Psychotic Disorders

What are the five core symptom domains that define schizophrenia spectrum and other psychotic disorders?

1. Delusions

2. Hallucinations

3. Disorganized thinking (speech)

4. Grossly disorganized or abnormal motor behavior (including catatonia)

5. Negative symptoms

What is a delusion?

A fixed belief not amenable to change despite conflicting evidence.

What is a persecutory delusion?

Belief that one is being harmed, harassed, conspired against, followed, poisoned, etc.

What is a referential delusion?

Belief that gestures, comments, or environmental cues are directed at oneself.

What is a grandiose delusion?

Belief that one has exceptional abilities, wealth, fame, or insight.

What is an erotomanic delusion?

False belief that another person is in love with the individual.

What is a nihilistic delusion?

Conviction that a major catastrophe will occur.

What is a somatic delusion?

Preoccupation with health, organs, or bodily functions.

What makes a delusion bizarre?

Clearly implausible, not understandable to same-culture peers, not derived from ordinary life experience.

Examples of bizarre delusions involving loss of control?

• Thought withdrawal

• Thought insertion

• Delusions of control

What is important when assessing delusions across cultures?

Consider cultural/religious context and trauma history before labeling beliefs as psychotic.

What is a hallucination?

A perception-like experience without external stimulus, vivid and not under voluntary control.

Most common type of hallucination in schizophrenia?

Auditory hallucinations (voices).

Are hypnagogic and hypnopompic hallucinations psychotic?

No. They occur during falling asleep or waking and are considered normal.

How is disorganized thinking assessed?

Through speech patterns.

What is derailment (loose associations)?

Switching topics with no logical connection.

What is tangentiality?

Answers that are obliquely related or unrelated to the question.

What is incoherence (“word salad”)?

Completely incomprehensible speech.

When does disorganized speech qualify as psychotic?

When severe enough to impair effective communication.

What can grossly disorganized behavior look like?

Childlike silliness, unpredictable agitation, inability to perform ADLs.

What is catatonia?

Marked decrease in reactivity to environment.

Catatonia requires how many symptoms?

Three or more.

Examples of catatonia symptoms?

• Stupor

• Mutism

• Negativism

• Waxy flexibility

• Posturing

• Stereotypy

• Echolalia

• Echopraxia

• Grimacing

• Agitation not influenced by stimuli

Two most prominent negative symptoms in schizophrenia?

• Diminished emotional expression

• Avolition

What is avolition?

Decreased motivation for purposeful activities.

What is alogia?

Diminished speech output.

What is anhedonia?

Decreased ability to experience pleasure

What is asociality?

Lack of interest in social interaction.

Duration of Brief Psychotic Disorder?

1 day to < 1 month

Duration of Schizophreniform Disorder?

≥ 1 month but < 6 months.

Duration of Schizophrenia?

≥ 6 months total, with ≥ 1 month of active-phase symptoms.

Core criterion for Delusional Disorder?

One or more delusions for ≥ 1 month.

Functioning in Delusional Disorder?

Not markedly impaired (outside impact of delusion).

Brief Psychotic Disorder requires at least one of which three symptoms?

• Delusions

• Hallucinations

• Disorganized speech

Can Brief Psychotic Disorder be specified as with marked stressor?

Yes (brief reactive psychosis).

What special onset specifier exists for Brief Psychotic Disorder?

With peripartum onset.

Number of symptoms required for Schizophreniform & Schizophrenia?

Two or more, with at least one being:

• Delusions

• Hallucinations

• Disorganized speech

What additional requirement does Schizophrenia have that Schizophreniform does not?

Marked functional decline.

Core requirement of Schizoaffective Disorder?

Major mood episode concurrent with Criterion A of schizophrenia.

What makes Schizoaffective different from mood disorder with psychotic features?

≥ 2 weeks of psychosis WITHOUT mood symptoms.

Schizoaffective subtypes?

• Bipolar type

• Depressive type