Professional Documents
Culture Documents
related disorder
By Dr. Noor Abdulamir
Classification of psychotic
disorders
The following is a list of schizophrenia and the related conditions of it
1. schizophrenia
2. schizophreniform disorders
3. schizoaffective disorders
4. delusional disorders
5. brief psychotic disorders
6. shared psychotic disorders
7. substance induced psychoses
8. psychoses due to medical conditions
9. psychoses not otherwise specified (or classified)
is one of the most common severe mental illnesses and
is reported to have a lifetime incidence of 1%.
Schizophrenia is typically diagnosed before age 25 and
is diagnosed equally in men and women .
When it is diagnosed after age 45, it is considered late
onset.
A. Family studies
B. Twin studies
So in details:
2nd and 3rd degree relatives have a 2.5% more possibility than the general population to be affected by
the disorder (5 in every 200 are affected).
If both parents are schizophrenics, the 25% will be affected of their children (i.e. if the schizophrenic
parents have 4 children then one of them will be affected).
• It's not clear if the presence of one schizophrenic patient in the family will affect the other members of
the family or relative by a genetic basis or environmental one because the presence of this patient may
have an effect on rearing up of the other members of the family and relatives
B-Twin studies:
The twins are either identical (the twin have the same genetic
material) or non identical (the twins have different genetic
material).
In fact, the study of identical twins gives more accurate
information about the genetic role towards this disorder.
Psychological
o Stressful life events: common precipitant of first episode psychosis
o High expressed emotion (EE): over-involvement, critical comments
and hostility from family
members > 35 hours/week increase the risk of relapse of schizophrenia
Demographic
o Age and gender: male schizophrenia patients tend to have more
severe disease, early onset, more structural brain diseases, worse
premorbid adjustment compared to female patients
Tangentiality Stream of thought diverges from the topic and speech appears to
be unrelated and irrelevant at the end
oOccurs in schizophrenia and mania
Flight of ideas Continuous speech where topics jump rapidly from one to
another and there is a logical link between topic
oOccurs in mania; accompanied by pressure of speech
Thought insertion Patient feels that external thoughts which do not belong to them
are being inserted into their mind
Thought withdrawal Patient feels that their own thoughts are being taken away
by others
Thought broadcasting Patient feels that their own thoughts are being made
known to others through broadcasting much like a radio or television station
delusion is a flase belief of morbid origin and is not consistent with his culture or
society. There are types of delusions (primary, secondary, …etc) but we want to
demonstrate only the following ones:
The following types are the predominate ones of delusional disorders:
1) Persecutory type:
The patient thinks that people want to hurt him and the supposed persecutors of
the deluded patient may be definite people in the environment like members of
family, neighbours, or friends or ….etc …. Others
2) Grandiose type
Here, the patient has delusions of inflated worth, power, knowledge, identity or
special relationship to a diety or famous person. In addition, he feels that he is
important, intelligent or a prophet.
3) Erotomatic type (delusions of love)
Erotomatic comes from erotic (sexual desire) and mania. Here , the patient thinks
that some person is in love with him. He may pester the victim with letters and
other behavior . if there is no response to the letters, then he thinks that are
people (enemies) who have wicked intention.
4) Somatic type
Here, the patient feels that he has some physical defect or general medical
condition . he may think that he has a tumor, tuberculosis, syphilis and other diseases .
Example / the following type, here the patient feels the presence of a bad smell coming
from his body (mouth, rectum, vagina …), so he tries to avoid other people so that they
cannot detect this disorder.
Example/ The dysmorphie type here, the patient feels that his nose is deviated, his mouth
is wide , his ears outwards (bat ears) , …. Etc his body is not well organized,… he tries to
correct these abnormalities by consulting doctors an asking them to do a plastic surgery
on his body, but the doctors tell him that he does not suffer from and abnormality and
that his body is normal. After that , the patient continues to consult doctors seeking for
help and intervention with his problem.
Example / Infestation type , here, the patient feels that he is infested by parasites, worms,
insects, …..etc. either in the skin (external) or in the GIT and other internal organs
(internal)
5) Nihilistic type
Here, the patient feels that or denies the existence of body, his mind, his loved
ones, and the world around him. he thinks that his body is dead, the world has
stopped.
He may think that the day is coming or that he is, so there is so need to drink and
eat because he will never die.
This type of delusions may be seen in severe agitated degree of depression or
schizophrenia or in delusional disorder
6) Jealous type
Here , the patient that his/her sexual partner is unfaithful …. But is most common
in males. This type of delusional disorder is more common in eastern countries
due to cultural factors that makes the husband think that his wife is a part of him,
his wife is not equal to him or that his wife is his own and he can do whatever he
wants with her. In addition, the husband thinks that and thing related to his wife
is related to him.
However, the patient with this type delusion thinks that his wife has a sexual
relationship with another person. So the patient to observe her behavior and may
follow her in the streets to detect her partner. He may interrogate his wife by
asking questions and may even search his wife's underclothes for stain of
seminal fluid. Sometimes , the wife is beaten to make her confession and not
uncommonly murder is attempted or committed. It's better to the wife not to
confess because the patient may kill her after wards . It has been found that
faithful loyal with no any sexual relationship.
7) Mixed type
Here , the patient has delusion of more than one of the previously mentioned
types, but no one theme predominates.
8)Unspecified type
In addition to the specific types of delusional disorders, we have the following
ones (rare):-
III- The symptoms of the patient must continue for six months or more
Note : If the symptoms last less than 6 months then the disorder may be either brief
psychotic disorder (1 day- 1 month) or schizophreniform disorder (1-6 months)
IV- the disturbance is not due to effects of a substance (e.g. drug abuse, medication ) or a
general medical condition.
V- relationships to pervasive developmental disorders like autistic disorders . In which
addition diagnosis of schizophrenia is made on if prominent hallucination and delusion are
present.
Diagnostic Criteria for
Schizoaffective Disorder
A. An uninterrupted period of illness during which there is a major
mood episode (major depressive or manic) concurrent with
Criterion A of schizophrenia.
Note: The major depressive episode must include Criterion A1:
Depressed mood.
B. Delusions or hallucinations for 2 or more weeks in the absence of
a major mood episode (depressive or manic) during the lifetime
duration of the illness.
C. Symptoms that meet criteria for a major mood episode are
present for the majority of the total duration of the active and
residual portions of the illness.
D. The disturbance is not attributable to the effects of a substance
(e.g., a drug of abuse, a medication) or another medical condition.
Medical condition induce
psychosis
Chlorpromazine
Fluphenazine
Haloperidol
Perphenazine
These antipsychotics are often cheaper than second-
generation antipsychotics, especially the generic
versions, which can be an important consideration when
long-term treatment is necessary.
Second-generation antipsychotics
These newer, second-generation medications are generally
preferred because they pose a lower risk of serious side effects
than do first-generation antipsychotics. Second-generation
antipsychotics include:
Aripiprazole (Abilify)
Asenapine (Saphris)
Brexpiprazole (Rexulti)
Cariprazine (Vraylar)
Clozapine (Clozaril, Versacloz)
Iloperidone (Fanapt)
Lurasidone (Latuda)
Olanzapine (Zyprexa)
Paliperidone (Invega)
Quetiapine (Seroquel)
Risperidone (Risperdal)
Ziprasidone (Geodon)
Long-acting injectable antipsychotics
Some antipsychotics may be given as an intramuscular or
subcutaneous injection. They are usually given every two to
four weeks, depending on the medicationThis may be an
option if someone has a preference for fewer pills and may
help with adherence.
Electroconvulsive therapy
For adults with schizophrenia who do not respond to
drug therapy, electroconvulsive therapy (ECT) may be
considered. ECT may be helpful for someone who also
has depression.
Thank you