SCHIZOPHRENIA & OTHER

PSYCHOTIC DISORDERS

Dr. Mohammedelamin Mukrim

MBBS, MSc HPE Clinical MD Psychiatry SMSB
Assistant Professor of Psychiatry OIU FMHS Sudan
BY THE END OF THIS LECTURE THE STUDENT WILL BE ABLE TO:

1. Def in e the different types of psychotic disorders

including Schizophrenia.
2. Know the chief symptoms and diagnostic criteria for
each one.
3. Elicit psychopathological features with competent
practical hints of interviewing skills.
3. Being able to generate differential diagnostic theories
towards reaching a f in al diagnosis of a psychotic
disorder.
4. Setting comprehensive plans of management tailored
for each psychotic disorder.
SCHIZOPHRENIA
SCHIZOPHRENIA
OTHER PSYCHOTIC DISORDERS
Brief Psychotic Disorders
Schizophreniform Disorder
Delusional disorder
Schizoaffective Disorder
Substance induced Psychotic Disorder
Psychotic disorder due to general medical
Condition
Catatonia
Schizotypal Personality Disorder
 BRIEF PSYCHOTIC DISORDER

 Briefpsychotic disorder is characterized by

hallucinations, delusions, disorganized speech
or behavior.
 Symptom onset is often rapid, with marked
functional impairment.
 The duration of symptoms is between one day
and one month.
 In contrast, diagnosis of schizophrenia requires
six-month duration of symptoms.
 DSM-5 DIAGNOSTIC CRITERIA FOR BRIEF PSYCHOTIC
DISORDER:

A. At least one of the following:

1. Delusions.
2. Hallucinations.
3. Disorganized speech.
4. Grossly disorganized or catatonic behavior.

B. Duration of symptoms is between one day and one

month, after which the patient returns to the
previous level of functioning.
C. The disturbance is not caused by a mood disorder with
psychotic features, substance abuse, schizoaffective
disorder, schizophrenia, or other medical condition.

Clinical Features of Brief

Psychotic Disorder:
A. Emotional turmoil and confusion are often present.
B. Mood and affect may be labile.
C. Onset is usually sudden and may abate as rapidly as it
began.
D. Attentional deficits are common.
E. Psychotic symptoms are usually of brief duration
(several days).
EPIDEMIOLOGY OF BRIEF PSYCHOTIC DISORDER:

A. The disorder is rare and younger

individuals have a higher rate
of illness, with the average age of
onset in the late twenties to early thirties.
B. The risk of suicide is increased in patients with this
disorder, especially in young patients.
C. Patients with personality
disorders have a higher risk
for brief psychotic disorder.
CLASSIFICATION OF BRIEF PSYCHOTIC DISORDER:

A. Brief Psychotic Disorder with

Marked Stressors:
is present if symptoms occur in
relation to severe stressors
(i.e. death of a loved one).
B. Brief Psychotic Disorder without Marked Stressors:
is present if symptoms occur without identifiable
stressors.
C. Brief Psychotic Disorder with Postpartum Onset:
occurs within four weeks of giving birth.
 DIFFERENTIAL DIAGNOSIS OF BRIEF PSYCHOTIC DISORDER:


A. Substance-Induced Psychotic Disorder:
1. Amphetamine, cocaine and PCP may produce symptoms indistinguishable
from brief psychotic disorder. Alcohol or sedative hypnotic withdrawal may
also mimic these symptoms.
2. Substance abuse should be excluded by history and with a urine toxicology
screen.
B. Psychotic Disorder Caused by a General Medical Condition:
1. Rule out with history, physical exam and labs. A CBC can be used to rule out
delirium and psychosis caused by infection. This is especially important in
elderly patients where the incidence of brief reactive psychosis is low
compared to younger patients.
2. Routine chemistry labs can be used to rule out electrolyte imbalances or
hepatic encephalopathy; VDRL (Venereal Disease Research Laboratory test)
to rule out neurosyphilis; HIV screening to rule out psychosis due to
encephalitis in at-risk patients.
3. Consider a MRI or head CT scan to rule out a mass or neoplasm.
4. An EEG should be considered to rule out seizure
disorders (such as temporal lobe epilepsy), especially
when there is a history of amnestic periods or impaired
consciousness.

C. Schizophreniform Disorder or Schizophrenia:

Schizophreniform disorder must last for over a month
and schizophrenia must have six-month duration.

D. Mood Disorder with Psychotic Features:

Brief psychotic disorder cannot be diagnosed if the full
criteria for major depressive, manic or mixed episode is
present
TREATMENT OF BRIEF PSYCHOTIC DISORDER:


A. Brief hospitalization may be necessary, especially if
suicidal or homicidal ideation is present. Patients can
also be very confused and impulsive.
B. A brief course of a neuroleptic, such as risperidone 2-4
mg per day, is usually indicated. Adjunctive
benzodiazepines can speed the resolution of symptoms.
Short-acting benzodiazepines, such as lorazepam 1-2 mg
every 4 to 6 hours, can be used as needed for associated
agitation and anxiety.
C. Supportive psychotherapy is indicated if precipitating
stressors are present.
Supportive psychotherapy is initiated
after psychosis has resolved.
 SCHIZOPHRENIFORM DISORDER


Patients with Schizophreniform disorder meet full criteria
for schizophrenia, but the duration of illness is between
one to six months.
DSM-5 Diagnostic Criteria for Schizophreniform Disorder:
A. The following criteria for schizophrenia must be met:
1. Two or more symptoms for one month. Symptoms may
include: delusions, hallucinations, disorganized speech,
grossly disorganized or catatonic behavior, or negative
symptoms.
2. Schizoaffective disorder and mood disorder with
psychotic features must be excluded.
3. Substance-induced symptoms or symptoms from a
general medical condition have been ruled out.
4. Symptomatology must last for at least one month, but
less than six months.
CLINICAL FEATURES OF SCHIZOPHRENIFORM
DISORDER:

A. Symptomatology, including positive and negative

psychotic features, is the same as schizophrenia.
B. Social and occupational functioning may or may not be
impaired.

Epidemiology of Schizophreniform Disorder:

A. Lifetime prevalence of Schizophreniform disorder is
approximately 0.2%.
B. Prevalence is the same in males and females.
C. Depressive symptoms commonly coexist and are
associated with an increased suicide risk.
CLASSIFICATION OF SCHIZOPHRENIFORM DISORDER:

A. Schizophreniform disorder with good prognostic

features:
1. Onset of psychosis occurs within four weeks of
behavioral change.
2. Confusion often present at peak of psychosis.
3. Good premorbid social and occupational functioning.
4. Lack of blunted or flat affect.
B. Schizophreniform disorder without good prognostic
features: is characterized by the absence of above
features.
DIFFERENTIAL DIAGNOSIS OF SCHIZOPHRENIFORM
DISORDER:

A. The differential diagnosis for Schizophreniform

disorder is the same as for schizophrenia and includes
psychotic disorder due to a general medical condition,
delirium, or dementia.
B. Substance abuse, medication or toxic substances may
cause symptoms that are similar to schizoaffective
disorder.
C. Concomitant use of drugs that can cause or
exacerbate psychosis, such as amphetamines, may
complicate the diagnostic process.
TREATMENT OF SCHIZOPHRENIFORM DISORDER:

A. Antipsychotic medication in conjunction with

supportive psychotherapy is the primary treatment.
B. Hospitalization may be required if the patient is unable
to care for himself or if suicidal or homicidal ideation is
present.
C. Depressive symptoms may require antidepressants or
mood stabilizers.
D. Early and aggressive treatment is associated with a
better prognosis.
 DELUSIONAL DISORDER


Delusional disorder is characterized by the presence of
irrational, untrue beliefs.
DSM-5 Diagnostic Criteria for Delusional Disorder:
A. The presence of one or more delusions have lasted
for at least one month.
B. This disorder is characterized by the absence of
hallucinations, disorganized speech, grossly
disorganized or catatonic behavior, or negative
symptoms of schizophrenia (tactile or olfactory
hallucinations may be present if related to the
delusional theme).
C. Behavior and functioning are not significantly bizarre
or impaired.
D. If mood episodes have occurred, the total duration of
mood pathology is brief compared to the duration of
the delusions.
CLINICAL FEATURES OF DELUSIONAL DISORDER:

A. The presence of a delusion is the cardinal feature of this
disorder. The delusion can be plausible, such as believing
that someone is trying to harm them or even bizarre.
B. Patient’s thought processes and thought content are
normal except when discussing the specific delusion.
C. Hallucinations are not prominent unless delusional
disorder is of the somatic type. Cognition and Sensorium
are intact.
D. There is generally no disturbance of thought processes,
such as loosening of associations or tangentiality.
E. The insight of patients into their illness is generally poor,
and this disorder may cause significant impairment in
social and occupational functioning.
Epidemiology of Delusional Disorder:

A. Delusional disorder is uncommon, with prevalence of

0.03%.

B. Mean age of onset is generally from 35 – 45 years;

however, age of onset is highly variable. The incidence
in males and females appears equal.
CLASSIFICATION OF DELUSIONAL DISORDER:


A. Persecutory type:
It involves delusions that the individual is being harassed.
B. Somatic type: Involves delusions of a physical deficit
or medical condition.
C. Erotomanic type: Involves delusions that another
person is in love with the patient.
D. Grandiose type: Involves delusions of exaggerated
power, wealth, knowledge, identity or relationship to a
famous person or religious figure.
E. Jealous type: Involves delusions that an individual's
partner is unfaithful.
F. Mixed type: Involves delusions of at least two of the
above without a predominate theme.
G. Bizarre type.
DIFFERENTIAL DIAGNOSIS OF DELUSIONAL DISORDER:

A. Schizophrenia/Schizophreniform Disorder: Delusional disorder
is distinguished from these disorders by a lack of other positive
or negative symptoms of psychosis.
B. Substance-Induced Psychotic Disorder:
1. Symptoms may be identical to delusional disorder if the patient
has ingested amphetamines or cocaine.
2. Substance abuse should be excluded by history and toxicology.
C. Psychotic Disorder Due to a General Medical Condition:
1. Simple delusions of a persecutory or somatic nature are often
present in delirium or dementia.
2. Cognitive exam, history and physical examination can usually
distinguish these conditions.
D. Mood Disorders with Psychotic Features: Although mood
symptoms and delusions may be present in both disorders,
patients with delusional disorder do not meet full criteria for a
mood episode and the duration of mood symptoms is brief
compared to delusional symptoms.
Treatment of Delusional Disorder:

A. Delusional disorders are often refractory to

antipsychotic medication.
B. Psychotherapy, including family or couples therapy,
may offer some benefit.
 SCHIZOAFFECTIVE DISORDER


DSM-5 Diagnostic Criteria:
A. Schizoaffective disorder is an uninterrupted period of
illness, which meets the criteria for a major depressive
episode, manic episode, or mixed episode.
B. The illness must also be associated with delusions or
hallucinations for two or more weeks, without significant
mood symptoms.
C. Mood symptoms must be present for a significant
portion of the illness.
D. A general medical condition or substance use
is not the cause of symptoms.
CLINICAL FEATURES OF SCHIZOAFFECTIVE DISORDER:

A. Symptoms of schizophrenia are present, but the

symptoms are also associated with recurrent or
chronic mood disturbances.
B. Psychotic symptoms and mood symptoms may
occur independently or together.
C. If manic or mixed symptoms occur, they must be
present for one week, and major depressive
symptoms must be present for two weeks.
Epidemiology of Schizoaffective Disorder:
A. The lifetime prevalence is under one percent.
B. First-degree biological relatives of schizoaffective
disorder patients have an increased risk of
schizophrenia as well as mood disorders.

Classification of Schizoaffective Disorder:

A. Bipolar Type: Diagnosed when a manic or mixed
episode occurs with psychotic features. Major
depression may also occur.
B. Depressive type: Diagnosed if only major depressive
episodes occur.
DIFFERENTIAL DIAGNOSIS OF SCHIZOAFFECTIVE DISORDER:


A. Schizophrenia: In schizophrenia, mood symptoms are
relatively brief in relation to psychotic symptoms. Mood
symptoms usually do not meet the full criteria for major
depressive or manic episodes.
B. Mood disorder with psychotic features:
In mood disorder with psychotic features, the psychotic
features occur only in the presence of a major mood
disturbance.
C. Delusional Disorder. Depressive symptoms can occur
in delusional disorders, but psychotic symptoms of a
delusional disorder are non-bizarre compared to
schizoaffective disorder.
D. Substance-Induced Psychotic Disorder:
Psychotic and mood symptoms of schizoaffective
disorder can also be mimicked by street drugs,
medications, or toxins.
E. Psychotic disorder due to a general medical condition,
delirium, or dementia: should be ruled out by medical
TREATMENT OF SCHIZOAFFECTIVE DISORDER:

A. Psychotic symptoms are treated with antipsychotic
agents.
B. The depressed phase of schizoaffective disorder is
treated with antidepressant medications.
C. For bipolar type, mood stabilizers (e.g. lithium,
valproate or carbamazepine) are used alone or in
combination with antipsychotics.
D. Electroconvulsive therapy may be necessary for
severe depression or mania.
E. Hospitalization and supportive psychotherapy may be
required.
SUBSTANCE/ MEDICATION INDUCED PSYCHOTIC
DISORDER
There is evidence from the History, Physical examination, or
laboratory findings of both:
1. The symptom developed during or soon after substance
intoxication. Withdrawal or after exposure to a
medication.
2. The involved substance/ Medication is capable of
producing the symptom.
PSYCHOTIC DISORDER DUE TO GMC
 CATATONIA
Can occur in the context of several disorders.
DSM-5 Diagnostic Criteria:
The clinical picture is dominated by 3 or more of the
following symptoms:
 Stupor:

 Catalepsy:

 Waxy flexibility:

 Mutism:

 Negativism:

 Posturing:

 Mannerism:
 Stereotypy:
 Agitation:
 Grimacing:
 Echolalia:
 Echopraxia:
THANK YOU !