Schizophrenia spectrum & other psychotic disorders include schizophrenia,

other psychotic disorders, & schizotypal (personality) disorder.

They are defined by abnormalities in 1 or more of the following 5 domains:
Delusions
Hallucinations
Disorganized Thinking (speech)
Grossly disorganized or abnormal motor behavior (including catatonia)
Negative symptoms.

SCHIZOPHRENIA Out of touch with reality

Definition Eugen Bleuler

It is a severe disorder that is often associated with considerable impairments in
functioning.
Hallmark feature is psychosis, which refers to a significant loss of reality.
Combination of Greek words for "split" (skhizein) & "mind" (phren)

Epidimiology

lifetime prevalence appears to be approx. 0.3%-0.7%, although there is reported

variation by race/ethnicity, across countries, & by geographic origin(immigrants)
Approx 1/140 people who live to the age of 55 will develop disorder

High susceptibility found among individuals with a parent/s with schizophrenia

Rates are also higher than expected in 1st & 2nd-gen immigrants

imbalanced ratio of M to F 1.4:1, so for every 3 men who develop disorder only 2
women do so.
Differences prevalent among age of onset in men & women.
males also tend to have a more severe form of schizophrenia

Etiology
Genetic Factors: Family history & specific genes play a role.
Neurobiological Factors: Dopamine dysregulation & brain abnormalities are implicated.
Environmental Factors: Prenatal factors, childhood adversity, & urban upbringing
contribute.
Neurochemical Factors: Glutamate & serotonin system dysregulation are involved.
Psychosocial Factors: Stress & family dynamics impact the disorder.
Substance Abuse: Certain substances can trigger or worsen symptoms.

Diagnostic Criteria:
2 (or more) of the following, each present for a significant portion of time during
1 month period (or less if successfully treated). At least one of these must be (1),
(2), or (3):
Delusions.
Hallucinations.
Disorganized speech (e.g., frequent derailment or incoherence).
Grossly disorganized or catatonic behavior.
Negative symptoms (i.e., diminished emotional expression or avolition).

For a sig. portion of time since onset of disturbance, level of functioning in 1 or

more major areas, such as work, interpersonal relations, or self-care, is markedly
below level achieved prior to onset (or when onset is in childhood or adolescence,
there is failure to achieve expected level of interpersonal, academic, or occupational
functioning).

Continuous signs of disturbance persist for at least 6 months. 6-month period must
include at least 1 month of symptoms that meet C.A (active-phase symptoms) &
may include periods of prodromal or residual symptoms. During these periods, signs
of disturbance may be manifested by only -ve symptoms or by 2 or more symptoms
listed in C.A present in an attenuated form (odd beliefs, unusual perceptual
experiences).

Schizoaffective disorder & depressive or bipolar disorder with psychotic features have
been ruled out because either no major depressive or manic episodes have occurred
concurrently with active-phase symptoms, or if mood episodes have occurred during
active-phase symptoms, they have been present for a minority of total duration of
the active & residual periods of illness.

Disturbance is not attributable to physiological effects of a substance(drug of abuse,

medication) or another medical condition.

If there is history of autism spectrum disorder or communication disorder of

childhood onset, additional diagnosis of schizophrenia is made only if prominent
delusions or hallucinations, in addition to other required symptoms of schizophrenia,
are also present for at least 1 month (or less if successfully treated).
The specifiers of schizophrenia are:
Course specifiers: that are applicable only after 1-year duration of the disorder &
if they are not in contradiction to the diagnostic course criteria.
Catatonia Specifier: Marked psychomotor disturbance that may involve decreased
motor activity.
Severity Specifier: rated by a quant. assessment of primary symptoms of psychosis,
including delusions, hallucinations, disorganized speech, abnormal psychomotor bhvr,
& -ve symptoms.

Symptomatology:
POSITIVE SYMPTOMS:
Delusions: False, fixed beliefs not influenced by conflicting evidence.
(Persecutory, Referential, Grandiose, Erotomanic, Nihilistic, Somatic, Mind control)
Hallucinations:Perception-like sensory experiences without external stimuli.
(Auditory (common), olfactory, gustatory, visual, tactile)
Disorganized Speech: Speech lacks coherence and organization.
(Derailment, thought blocking, circumstantiality, incoherence (word salad))
Grossly Disorganized or Catatonic Behavior:
Wide range of behaviors, from silliness to agitation.
Impaired goal-directed activity, daily functioning, social relations, self-care.
Catatonic behaviors include negativism, stupor, mutism, and catatonic excitement.

NEGATIVE SYMPTOMS:
Reflect an absence or deficit of normal behaviors.
Common -ve symptoms:
Flat Affect (reduced emotional expression)
Avolition (decreased motivation)
Alogia (limited speech)
Anhedonia (lack of pleasure)
Asociality (lack of interest in social interactions)

Onset & Course of Schizophrenia:

Age of Onset: Typically emerges in late adolescence or early adulthood (peak
at 18-30 years).
Wide age range: Childhood onset to onset in the sixties (uncommon).
Onset Nature: Can be acute (weeks or months) or insidious (over months or
years).
Prognosis: Earlier onset often indicates a worse prognosis.

Course:
Schizophrenia is chronic.
2 main patterns: Waxing & Waning: Symptoms fluctuate.
Stable Chronicity: Symptoms remain relatively stable.
Phases of Illness: Prodromal Phase: Non-specific symptoms.
Active Phase: Noticeable psychotic symptoms.
Residual Phase: Mild or absent symptoms.

Symptom Changes Over Time: Psychotic symptoms tend to decrease with age.
-ve symptoms are more persistent & impact prognosis.
Cognitive deficits may not improve over course of the
illness.

Differential Diagnosis:
Major Depressive or Bipolar Disorder with Psychotic Features:
Exclusive occurrence during depressive or manic episodes.
Schizoaffective Disorder:
Mood symptoms present for the majority of active periods.
Schizophreniform Disorder & Brief Psychotic Disorder:
Shorter duration than schizophrenia
Delusional Disorder:
Lacks other schizophrenia symptoms.
Schizotypal Personality Disorder:
Subthreshold symptoms with persistent personality features.
OCD & BDD:
Distinguished by prominent obsessions, compulsions, or preoccupations related to
appearance, body odor, hoarding, or repetitive behaviors.
PTSD:
Requires a traumatic event & characteristic symptom features related to reliving or
reacting to the event.
Autism Spectrum Disorder or Communication Disorders:
Characterized by deficits in social interaction, repetitive bhvrs, & cog/communication
deficits.

Comorbidity
High comorbidity rates with substance-related disorders.
Increasing recognition of comorbidity with anxiety disorders.
Schizotypal or paranoid personality disorder may precede schizophrenia.
Reduced life expectancy due to associated medical conditions.

OTHER PSYCHOTIC DISORDERS

SCHIZOPHRENIFORM DISORDER
category reserved for schizophrenia-like psychoses that last at least a month but
don't last for 6 months & so don't warrant diagnosis of schizophrenia.
Due to possibility of early & lasting remission after 1st psychotic breakdown, the
prognosis for schizophreniform disorder is better than that for established forms of
schizophrenia.

Diagnostic Criteria
Same as Schizophrenia
An episode of the disorder lasts at least 1 month but less than 6 months. When
diagnosis must be made without waiting for recovery, it should be qualified as
"provisional."
Same as Schizophrenia D confusion or perplexity:
good premorbid social &
Same as Schizophrenia E occupational functioning;
and absence of blunted
or flat affect.
Specify if:
With good prognostic features: Requires presence of at least 2 of these: onset of
prominent psychotic symptoms within 4 weeks of the first noticeable change in
usual behaviour or functioning
Without good prognostic features: Applied if 2 or more of above features have not
been present.
With catatonia

Specify current severity:

Severity is rated by quant. assessment of primary symptoms of psychosis. Each of
these may be rated for its current severity (most severe in the last 7 days) on a
5-point scale ranging from 0 (not present) to 4 (present and severe).

SCHIZOAFFECTIVE DISORDER
used to describe people who have features of schizophrenia & severe mood disorder.
person not only has psychotic symptoms that meet criteria for schizophrenia but also
has marked changes in mood for substantial amount of time

Diagnostic Criteria

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 MDE must include Criterion A1: Depressed mood.

Delusions or hallucinations for 2 or more weeks in the absence of a

major mood episode (depressive or manic) during lifetime duration of
the illness.
Symptoms that meet criteria for a major mood episode are present for the majority
of the total duration of the active & residual portions of the illness.

Same as Schizophrenia E

Specify whether:
Bipolar type: This subtype applies if a manic episode is part of the presentation.
Major depressive episodes may also occur.
Depressive type: This subtype applies if only major depressive episodes are part of the
presentation.

Specify if:
With catatonia

Specify if:
Following course specifiers are only to be used after 1 year duration of disorder &
if they are not in contradiction to diagnostic course criteria.

First episode, currently in acute episode:

First episode, currently in partial remission:
First episode, currently in full remission:
Multiple episodes, currently in acute episode:
Multiple episodes, currently in partial remission
Multiple episodes, currently in full remission
Continuous:
Unspecified

Specify current severity

Rated by quant. assessment of primary symptoms of psychosis. Each of these symptoms
may be rated for its current severity (most severe in the last 7 days) on a 5-point
scale ranging from 0 (not present) to 4 (present & severe).

DELUSIONAL DISORDER
hold beliefs that are considered false & absurd by those around them may
otherwise behave quite normally.
Their behaviour doesn't show gross disorganization & performance deficiencies
characteristic of schizophrenia

Diagnostic Criteria
The presence of one (or more) delusions with duration of 1 month or longer.

Criterion A for schizophrenia has never been met.[Hallucinations, are not

prominent & are related to delusional theme (e.g sensation of being infested
with insects associated with delusions of infestation).
Apart from impact of delusion(s) or its ramifications, functioning is not markedly
impaired, & behaviour is not obviously bizarre or odd.

If manic or major depressive episodes have occurred, these have been brief relative
to duration of delusional periods.

Same as Schizophrenia E

Specify if:
Erotomanic: applies when C.T of delusion is that another person is in love with
individual.
Grandiose: applies when C.T of delusion is conviction of having some great (but
unrecognized) talent or insight or having made some important discovery.
Jealous: applies when C.T of individual's delusion is that his or her spouse or lover is
unfaithful.
Persecutory: applies when C.T of delusion involves individual's belief that he or she is
being conspired against, cheated, spied on, followed, poisoned or drugged, maliciously
maligned, harassed, or obstructed in pursuit of long-term goals.
Somatic: applies when C.T of delusion involves bodily functions or sensations.
Mixed: applies when no one delusional theme predominates.
Unspecified: applies when dom. delusional belief can't be clearly determined or is not
described in specific types (e.g., referential delusions without a prominent persecutory
or grandiose component).

Specify if:
With bizarre content: Delusions are deemed bizarre if they are clearly implausible,
not understandable, & not derived from ordinary life experiences (e.g., individual's
belief that stranger has removed his/her internal organs & replaced them with
someone else's organs without leaving any wounds or scars).

Same specifier of course & severity as schizoaffective disorder course wala

BRIEF PSYCHOTIC DISORDER

involves sudden onset of psychotic symptoms or disorganized
speech or catatonic bhvr.
Episode usually lasts only a matter of days (too short to issue
a diagnosis of schizophreniform disorder).
After this, person returns to his/her former level of functioning
& may never have another episode again.
Cases of brief psychotic disorder are infrequently seen in
clinical settings, perhaps because they remit so quickly.
Diagnostic Criteria
Presence of one (or more) of following symptoms. At least one of these must be
(1), (2), or (3):
Delusions.
Hallucinations.
Disorganized speech (e.g., frequent derailment or incoherence).
Grossly disorganized or catatonic behaviour.

Note: Do not include a symptom if it is a culturally sanctioned response.

Duration of an episode of the disturbance is at least 1 day but less than 1 month,
with eventual full return to premorbid level of functioning.

The disturbance is not better explained by major depressive or bipolar disorder with
psychotic features or another psychotic disorder such as schizophrenia or catatonia,
and is not attributable to the physiological effects of a substance (e.g., a drug of
abuse, a medication) or another medical condition.

Specify if:
With Catatonia

Specify current severity same

SCHIZOTYPAL DISORDER
often described as odd or eccentric & usually have few, if any, close relationships.
Struggle to comprehend how relationships develop, impact of their actions on others.
Tend to misunderstand others' motivations & behaviors, leading to distrust.
Experience severe anxiety, leading to avoidance of social situations
Hold unconventional or peculiar beliefs may hinder social interactions

Diagnostic Criteria
A pervasive pattern of social & interpersonal deficits marked by acute discomfort
with, & reduced capacity for, close relationships as well as by cog. or perceptual
distortions & eccentricities of behaviour, beginning by early adulthood & present
in a variety of contexts, as indicated by 5 (or more) of the following:
Ideas of reference (excluding delusions of reference).
Odd beliefs or magical thinking that influences behaviour & is inconsistent with
subcultural norms
Unusual perceptual experiences, including bodily illusions.
Odd thinking and speech
Suspiciousness or paranoid ideation.
Inappropriate or constricted affect.
Behaviour or appearance that is odd, eccentric, or peculiar.
 Lack of close friends or confidants other than first-degree relatives.
Excessive social anxiety that does not diminish with familiarity and tends to be
associated with paranoid fears rather than negative judgments about self.

Does not occur exclusively during the course of schizophrenia, a bipolar disorder or
depressive disorder with psychotic features, another psychotic disorder, or autism
spectrum disorder.

SUBSTANCE /MEDICATION-INDUCED PSYCHOTIC DISORDER

Psychotic episodes occurring during withdrawal from alcohol, sedatives, hypnotics,
anxiolytics, & other unknown substances.
Hallucinations or delusions caused by substance use or withdrawal without delirium.
Psychotic disorders linked to alcohol, cannabis, hallucinogens (like phencyclidine),
inhalants, sedatives, hypnotics, anxiolytics, stimulants (like cocaine), & other
unknown substances.

Diagnostic Criteria
Presence of one or both of the following symptoms:
1. Delusions
2. Hallucinations.

There is evidence from history, physical examination, or laboratory findings of both

(1) & (2):
1. Symptoms in Criterion A developed during or soon after substance intoxication or
withdrawal or after exposure to a medication.
2. Involved substance/medication is capable of producing symptoms in Criterion A.

The disturbance is not better explained by psychotic disorder that is not

substance/medication-induced. Such evidence of an independent psychotic disorder
could include the following,
Symptoms preceded onset of substance/medication use; symptoms persist for a
substantial period of time after cessation of acute withdrawal or severe
intoxication: or there is other evidence of an independent non-substance/
medication-induced psychotic disorder

The disturbance does not occur exclusively during the course of a delirium.

The disturbance causes clinically sig. distress or impairment in social, occupational,

or other important areas of functioning.
Note: diagnosis should be made instead of diagnosis of substance intoxication or
substance withdrawal only when symptoms in Criterion A predominate in the
clinical picture & when they are sufficiently severe to warrant clinical attention.
Specify if:
With onset during intoxication: If criteria are met for intoxication with substance &
symptoms develop during intoxication.
With onset during withdrawal: If criteria are met for withdrawal from substance &
symptoms develop during, or shortly after, withdrawal.

Same severity specific