SCHIZOPHRENIA SPECTRUM

and
OTHER PSYCHOTIC DISORDERS

DSM 5
 DSM 5 Classification
• Schizophrenia
• Other Psychotic Disorders
• Schizotypal Personality Disorder
Schizophrenia
Diagnosis (DSM-IV-TR and DSM 5 criteria)
A. Characteristic symptoms
B. Social/Occupational impairment
C. Length / duration of illness
D. Schizoaffective and mood disorder exclusion
E. Substance/gen. med. condition exclusion
F. Relationship to a pervasive devt.al disorder
specifiers
Diagnosis (DSM-5 Diagnostic Criteria)

2 or more of the following must be present during a

1-month period (or less if treated)*
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
5. Negative symptoms

*at least one of these must be (1), (2),or (3)

Other Psychotic Disorders
 Other Psychotic Disorders (DSM 5)
1. Schizophreniform Disorder
2. Schizoaffective Disorder
3. Delusional Disorder
4. Shared Psychotic Disorder
5. Brief Psychotic Disorder
6. Substance/Medication-Induced Psychotic D.
7. Psychotic D due to another medical condition
8. Catatonia
9. Other Specified SSOPD
10.Unspecified SSOPD
Outline
• History
 Epidemiology (risk factors)
• Etiology
 Diagnosis (criteria and classification)
 Clinical features
 Differential Diagnosis
 Course and Prognosis
 Treatment
SCHIZOPHRENIFORM DISORDER
Schizophreniform Disorder
• Introduced by Gabriel Langfeldt in 1939

• Adolescents and young adults , M > F

Lifetime prevalence 0.11 %

• Unknown etiology
Relatives more likely to have Mood D
Brains show changes similar to schiz

• Acute disorder with rapid onset

Lacks a long prodromal phase
No progressive decline in functioning
 Schizophreniform Disorder
Diagnosis (DSM-IV-TR and DSM 5)

A. Characteristic symptoms : same as Schiz

B. Duration : 1 month to 6 months
C. Schizoaffective and mood disorder exclusion
D. Substance/gen. med. condition exclusion
Specifiers
w/ and w/o good prognostic factors
w/ and w/o catatonia
current severity
 “With good prognostic factors”

Requires the presence of at least 2 of the ff:

1. Onset of prominent psychotic symptoms within 4
wks of the first noticeable change in usual behavior
or functioning
2. Confusion or perplexity
3. Good premorbid social/occupational functioning
4. Absence of blunted or flat affect
Schizophreniform Disorder
Diffl Dx : Psychoses due to substance use /
medications / medical conditions
Mood disorders w/ psychotic features

Course: 60 to 80% progress to Schizophrenia

20 – 40 % may have a single episode

Treatment:Hospitalization; antipsychotics (rapid

response in 75%) ; psychotherapy ; ECT
SCHIZOAFFECTIVE DISORDER
 Schizoaffective disorder
• Features of both Schiz and Mood D
• 6 categories of patients
– with Schiz who have mood sx
– with Mood D. who have sx of Schiz
– with both Mood D and Schiz
– with a 3rd psychosis unrelated to Schiz / Mood D
– continuum between Schiz and Mood D
– some combination of the above
 Schizoaffective disorder
History :G. H. Kirby (1913) and A. Hoch (1921)
Jacob Kasanin (1933)

Epidemiology: lifetime prev. of 0.5 to 0.8 %

young adults, M=F (bipolar type)
older adults, F>M (depressive type)
men often have antisocial behavior

Etiology: unknown
 Schizoaffective Disorder
DIAGNOSIS
• Uninterrupted period of illness with a major mood episode
concurrent with Schizophrenia symptoms
• Delusions or hallucinations for 2 or more weeks in the
absence of a major mood episode
• Symptoms of major mood episode are present for a majority
of the total duration of illness
• Not due to substance use/another med condition

 Needs accurate diagnosis of the affective illness

 Schizoaffective Disorder
• Differential Diagnosis
• Prognosis more closely resembles that of
Schizophrenia
• Treatment:
– mood stabilizers; antidepressants
– Psychosocial tx : family therapy, cognitive rehab
DELUSIONAL DISORDER
 Delusional Disorder
• One or more delusions for at least 1 month
• Criterion A for Schiz has never been met
• Delusions NOT obviously bizarre or odd
• Functioning NOT markedly impaired
• Manic/depressive episodes were brief
• Types: Erotomanic Grandiose
Jealous Persecutory
Somatic Mixed
Unspecified
 Delusional disorder
• Lifetime prevalence is 0.2%
• Most common type: persecutory
• Onset often assoc’d with psychosocial stressor
• 50% recover, 30% status quo, 20% improve
• Specifiers: if w/bizarre content/status/severity
• Treatment:
– Psychotherapy
– Medications are often ineffective
 Diagnosis*
• Eliminate medical conditions as cause
– Neurodegenerative disorders
– Other CNS disorders
– Vascular disease
– Infectious diseases
– Metabolic disorder
– Endocrinopathies
– Substances, medications, toxins
 Shared psychotic disorder
• Shared paranoid disorder
• Induced psychotic disorder
• Folie impose
• Double insanity
• Folie a deux
• 20 % will recover upon removal from inducer
• Tx:
– Psychotherapy
– Antipsychotics if sx persist 1-2 wks after separation
BRIEF PSYCHOTIC DISORDER
 Brief Psychotic Disorder
• Less common than Schiz; uncommon
• May account for 9% of cases of first-onset
psychosis (APA)
• 2x more common in Females, in younger
individuals (20-30 y.o.), with low S-E status,
and exposed to major stress/trauma
• More common in developing countries
 Brief psychotic disorder
• Absence of negative symptoms (#5) in criteria
• Duration of sx from 1 day to less than 1 month
• Specify if:
– With marked stressor (brief reactive psychosis)
– W/out marked stressor
– With postpartum onset (during pregnancy or 4
weeks postpartum)
– With catatonia
 Brief Psychotic Disorder
• 50-80% recovery rate
• 20-50% may develop into Schiz or Mood D.

• Brief hospitalization
• Supportive psychotherapy
• Meds : Antipsychotics/benzodiazepine
SUBSTANCE/MEDICATION-INDUCED
PSYCHOTIC DISORDER
 Substance/medication-induced Psychotic
disorder
• Presence of delusions and/or hallucinations
• There is evidence that the symptoms
developed during or soon after the substance
intoxication or withdrawal or after exposure to
a medication
• Seen in 7% to 25% of individuals presenting
with first episode of psychosis
 Substance/medication-induced Psychotic
disorder
• Must be differentiated from the ff:
– Substance intoxication or withdrawal (in which there
is intact reality-testing or absence of psychosis)
– Delirium (in which there is clouded sensorium)
– Dementia (which has major intellectual deficits)
– Psychotic disorder due to a general medical
condition (presence of medical condition)
– Schizophrenia (presence of other thought disorders and
impairment of functioning)
ICD-10 has codes for psychosis induced by the
following substances:

• Alcohol
• Cannabis
• Phencyclidine
• Other hallucinogens
• Inhalant
• Sedative, hypnotic, or anxiolytic
• Amphetamine (or other stimulant)
• Cocaine
• Other (unknown) substance
PSYCHOTIC DISORDER DUE TO A
GENERAL MEDICAL CONDITION
 Psychotic disorder due to a general medical
condition
• The medical condition, and the predominant
symptom pattern, should be included in the
diagnosis (ex. Psychotic disorder due to a brain
tumor, with delusions)
CATATONIA
CATATONIA
 Catatonia
• Defined by the presence of 3 or more of 12
psychomotor features
• Syndrome marked by striking behavioral
abnormalities
• Uncommon condition; found mostly in
advanced cases of mood disorder or psychosis
– 25-50% of catatonic in-patients have mood
disorders
– 10% have Schizophrenia
 Catatonia
• Etiology:
– Medications
• Corticosteroids
• Immunosuppressants
• Antipsychotic agents
– Medical conditions:
• Neurological disorders (head trauma)
• Infections (encephalitis)
• Metabolic disturbances (hyponatremia, hypercalcemia)
 Catatonia
classification

I. Catatonic Disorder due to a general medical

condition

II. Catatonia due to a mental disorder

 Catatonia
BEHAVIORAL ABNORMALITIES
1. Stupor 7. Mannerism
2. Catalepsy 8. Stereotypy
3. Waxy flexibility 9. Agitation
4. Mutism 10.Grimacing
5. Negativism 11.Echolalia
6. Posturing 12.Echopraxia
 Catatonia
DIFFERENTIAL DIAGNOSIS
• Hypoactive delirium
• Akinetic mutism
• End-stage dementia
• Catatonia due to a primary mental disorder
 Course and Treatment
• Hospitalization is a must
– Fluid intake, nutrition, and hygiene must be
maintained
• Identify and correct underlying medical or
pharmacological cause
• Biological Therapy:
– Bezodiazepines
– ECT or Electro Convulsive therapy (for life-
threatening catatonia)
THANK YOU