Schizophrenia

Spectrum and Other

Psychotic Disorders
SOCW 601

Framework for Diagnoses

As we are learning the diagnostic process for each condition
we can use the following framework:
I. Required, defined time frame
II. Symptom cluster/constellation and threshold
III. Causes distress/impairment
IV. Rule out
V. Specifiers and severity indicators
VI. ICD code
VII.Tell me more

Schizophrenia Spectrum and Other Psychotic

Disorders
Schizotypal (Personality) Disorder-we will come back to this when we cover personality
disorders
Delusional Disorder
Brief Psychotic Disorder
Schizophreniform Disorder
Schizophrenia
Schizoaffective Disorder-will come back to this when we cover Bipolar and Related Disorders
Substance/Medication-Induced Psychotic Disorder-not going to cover, typically diagnosed by
medical professionals in hospital settings with lab results
Psychotic Disorder Due to Another Medical Condition-not going to cover, typically diagnosed
by medical professionals in hospital settings with lab results
Catatonia-not going to cover, usually done in medical, hospital settings
Other Specified Schizophrenia Spectrum and Other Psychotic Disorder
Unspecified Schizophrenia Spectrum and Other Psychotic Disorder

Schizophrenia Spectrum and Other Psychotic

Disorders
Defined by abnormalities in one or more of the following
5 domains:
Delusions
Hallucinations
Disorganized Thinking (Speech)
Grossly Disorganized or Abnormal Motor Behavior
(including catatonia)
Negative Symptoms

Schizophrenia Spectrum and Other Psychotic

Disorders
This section lists the conditions in a particular order
based on a continuum, spectrum, we are going to go in
reverse
Three dimensions:
Psychoticism dimension
Negative Dimension
Disorganized dimension

Psychoticism dimension
Psychoticism-positive (meaning active, the presence of
something that should be absent) symptoms include
hallucinations and delusions
Various delusions-p. 137 psych textbook

Negative dimension
Negative dimension-negative symptoms (meaning less
active, or passive, the absence of something that should
be present) symptoms are most common with
Schizophrenia, less common with other psychotic
disorders
Diminished emotional expression-reduction in the
expression of emotion, including in the face, eye
contact and intonation of speech
Avolition-decrease in motivated, purposeful activities
(ex. Sitting for long periods of time, disinterest in
participating in work or social activities

Negative Symptoms
Anhedonia-decreased ability to experience pleasure from
positive stimuli or degradation in recollection of previous
pleasurable experiences
Asociality-apparent lack of interest in social interactions
Cognitive impairment-I put these here because these
persist even when positive symptoms are reduced or have
subsided, include decreases in declarative memory (verbal
knowledge of previous information, events), working
memory (immediate processing), concentration, slower
processing speed

Disorganized dimension
Disorganized dimension-disorganized speech and
behavior and disorganized affect
Disorganized motor and social behavior-p. 139 psych
textbook

Schizophrenia
P. 99
ICD code (F20.9)
Symptom constellation, threshold and required timeframe
Criteria A and C
Causes distress and impairment
Criterion C
Rule outs
Criteria D-F
Specifiers p. 99-100
Severity rating not required
F20.9 Schizophrenia, multiple episodes, currently in acute episode

Schizophrenia
P. 99
Other data
Prodromal symptoms often precede the active phase,
and residual symptoms may follow it, characterized by
mild or subthreshold forms of hallucinations or delusions
Presence of hallucinations and delusions required in the
absence of mood episodes

Schizophrenia
P. 99
Associated features
Depression, anxiety, anger common
Disturbed sleep common (daytime sleeping with
nighttime activity)
Depersonalization, derealization and somatic concerns
common (night become delusional)
Deficits in cognition
Common to have lack of insight or awareness (not
coping, denial)
Lack of insight associated with poorer treatment

Schizophrenia
P. 99
Prevalence-p.102
Risk and Prognostic factors-p. 103
Gender-related diagnostic issues-p. 103-104
Suicide risk-p. 104
Differential diagnosis-p. 104-105
Comorbidity-p. 105
Course of illness-p. 140 psych book
Etiology and pathophysiology-p. 143-148 psych book
Clinical management-. 148-150 psych book
Not split personality-p. 125 Psych book

Schizophreniform Disorder
P. 96
ICD Code (F20.81)
Criteria A Same as for Schizophrenia
Time frame differs: at least one month but less than 6 months
Rule outs
Criteria C and D
Specifiers p. 97
With good prognostic features, without good prognostic features
Severity rating not required
F20.81 Schizophreniform Disorder, without good
prognostic features

Schizophreniform Disorder
P. 96
Other data
If disturbance lasts more than 6 months, diagnosis
becomes schizophrenia
Unlike schizophrenia there is no criteria requiring
impaired social or occupational functioning, thought this
might be there
Developmental course-p. 98
Differential diagnosis-p. 98-99

Brief Psychotic Disorder

P. 94
ICD Code (F23)
Symptoms-same as schizophrenia and schizophreniform EXCEPT
Different time requirement
Absence of negative symptoms
Duration-Criteria B
Rule out-Criteria C
Specifiers
With marked distress
Without marked distress
With postpartum onset
F23 Brief Psychotic Disorder, with marked stressors

Brief Psychotic Disorder

P. 94
Associated features-p. 95
Prevalence-p. 95
Development and course-p. 95
Differential diagnosis-p. 96

Delusional Disorder
P. 90
ICD code (F22)
Symptoms, timeframes, requirements
Criteria A-C
Rule out Criteria D-E
Specify:
Type
Content
Episode
Severity rating not required
F22 Delusional Disorder, Persecutory Type, with bizarre content,
first episode, currently in acute episode

Delusional Disorder
P. 90
Subtypes:
Erotomanic-belief that another person is in love with the individual, usually
someone of a higher status (ex. Celebrity)
Grandiose-conviction of having some great talent or insight or having made
some important discovery, or having a relationship with a prominent
individual or being a prominent person and that the other may be an
impostor
Jealous-conviction that partner is being unfaithful
Persecutory-belief that others are conspiring against, cheat, spying on, being
followed, possibly being poisoned, maliciously maligned, harassed,
obstructing
Somatic-bodily functions or sensations

Delusional Disorder
P. 90
Other data
May have some insight, or at least realize that others do not believe
Irritability and dysphoric mood can accompany, especially if others
question or challenge delusion
Anger and violence can occur with persecutory, jealous, or
erotomanic subtypes
Prevalence, development and course-p. 92-93
Functional consequences-p. 93
Differential diagnosis-p. 93
Clinical management-p. 130-131 Psychiatry text

Schizophrenia Spectrum and Other Psychotic

Disorders
Rating psychosis symptom severity P. 742-744
Videos
If you were the interviewer, how would you ask about:
Hallucinations
Delusions
Negative symptoms
Remember: our presence, tone and response are vital to
exploring these issues in a caring and productive
manner