Mental Disorders

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 Schizophrenia Spectrum And Other
Psychotic Disorders
• Schizotypal (Personality) Disorder
• Brief Psychotic Disorder
• Delusional Disorder (Erotomanic type, grandiose type, jealous type,
persecutory type, somatic type, mixed type, and unspecified))
• Schizophreniform Disorder
• Schizophrenia -Schizoaffective Disorder (Bipolar type and depressive
type)
• Substance/Medication-Induced Psychotic Disorder
• Psychotic Disorder Due to Another Medical Condition
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Catatonia
• Catatonia Associated With Another Mental Disorder
(Catatonia Specifier) Catatonic Disorder Due to Another
Medical Condition
• Unspecified Catatonia
• Other Specified Schizophrenia Spectrum and Other Psychotic
Disorder
• Unspecified Schizophrenia Spectrum and Other Psychotic
Disorder

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 Key Features of Schizophrenia Spectrum
and other Psychotic Disorders

There are five key symptoms that define schizophrenia

spectrum and other psychotic disorders:

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 1.Delusio
ns
• Delusions are beliefs that a person holds which cannot be changed
regardless of conflicting evidence proving these beliefs to be untrue.

• The delusions may vary in their content, but common delusions

include:
a) persecutory
b) referential
c) somatic
d) religious.

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 2.
Hallucinations
• A hallucination is a sensory experience of something that does
not exist outside the mind.

• Hallucinations can involve any of the senses, but auditory

hallucinations are the most common in schizophrenia and related
disorders.

• These auditory hallucinations are typically experienced as voices.

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 3.Disorganized thinking
(speech)
• Disorganized thinking is usually picked up in the way a person
speaks.

• The person may switch from one topic to another without any clear
link between the two, or answers to questions may be unrelated.

• In rare cases disorganized thinking may lead to speech being

incomprehensible.

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 4. Grossly Disorganized or Abnormal Motor
Behaviour (including Catatonia)
• Grossly disorganized or abnormal motor behaviour may manifest as childlike
or silly behaviour, or as irregular agitation which can lead to challenges with
everyday functionality.
• Catatonic behavior is characterized by a marked decrease in reactions to the
environment.
This can range from;
a) resistance to instructions
b) to maintaining a rigid or inappropriate posture
c) to a complete lack of movement or speech

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 5. Negative
Symptoms
• The negative symptoms of schizophrenia include:
a) problems with motivation
b) social withdrawal
c) diminished affective responsiveness, speech, and movement.

• These symptoms play a large role in the poor functional outcomes

and quality of life for individuals with schizophrenia.

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 Brief Psychotic
What it is: Disorder
• Brief psychotic disorder is a sudden, short-term display of psychotic
behaviour, such as hallucinations or delusions.

• A psychotic episode lasts for a short period of time, and afterwards the
individual returns to the same level of functionality as before the episode.

• Individuals experiencing brief psychotic disorder may feel overwhelming

confusion during and after a psychotic episode, and supervision may be
needed to ensure safety and adequate self-care during an acute episode.

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There
. are three different possible types of brief psychotic
disorder:

1. Brief psychotic disorder with a marked stressor(s) - When a psychotic

episode is triggered by an emotionally stressful event or events in an
individual’s life

2. Brief psychotic disorder without a marked stressor(s) – When a

psychotic episode occurs without any stressful event acting as a trigger

3. Brief psychotic disorder with postpartum onset – When a psychotic

episode occurs during pregnancy or within the 4 weeks postpartum

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Common symptoms of brief psychotic disorder

i. Delusions
ii. Hallucinations
iii. Disorganized speech
iv. Grossly disorganized or catatonic behavior
v. Psychotic episode must last for at least one day, but less than
one month
vi. After the episode the individual returns to the same
functional state as before

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Causes:
• One likely cause for brief psychotic disorder seems to be pre-
existing personality disorders and character traits. For example, an
individual with schizotypal personality disorder or borderline
personality disorder, may be more likely to develop this disorder.

• Stress and/or a traumatic life event, such as the loss of a loved one
or a physical attack, may also cause brief psychotic disorder.

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 Delusional
Disorder
• The essential feature of delusional disorder is the occurrence of
one or more delusions that continue for at least a month.

• These delusions can lead to social and occupational problems, as

others begin to see these individuals as irrational.

• The individual has one or more delusions that persist for at least
a month or more.

• Criterion A for schizophrenia is not and never has been met.

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• Aside from the delusion(s) direct effects, functioning is not

obviously impaired, and behavior is not noticeably strange.
• Any manic or major depressive episodes have been brief, compared
to the length of the delusional period.
• The disturbance cannot be attributed to the physiological effects of
a substance, another medical condition, or another mental
disorder.
• The severity of the delusions should be noted and it should also be
specified if delusions involve bizarre content, or are clearly
implausible.

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• Additionally, there are a few subtypes with specific delusional

themes that should be specified:

1. Erotomanic type: This involves delusions about another person

being in love with the affected individual.
2. Grandiose type: Individuals with the grandiose type of delusional
disorder believe they have a great talent (which is unrecognized)
or made a great, important discovery.
3. Jealous type: This involves delusions about his or her lover being
unfaithful.

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4. Persecutory type: This subtype pertains to individuals with delusions

involving their beliefs that they are being conspired against, spied or cheated
on, poisoned or drugged, harassed or followed, or generally obstructed in the
pursuit of long-term goals.

5.Somatic type: Individuals with the somatic type of delusional disorder have
delusions involving bodily functions/and or sensations.

6. Mixed type: There is not one delusional theme that persists over others.

7.Unspecified type: The dominant delusional belief cannot be clearly

determined or does not fall into the descriptions of the specific types.
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 Risk
• While an individual’s culturalFactors
and religious background must be
considered during assessment of a possible delusional disorder, there is
not one cultural or religious group that is at a higher risk of developing
delusional disorder.

• Furthermore, one gender is not more prone to developing the disorder

either, although the jealous subtype is most likely more common in
males.

• The only existential risk factor involves the presence of schizophrenia

and schizotypal personality disorder, as there is a significant familial
relationship
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 Schizophreni
• Schizophrenia involves a rangeaof cognitive, behavioral, and emotional
symptoms, and it can be difficult to diagnose.

• There’s no simple physical or lab test for schizophrenia, and diagnosis involves
the recognition of a constellation of symptoms negatively impacting social or
occupational functioning.

• Schizophrenia is a serious mental disorder in which people interpret reality

abnormally.

• Schizophrenia may result in some combination of hallucinations, delusions, and

extremely disordered thinking and behavior that impairs daily functioning, and
can be disabling.
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Diagnosis
• The DSM 5 outlines the following criterion to make a diagnosis of
schizophrenia:
• Criteria A: Two or more of the following for at least a one-month (or
longer) period of time, and at least one of them must be 1, 2, or 3:
i. Delusions
ii. Hallucinations
iii. Disorganized speech
iv. Grossly disorganized or catatonic behavior
v. Negative symptoms, such as diminished emotional
expression

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B..Impairment in one of the major areas of functioning for a
significant period of time since the onset of the disturbance: Work,
interpersonal relations, or self-care.

C: Some signs of the disorder must last for a continuous period of
at least 6 months. This six-month period must include at least one
month of symptoms (or less if treated) that meet criterion A (active
phase symptoms) and may include periods of residual symptoms.
During residual periods, only negative symptoms may be present.

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D: Schizoaffective disorder and bipolar or depressive disorder with

psychotic features have been ruled out:
1. No major depressive or manic episodes occurred concurrently
with active phase symptoms
2. If mood episodes (depressive or manic) have occurred during
active phase symptoms, they have been present for a minority
of the total duration of the active and residual phases of the
illness.
D: The disturbance is not caused by the effects of a substance or
another medical condition

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E: If there is a history of autism spectrum disorder or a

communication disorder (childhood onset), the diagnosis of
schizophrenia is only made if prominent delusions or
hallucinations, along with other symptoms, are present for at
least one month

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Associated Features
• There are a number of symptoms that contribute to a diagnosis of
schizophrenia.
1. Inappropriate affect (laughing in the absence of a stimulus)
2. Disturbed sleep pattern
3. Dysphoric mood (can be depression, anxiety, or anger)
4. Anxiety and phobias
5. Depersonalization (detachment or feeling of disconnect from
self)

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6. Derealization (a feeling that surrounding aren’t real)

7.Cognitive deficits impacting language, processing, executive function,
and/or memory
8. Lack of insight into disorder
9. Social cognition deficits
10. Hostility and aggression
11.Cognitive impairments caused by the disorder may persist when other
symptoms are in remission.
This contributes to impairments in functioning in employment, interpersonal
relationships, and the ability to engage in proper self-care.

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Suicide Risk
• Five to 6% of people with schizophrenia die by suicide, about
20% make suicide attempts on more than one occasion, and
many more have significant suicidal thoughts.

• Suicidal behavior can be in response to hallucinations and suicide

risk remains high over the lifespan of individuals with
schizophrenia.

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Functional Consequences
• Schizophrenia is associated with social and occupational
dysfunction.
• Completing education and maintaining employment are
negatively impacted by symptoms of the illness, and most
individuals diagnosed with schizophrenia are employed at a
lower level than their parents.
• Many have few or limited social relationships outside of their
immediate family.

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Symptoms in teenagers
• Schizophrenia symptoms in teenagers are similar to those in
adults, but the condition may be more difficult to recognize. This
may be in part because some of the early symptoms of
schizophrenia in teenagers are common for typical development
during teen years, such as:
• Withdrawal from friends and family
• A drop in performance at school
• Trouble sleeping

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• Irritability or depressed mood

• Lack of motivation
• Also, recreational substance use, such as marijuana,
methamphetamines or LSD, can sometimes cause similar signs
and symptoms.
• Compared with schizophrenia symptoms in adults, teens may
be:
• Less likely to have delusions
• More likely to have visual hallucinations

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 Risk
• Although the precise causeFactors
of schizophrenia isn't known, certain
factors seem to increase the risk of developing or triggering
schizophrenia, including:

1. Having a family history of schizophrenia

2. Some pregnancy and birth complications, such as malnutrition or
exposure to toxins or viruses that may impact brain
development
3. Taking mind-altering (psychoactive or psychotropic) drugs during
teen years and young adulthood
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Causes
• It's not known what causes schizophrenia, but researchers believe that a
combination of genetics, brain chemistry and environment contributes to
development of the disorder.

• Problems with certain naturally occurring brain chemicals, including

neurotransmitters called dopamine and glutamate, may contribute to
schizophrenia.

• Neuroimaging studies show differences in the brain structure and central nervous
system of people with schizophrenia.

• While researchers aren't certain about the significance of these changes, they
indicate that schizophrenia is a brain disease
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 Dissociative and Somatoform
Disorders
(DSM-1V)
A somatoform disorder is diagnosed when the primary disorder is a
mental disorder with prominent physical complaints.

• Somatoform is a pathological concern of individuals with the appearance

or functioning of their bodies when there is no identifiable medical
condition causing the physical complaints

• Individuals feel detached from themselves or their surroundings,

and reality, experience, and identity may disintegrate

• Somatoform disorders have been around for most of history.

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 The ancient Egyptians reported cases of somatoform disorders, as did the

ancient Greeks, Romans and most modern societies.

• It was believed that somatoform disorders only happened in women.

• Egyptian doctors suggested that perhaps the problem was that the womb had
detached and was floating around inside the body

• Greeks gave somatoform disorders the name hysteria or Womb.

• In the 19th century, Sigmund Freud finally gave hysteria a new name, Conversion
Disorder, because he believed that it was caused by converting psychological pain
into physical pain

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Dissociative disorders involve the disruption or loss of

the integrative mechanisms of consciousness,
memory, identity, or perception

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Somatoform Disorders
• Somatization disorder.
• Undifferentiated somatoform disorder.
• Conversion disorder.
• Pain disorder.
• Hypochondriasis.
• Body dysmorphic disorder.
• Somatoform disorder not otherwise specified.

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