This chapter focuses on psychotic disorders that resemble schizophrenia, ranging from brief psychotic disorder to schizotypal personality disorder. Each has characteristic psychotic features but differs in symptomatology and duration.
SCHIZOTYPAL PERSONALITY DISORDER (301)
Schizotypal personality disorder (SPD) is one of six personality disorders in the DSM-V. Individuals with SPD exhibit odd thinking or behavior, leading to significant social deficits. They prefer solitude, lack interest in social situations, and often live in a fantasy world. These individuals are typically apathetic, emotionless, and struggle with expressing emotions. Common coexisting conditions include anxiety disorders, depression, and other personality disorders. Patients often have difficulty forming and maintaining relationships and prefer to control relationships through rules rather than emotions. Psychotherapy, alongside behavioral training, is recommended, while antipsychotics may be unnecessarily prescribed.
DELUSIONAL DISORDER (297.1)
Delusional disorder is diagnosed less frequently. Patients hold strong beliefs despite evidence against them, with symptoms lasting at least a month. Common types of delusions include mood-congruent, mood-neutral, bizarre, and nonbizarre. Treatment often includes atypical antipsychotics, and compliance with medications can be challenging due to the entrenched nature of delusions.
BRIEF PSYCHOTIC DISORDER (298.8)
Brief psychotic disorder is a transient thought disorder, primarily seen in late adolescence or early adulthood, lasting at least one day but resolving within a month. Symptoms include hallucinations, delusions, disorganized speech, and behavior. Risk factors include major stressors, trauma, and certain personality disorders.
SCHIZOPHRENIFORM DISORDER (295.40)
Schizophreniform disorder is similar to schizophrenia but occurs over a shorter duration. Symptoms persist for less than six months, and there is less social or occupational impairment. It often requires antipsychotic treatment, with more favorable outcomes linked to recent onset of symptoms and prior good functioning.
SCHIZOPHRENIA (259.90)
Schizophrenia is a chronic psychotic disorder lasting at least six months, typically presenting in young adulthood. The DSM-V diagnosis requires two core symptoms, including delusions or hallucinations. Comorbid conditions often complicate treatment, which typically involves antipsychotic medications.
SCHIZOAFFECTIVE DISORDER (295.70)
Schizoaffective disorder combines psychotic and mood-related symptoms. A diagnosis requires mood episodes alongside hallucinations and delusions for at least two weeks. There are two subtypes: depressive and bipolar types.
SUBSTANCE OR MEDICATION-INDUCED PSYCHOSIS (292.9)
This involves psychotic symptoms directly related to substance use. Symptoms generally include hallucinations or delusions, resolving after substance removal. Treatment can include cognitive-behavioral therapy for delusions.
PSYCHOTIC DISORDER DUE TO A MEDICAL CONDITION
Certain medical disorders can lead to psychotic symptoms, which resolve with appropriate treatment of the underlying condition.
CATATONIA (MULTIPLE DSM-V CODES)
Catatonia is a symptom categorizing a range of motor behaviors and can be present in various mental and medical conditions. It may manifest as rigidity or stupor, and is specified under different disorders in the DSM-V.
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