Schizophrenia Sepectrum And Other Psychotic Disorders

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Schizophrenia: Criteria

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Several disorders are contained within the classification of schizophrenia and other psychotic disorders, as follows: schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional 78 disorder, brief psychotic disorder, shared psychotic disorder, psychotic disorder due to another medical condition, substance-induced psychotic disorder and psychotic disorder not otherwise specified (APA, 2000).

Schizophrenia spectrum is defined by abnormalities in delusions, hallucinations, disorganized thinking (speech), grossly disorganized or abnormal motor behaviors (catatonia) and negative symptoms.

Psychosis is manifested by perceptual distortions, delusions, or hallucinations. Auditory are more common than visual, tactile, or olfactory. Psychotic symptoms also may include disorganized speech and behavior. Each of the psychotic disorders is characterized by varying etiological, age of onset, duration and symptomatic characteristics.

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Schizophrenia: SX types

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positive and negative.

Positive symptoms include the two most obvious signs of psychosis: 1. Hallucinations, most commonly auditory, i.e., hearing voices, noises, or music; visual, i.e., persons, lights, or things; and less frequently olfactory, gustatory, or tactile; and

2. Delusions, fixed false ideas, i.e., somatic, grandiose, religious, nihilistic, or persecutory.

Negative symptoms are less obvious and resemble depression, yet they also can impair normal functioning because of avolition (loss of will), limited range of affect, anhedonia (loss of pleasure), or alogia (diminished cognitive capacity and fluency and content of speech).

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Schizophrenia: Instrumentation

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Instrumentation:

1. Schedule for Affective Disorders and Schizophrenia

2. Brief Psychiatric Rating Scale (BPRS)

3. Repeatable Battery for the Assessment of Neuropsychological Status

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Schizophrenia: Treatment

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To be truly effective, caregivers for clients with schizophrenia must communicate clearly and simply. When clients seem to be hallucinating, caregivers should redirect them to concrete tasks.

Supportive therapy (confrontation should be avoided)

Enhancing social support through affect recognition - addressing the failure of individuals with schizophrenia to recognize emotional cues necessary for interpersonal relationships.

Training in emotion recognition using the micro-expression training tool has been shown to be useful

Pharmacotherapy provides improvements in acute and chronic

atypical antipsychotic medications prescribed at the most effective dose can control positive symptoms such as hallucinations and delusions and abate or reduce the severity of negative symptoms such as anhedonia, depression, and detached emotional responsivity and generally have fewer side-effects when prescribed and monitored

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Catonia Associated with Another Mental Disorder (Catatonia Specifier)

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Catatonia can be a specifier for depressive, bipolar, and psychotic disorders.

distinguishing features of catatonic specifier are psychomotor disturbances that may involve immobility or excessive mobility, peculiar movements, catalepsy, stupor, waxy flexibility, extreme negativism, agitation, stereotypy, mannerism, posturing, mutism, echolalia, or echopraxia.

Many catatonics alternate between periods of immobility and heightened motor activity

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Delusional Disorder Def

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consist of delusions of grandiosity, eroticism, jealousy, somatic, mixed type, and unspecified type which are different from delusions associated with either a mood disorder or schizophrenia. The assessor is to specify if the delusion is with bizarre content. These delusions are often not bizarre in nature as are commonly found in schizophrenic patients (i.e., being followed by the FBI or being controlled by extraterrestrials). These individuals also lack other schizophrenic symptoms, such as hallucinations, flat affect, and other aspects of thought disorder. Paranoia may also be found in other mental states such as dementia or delirium.

Many clients with delusional disorder are socially isolated and may develop a profound distrust of others. They typically use denial to avoid awareness of painful reality or their own feelings of anger and hostility, tending rather to project their resentment and anger onto someone else.

Psychosocial functioning of individuals suffering from delusional disorder is not generally impaired aside from the direct impact of the delusion.

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Delusional Disorder: Specifiers

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jealous type may be most common. T

erotomanic (central theme that another person is in love with the individual),

grandiose (the conviction of having some great but unrecognized talent),

jealous (the perception that one’s spouse is unfaithful, derived from incorrect inferences serving as “evidence”),

persecutory (perception that one is being conspired against),

somatic (involves bodily functions or sensations), mixed (no one theme predominates)

mixed and unspecified (type cannot be identified).

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Delusional Disorder: Treatment

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Relatively little is known about the treatment of delusional disorder;

clients usually deny they have a problem and are difficult to keep in treatment

Supportive counseling or therapy is the mainstay. The clinician must attempt to develop a trusting relationship. During assessment of the delusions, be sensitive to the degree in which the client’s core delusions will be met with a wall of negativism, skepticism, denial, and projection

Treatment for delusional disorders is hospitalization to rule out any medical related causes.

In addition, a neurological assessment may be necessary for explanations for the admitting causes

Medication may be helpful if the patients are willing to take it.