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Schizophrenia Spectrum Disorder


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Angela Soto


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How are Schizophrenia spectrum disorders defined?
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Defined by 5 Domains. Delusions, Hallucinations, Disorganized thinking (speech), Grossly disorganized or Abnormal behavior including catatonia and Negative sx

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Schizophrenia Spectrum Disorder - Details

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How are Schizophrenia spectrum disorders defined?
Defined by 5 Domains. Delusions, Hallucinations, Disorganized thinking (speech), Grossly disorganized or Abnormal behavior including catatonia and Negative sx
What are delusions?
Fixed beliefs that are not amenable to change in light of conflicting evidence.
What are common themes of delusions?
Persecutory, referential, somatic, religious, grandiose
What are PERSECUTORY delusions?
Belief that one is going to be harmed, harassed, and so forth by an individual or other group
What are REFERENTIAL delusions?
Belief that certain gestures, comments, environmental cues, and so forth are directed at oneself
What are GRANDIOSE delusions?
When an individual believes he or she has exceptional abilities, wealth, or fame
What are EROTOMANIC delusions?
When an individual believes falsely that another person is in love with him or her.
What are NIHILISTIC delusions?
Involve the conviction that a major catastrophe will occur.
What are SOMATIC delusions?
Focus on preoccupations regarding health and organ function
When are delusions deemed BIZARRE? (Loss of control over mind)
If they are clearly implausible and no understandable to same to same culture peers and do not derive form ordinary life experiences (i.e. outside force removes organs and no visible wounds..)
What is an example of a NONBIZARRE delusion?
An example is that one is under surveillance by the police, despite a lack of convincing evidence
What are examples of delusions that express loss of control over mind?
I.e. Though withdrawal, thought insertion, delusions of control (DSM 5 p. 87)
What is the distinction between a DELUSION and STRONGLY HELD IDEA?
Depends in part on the degree of conviction with which the belief is held despite clear or reasonable contradictory evidence.
What is a hallucination?
Perception-like experience that occur without an external stimulus with vivid and full force of normal perceptions.
How DO hallucinations occur?
In any sensory modality, but auditory hallucinations are the most common in schizophrenia and related disorders.
How do AUDITORY hallucinations occur?
Usually experiences as voices, familiar or unfamiliar, that are perceived as distinct as individual thoughts.
How do HYPNAGOGIC and HYPNOPMPIC hallucinations occur?
HYPNAGOGIC occur while falling asleep and HYPNOPMPIC occurs while waking up- considered within normal range of experience.
What is disorganized thinking?
Aka Formal though disorder, inferred from individual speech.
What is derailment or loose association?
Answers may be obliquely related or completely unrelated (tangentiality)
What is INCOHERANCE?
Rarely, speech can be so severely disorganized it can be nearly incomprehensible. "Word Salad"
When can LESS SEVERE disorganized thinking occur?
May occur during prodromal and residual periods of schizophrenia.
What is GROSSLY DISORGANIZED THINKING OR ABNORMAL MOTOR BEHAVIOR? Including CATATONIA?
May manifest in variety of ways incl. childlike "silliness" to unpredictable agitation, leading to difficulties performing activities of daily living (ADLs)
What is CATATONIC BEHAVIOR?
Marked decrease in reactivity to the environment
What is NEGATAVISM?
Resistance to instructions
What is MUTISM and STUPOR?
A complete lack of verbal and motor responses
What is CATATONIC EXCITEMENT?
Purposeless and excessive motor activity
What are some features of CATATONIA?
Stereotyped movements, staring, grimacing, mutism, and echoing of speech.
In which OTHER MENTAL HEALTH DISORDERS will CATATONIA appear?
Although historically linked with Schizophrenia, may occur in other mental health disorders such as Bipolar or Depressive Disorders with Catatonia and due to some medical conditions.
What are NEGATIVE SYMPTOMS?
Account for substantial portion of morbidity associated with Schizophrenia nut are less prominent in other disorders.
What are TWO NEGATIVE SX PROMINENT in Schizophrenia.
Diminished emotional expression and avolition
What is DIMINISHED EMOTIONAL EXPRESSION?
Reduction in expression of emotion 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
What is AVOLITION?
Decrease in motivated self-initiated purposeful activities. I.e.. ndiv may sit for long periods of time and show little interest in participating in motivated self-initiated purposeful activities.
What is ALOGIA?
Manifested by diminished speech output.
What is ANHEDONIA?
Decreased ability to experience pleasure from positive stimuli or a degradation in the recollection of pleasure previously experienced.
What is ASOCIALITY?
Apparent lack of interest in social interactions and MAY BE ASSOCIATED with avolition, BUT it can also be a manifestation of limited opportunities for social interactions.
How is Schizophrenia Spectrum and Psychotic Disorder Chapter organized?
Chapter is organized along a gradient of psychopathology
What should clinicians should first consider when diagnosing Schizophrenia or Psychotic Disorders
Should first condier conditions that that do not reach full criteria for a psychotic disorder or are limited to one domain of psychopathology, then consider time limited conditions, and requires exclusion of another condition.
What is Schizotypal Disorder?
Captures a pervasive pattern of social and interpersonal deficits, including reduced capacity for close relationships, cognitive/ perceptual distortions; eccentricities of behavior usually beginning by early adulthood.
What are two conditions defined by abnormalities limited to ONE DOMAIN of PSYCHOSIS
Either Delusions or Catatonia can be limited to one domain of psychosis.
What is DELUSIONAL DISORDER?
Is characterized by 1 month of delusions with no other symptoms
What is BRIEF PSYCHOTIC DISORDER?
Lasts more than a day and remits by 1 month
What is Schizophreniform Disorder?
Symptomatic presentation equivalent to schizophrenia except for duration of less than 6 mos.
How else can Psychotic disorders be induced?
May be induced by substance or medication induced
What happens during Medication of substance induced Psychotic Disorder?
Psychotic symptoms are judged to be a physiological consequence of drug abuse, medication, or toxic exposure and cease after removal of agent.
What happens in Psychotic disorder judged to be caused by a medical condition?
The psychotic sx are judged to be a direct physiological consequence of another medical condition
In which other disorders can Catatonia occur?
Can occur in Neurodevelopmental, psychotic, bipolar, depressive, and others. There are also "Catatonia Specifiers" to aide with differentiating.
Psychotic disorders are heterogenous, how we differentiate?
The severity of the sx can predict important aspects such as degree or neurobiological deficits.
What guides treatment in people with Psychosis?
The severity of mood symptoms in psychosis has prognostic value and guides treatment.
Where is Schizotypal disorder discussed in DSM?
Can be found in chapter "Personality Disorders" it is part of the schizophrenia spectrum of disorders
What is Delusional Disorder
The essential feature of delusional disorder is presence of one or more delusions that persist for at least one month.
What are some diagnostic criteria for delusional Disorder?
A. presence of 1 or more delusions over 1 mo. B. Criteria for Schizophrenia never met C. Functioning not markedly impaired, behave also not bizarre or odd. D. If manic or major depressive episodes have occurred, they have been brief relative to delusions E. Disturbance not attributed to physiological effect of substance or another medical condition.
Similarities to Schizophrenia
Review Erotomaniac, grandiose, Persecutory,
What are some associated features supporting diagnosis for schizophrenia?
May display inappropriate affect i.e. laughing in absence of an appropriate stimulus, a dysphoric mood which can take form of depression, anxiety, anger, disturbed sleep pattern, lack of eating or food refusal
What are functional consequences of Schizophrenia
Schizophrenia is associated with significant social and occupational dysfunction. Education progress and employment frequently impaired by avolition or other disorder manifestations.
Schizophrenia Differential Diagnosis: Major Depressive or Bipolar
The difference between Schizophrenia and other major depressive or bipolar disorder with psychotic features or one with catatonia depends on the temporal relationship between the mood disturbance and the psychosis and on the severity of the depressive or manic sx. This also depends if delusions or hallucinations occur within a major depressive or manic episode.
Schizoaffective Disorder
Dx requires that Major depressive or manic episode occurs occur concurrently with the active phase sx and that the mood symptoms be present for majority of the total duration of the active periods.