Schizophrenia Spectrum and Other Psychotic Disorders

Delusions

are fixed beliefs that are not amenable to change in light of conflicting evidence.

Persecutory delusions

belief that one is going to be harmed, harassed, and so forth by an individual, organization, or other group, the most common type of delusions

Referential delusions

belief that certain gestures, comments, environmental cues, and so forth are directed at oneself

Grandiose delusions

when an individual believes that he or she has exceptional abilities, wealth, or fame

erotomanic delusions

when an individual believes falsely that another person is in love with him or her

Nihilistic delusions

involve the conviction that a major catastrophe will occur

somatic delusions

focus on preoccupations regarding health and organ function

Bizarre Delusions

Delusions that are clearly implausible and not understandable to same-culture peers and do not derive from ordinary life experiences. Delusions that express a loss of control over mind or body are generally considered to be bizarre

Hallucinations

are perception-like experiences that occur without an external stimulus. They are vivid and clear, with the full force and impact of normal perceptions, and not under voluntary control.

Auditory Hallucinations

the most common in schizophrenia and related disorders

Hypnagogic

hallucination that occur while falling asleep

Hypnopompic

hallucinations that occur while waking up

Disorganized thinking (formal thought disorder)

is typically inferred from the individual’s speech. The individual may switch from one topic to another (derailment or loose associations). Answers to questions may be obliquely related or completely unrelated (tangentiality)

Derailment

individual may switch from one topic to another

Tangentiality

Answers to questions may be obliquely related or completely unrelated

Grossly disorganized or abnormal motor behavior

may manifest itself in a variety of ways, ranging from childlike “silliness” to unpredictable agitation. Problems may be noted in any form of goal-directed behavior, leading to difficulties in performing activities of daily living

Catatonic behavior

is a marked decrease in reactivity to the environment. This ranges from resistance to instructions (negativism); to maintaining a rigid, inappropriate or bizarre posture; to a complete lack of verbal and motor responses (mutism and stupor). It can also include purposeless and excessive motor activity without obvious cause (catatonic excitement).

Negativism

kind of catatonia characterized by resistance to instructions

mutism

a complete lack of verbal and motor responses

stupor

maintaining a rigid, inappropriate or bizarre posture

catatonic excitement

purposeless and excessive motor activity without obvious cause

catatonic symptoms

are nonspecific and may occur in other mental disorders (e.g., bipolar or depressive disorders with catatonia) and in medical conditions (catatonic disorder due to another medical condition).

Negative symptoms

account for a substantial portion of the morbidity associated with schizophrenia but are less prominent in other psychotic disorders

Diminished emotional expression

includes reductions in the expression of emotions in the face, eye contact, intonation of speech (prosody), and movements of the hand, head, and face that normally give an emotional emphasis to speech

Avolition

is a decrease in motivated self-initiated purposeful activities

Alogia

is manifested by diminished speech output

Anhedonia

is the decreased ability to experience pleasure. Individuals with schizophrenia can still enjoy a pleasurable activity in the moment and can recall it, but show a reduction in the frequency of engaging in pleasurable activity

Asociality

refers to the apparent lack of interest in social interactions and may be associated with avolition, but it can also be a manifestation of limited opportunities for social interactions.

1 month or longer

In delusional disorder, the presence of 1 or more delusions should be how long?

Criterion A for schizophrenia has never been met

What is the criterion B of delusional disorder?

not markedly impaired

Delusional Disorder Criterion B

Apart from the impact of the delusion(s) or its ramifications, functioning is _________, and behavior is not obviously bizarre or odd.

Mixed type

Subtype of delusional disorder that applies applies when no one delusional theme predominates

Unspecified type

Subtype of delusional disorder which applies when the dominant delusional belief cannot be clearly determined or is not described in the specific types (e.g., referential delusions without a prominent persecutory or grandiose component).

FIRST-GENERATION ANTIPSYCHOTICS

antipsychotics are medications like chlorpromazine (Thorazine) and haloperidol (Haldol), thought to work because they are dopamine antagonists. This means that they block the action of dopamine, primarily by blocking (occupying) the D2 dopamine receptors. Work best for the posi tive symptoms of schizophrenia

positive symptoms

First-generation antipsychotics work best for the ________ of schizophrenia

SECOND-GENERATION ANTIPSYCHOTICS

The first of these to be used clinically was clozapine (Clozaril). medications are risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), and ziprasidone (Geodon). More recent additions include aripiprazole (Abilify) and lurasidone (Latuda). cause fewer extrapyramidal symptoms than the earlier antipsychotic medications

Female

which gender tend to do better with schizophrenia?

2 or more, at least 1 month but less than 6 months

How many symptoms and how long should theses symptoms be present in schizophreniform disorder.

provisional

For schizophreniform, an episode of the disorder lasts at least 1 month but less than 6 months. When the diagnosis must be made without waiting for recovery, it should be qualified as ________

necessary

Another distinguishing feature of schizophreniform disorder is the lack of a criterion requiring impaired social and occupational functioning. While such impairments may potentially be present, they are not ________ for a diagnosis of schizophreniform disorder

1. Delusions

2. Hallucinations

3. Disorganized Speech

Grossly disorganized or catatonic behavior

Negative symptoms

In schizophrenia. two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfuly treated). At least one of these must be 1, 2, or 3

6 months, 1 month

In schizophrenia, continuous signs of the disturbance persist for at least _______. This 6-month period must include at least _____ of symptoms (or less if successfuly treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms.

Residual symptoms

Symptoms that remain after the intense psychotic episode has subsided

Prodromal symptoms

Early warning signs before full psychosis starts (e.g., social withdrawal, odd thinking, mild paranoia)

anosognosia

lack insight or awareness of their disorder

2 or more weeks

In schizoaffective disorder, delusions or hallucinations in the absence of a major mood episode should last for

Substance/Medication-Induced Psychotic Disorder

Delusions and hallucinations should have developed during or soon after substance intoxication or withdrawal or after exposure to or withdrawal from a medication. The involved substance/medication is capable of producing delusions and/or hallucinations

STUPOR

no psychomotor activity; not actively relating to environment

CATALEPSY

passive induction of a posture held against gravity

Waxy flexibility

slight, even resistance to positioning by examiner

Mutism

no, or very little, verbal response

Negativism

opposition or no response to instructions or external stimuli

Posturing

spontaneous and active maintenance of a posture against gravity

Stereotypy

repetitive, abnorma ly frequent, non-goal directed movements

Extrapyramidal symptoms (EPS)

are a group of side effects that can occur when taking certain medications, particularly antipsychotics, that affect the motor system