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24 Cards in this Set

  • Front
  • Back
Abnormalities in five domains
- Delusions
- Hallucinations
- Disorganized thinking
- Disorganized motor behaviour
- Negative sx
Delusions definition
Delusions are fixed beliefs that are not amenable to change in light of conflicting evidence.
Types of delusions
- Persecutory delusions: belief that one is going to be harmed, harassed, and so forth by an individual, organization, or other group.
- Referential delusions: belief that certain gestures, comments, environmental cues, and so forth are directed at oneself.
- Grandiose delusions: when an individual believes that he or she has exceptional abilities, wealth, or fame
- Erotomanie delusions: when an individual believes falsely that another person is in love with him or her
- Nihilistic delusions: involve the conviction that a major catastrophe will occur
- Somatic delusions: focus on preoccupations regarding health and organ function.
Bizarre delusions
Delusions are deemed bizarre if they are clearly implausible and not understandable to same-culture peers and do not derive from ordinary life experiences.
Hallucinations
- Hallucinations are perception-like experiences that occur without an external stimulus. They are vivid and clear, with the full force and impact of normal perceptions, and not under voluntary control.
- They may occur in any sensory modality, but auditory hallucinations are the most common.
Disorganized thought characteristics
- Loose associations
- Tangentiality: answers to questions may be obliquely related or completely unrelated
- Incoherence or word salad: incomprehensible speech
Catatonic behaviour
Catatonic behavior is a marked decrease in reactivity to the environment.
- Negativism: resistance to instructions
- maintaining a rigid, inappropriate or bizarre posture
- Mutism/stupor: lack of verbal and motor responses
- Catatonic excitementpurposeless and excessive motor activity without obvious cause
- Other features: repeated stereotyped movements, staring, grimacing, mutism, and echoing of speech.
Negative Symptoms
- Diminished emotional response: reductions in the expression of emotions in the face, eye contact, intonation of speech (prosody), and movements of the hand, head, and face that normally give an emotional emphasis to speech.
- Avolition: decrease in motivated self-initiated purposeful activities
- Alogia: diminished speech output
- Anhedonia
- Asociality
Delusional Disorder
A. 1+ delusion for 1mo+.
B. No criteria A for schizo.
Note: Hallucinations, if present, are not prominent and are related to the delusionè
C. Apart from the impact of the delusion, function is not impaired/behavior is not obviously bizarre or odd.
D. If manic or MDE occurred, brief relative to delusion.
E. Not attributable to a substance or an other medical condition and not better explained by another mental disorder: s.a. body dysmorphic disorder or obsessive-compulsive disorder.
Specify type, severity, if with bizzare content (if they are clearly implausible, not understandable, and not derived from ordinary life experiences)
Delusional disorder types
- Erotomanie type: another person is in love with the individual.
- Grandiose type: conviction of having some great (but unrecognized) talent or insight or having made some important discovery.
- Jeaious type: his or her spouse or lover is unfaithful.
- Persecutory type: belief that he or she is being conspired against, cheated, spied on, followed, poisoned or drugged, maliciously maligned, harassed, or obstructed in the pursuit of long-term goals.
- Somatic type: bodily functions or sensations.
- Mixed: no one delusional theme predominates.
- Unspecified type: dominant delusional belief cannot
be clearly determined or is not described in the specific types
Somatic Delusions Examples
Most common is the belief that the individual emits a foul odor; that there is an infestation of insects on or in the skin; that there is an internal parasite; that certain parts of the body are misshapen or ugly; or that parts of the body are not functioning
DDx of Delusional Disorder
- OCD and related disorders (body dysmorphic disorder)
- Delirium, major NCD, psychotic disorder due to another medical condition or substance-induced.
- Schizophrenia and schizophreniform disorder
- Depressive/bipolar and schizoaffective disorder
Brief Psychotic Disorder
A. 1+ sx. At least one of (1), (2), or (3):
1. Delusions.
2. Hallucinations.
3. Disorganized speech (derailment or incoherence).
4. Disorganized or catatonic behavior.
Note: Do not include sanctioned response.
B. >1day <1mo, w/ full return to premorbid level of fnct.
C. Not better explained by MDD or bipolar w/
psychotic feat. or another psychotic disorder (schizophrenia, catatonia), and not attributable to physiological effects of substance or medical condition.
Specify severity and if: w/ or w/o marked stressors, postpartum (4w), catatonia
DDx of Brief Psychotic Disorder
- Other medical conditions
- Substance- related disorders
- Depressive and bipolar disorders
- Other psychotic disorders
- Malingering and factitious disorders
- Personality disorders:
Schizophreniform disorder
A. 2+ sx for 1mo period. At least one of (1), (2), or (3):
1. Delusions.
2. Hallucinations.
3. Disorganized speech (derailment or incoherence).
4. Grossly disorganized or catatonic behavior.
5. Neg. sx (diminished emo. expression or avolition)
B. >1mo <6mo
C. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either 1) no MDE or manic episodes w/ active-phase sx, or 2) if mood episodes have occurred: present for a min. of the total duration of the illness.
D. Not attributable to the physiological effects of a substance or another medical condition.
Specify severity; if w/catatonia and w/ or w/o good prog. features
DDx of schizophreniform disorder
Other mental disorders and medical conditions incl.
- psychotic disorder and delirium (due to something or not)
- NCD
- depressive or bipolar disorder w/ psychotic features;
- schizoaffective disorder;
- bipolar or depressive (w/ catatonic features)
- schizophrenia
- brief psychotic disorder
- delusional disorder
- schizophrenia spectrum and other psychotic disorder
- schizotypal, schizoid, or paranoid personality
- autism spectrum disorder
- Other: ADHD, OCD, PTSD, TBI
Schizophrenia
A. 2+ for 1mo, with at least (1 ), (2), or (3):
1. Delusions.
2. Hallucinations.
3. Disorganized speech (derailment or incoherence).
4. Grossly disorganized or catatonic behavior.
5. Neg sx (diminished emo.expression or avolition)
B. Level of fnct in 1+ major areas (work, relations, or self-care), ibelow the level prior to the onset.
C. 6mo+ w/ 1 month of sx (less if successfully treated) +/- prodromal or residual period
D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either 1) no MDE or manic episodes w/ sx or 2) if mood episodes occurred present for a min. time.
E. Not attributable to the a substance or another medical condition.
F. If there is a history of ASD or comm disorder, dx of schizo only if prominent delusions/hallucinations, 1mo+
Prodromal and residual sx of schizophrenia
- Mild or subthreshold hallucinations or delusions.
- Unusual/odd beliefs that are not of delusional proportions (e.g., ideas of reference, magical thinking);
- Unusual perceptual experiences
- Speech may be generally understandable but vague;
- Behavior may be unusual but not grossly disorganized (e.g., mumbling in public).
- Negative sx
- Individuals who had been socially active may become withdrawn from previous routines.
DDx of schizophrenia
- Major depressive or bipolar disorder with psychotic or catatonic features
- Schizoaffective disorder
- Schizophreniform disorder and brief psychotic disorder
- Delusional disorder
- Schizotypal personality disorder
- OCD and body dysmorphic disorder
- PTSD
- ASD or comm disorders
- Other mental disorders associated with a psychotic episode
Comorbidities of schizophrenia
- >50% tobacco use disorder
- Anxiety disorder
- OCD
- Panic disorder
- Schizotypal or paranoid personality disorder may sometimes precede the onset of schizophrenia
- Other medical conditions: weight gain, diabetes, metabolic syndrome, and cardiovascular and pulmonary disease
Schizoaffective Disorder
A. Uninterrupted period of illness during w/ major mood episode (depressive or manic) + Criterion A of schizophrenia.
Note: MDE must include Criterion A1: depressed mood.
B. Delusions or hallucinations for 2+ weeks w/o major mood episode during lifetime duration of the illness.
C. Sx that meet criteria for a MME are present for the majority of time of illness.
D. Not attributable to the effects of a substance or another medical condition.
Specify severity, if bipolar or depressive type, w/ catatonia
DDX of schizoaffective disorder
- Other mental disorders and medical conditions.
- Psychotic disorder due to another medical condition.
- Schizophrenia, bipolar, and depressive disorders
Comorbidities of schizoaffective disorder
- substance use
- anxiety
Catatonia due to another mental disorder or medical condition
1. Stupor (i.e., no psychomotor activity).
2. Catalepsy (i.e., passive induction of a posture held against gravity).
3. Waxy flexibility (i.e., slight, even resistance to positioning by examiner).
4. Mutism (i.e., no, or very little, verbal response).
5. Negativism (i.e., opposition or no response to instructions or external stimuli).
6. Posturing (i.e., spontaneous and active maintenance of a posture against gravity).
7. Mannerism (i.e., odd, circumstantial caricature of normal actions).
8. Stereotypy (i.e., repetitive, abnormally frequent, non-goal-directed movements).
9. Agitation, not influenced by external stimuli.
10. Grimacing.
11. Echolalia (i.e., mimicking another’s speech).
12. Echopraxia (i.e., mimicking another’s movement)