was prior Or failure to achieve expected level if onset is in
childhood/adolescence3. Symptoms persist for at least 6 months Psychotic features typically emerge between the late
teens and the mid-30s
Rule OutSubstance or medically induced
Diagnosis IIPositive Symptoms are excesses in behavior: Hallucinations (critical voices) Delusions: Unrealistic beliefsDisorganized speech, inability to maintain conversationDisorganized or catatonic behavior can be bizarreNegative Symptoms are deficits in behavior (reduced function): Reduction of emotional expressionLack of motivation or energyLoss of enjoyment in activities (social interaction)Negative symptoms tend to be the most persistent
Four A’s of Schizophrenia: Inappropriate AffectLoosening of AssociationsAutistic ThoughtsAmbivalence
Common Delusions: GrandeurPersecutionReferenceSomaticControl
S1. To Find Out S2. Assess & ReferVeriPsych Blood Test (measures 51 biomarkers)TestsPNSS Positive & Negative Syndrome ScalesStructured Interview for Psychotic SymptomsMental status exam
S4. TreatmentMedicationsAntipsychotics (Abilify, Clozaril, Seroquel, Risperdal)
TherapyPsychoeducationSocial Skills TrainingHospitalization until positive symptoms under controlStress ManagementNAMI for community support
S5. MonitoringCompletion of homework assignmentsFrequency and severity of symptoms check list Medication compliance
S6. TerminationContinued medicationAnxiety support group
DiagnosisSymptoms of both schizophrenia and a mood disorder Uninterrupted period of illness where there is a major mood episode
(major depressive/manic) concurrent with Schizophrenic symptoms, or alternating▪ Delusions or hallucinations for 2 or more weeks in the absence of
major mood episode (depressive or manic) during the lifetime duration of illness
▪ Major mood symptoms are mostly presentSpecify type Bipolar Depressive
S4. TreatmentMedicationsMood stabilizers for bipolar type (Lithium, Depakote)
Also anticonvulsants Antidepressants for depression (Prozac, Lexapro)Antipsychotics
Therapy
Diagnosis1. Presence of 1 or both of the following: DelusionsHallucinations2. Symptoms developed during or soon after substance intoxication or withdrawal or after exposure to a medicationInvolved substance is capable of producing the psychotic symptomsAs shown from the history, physical examination or laboratory findings
Rule OutIndependent psychotic disorderDelirium
Diagnosis1. Prominent hallucinations or delusions2. Direct pathophysiological consequence of another medical conditionNot better explained by another mental disorderNot occurring exclusively during the course of a deliriumSpecify with delusions or hallucinations
S4. TreatmentResolve medical conditions
Catatonia Associated with Another Mental DisorderCatatonia Disorder due to Another Medical ConditionUnspecified Catatonia