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Flashcards by Mione Labuschagne, updated more than 1 year ago
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Created by Mione Labuschagne
over 9 years ago
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| Question | Answer |
| PSYCHOTIC DISORDERS *Delusions *Hallucinations *Disorganised Thinking (Speech) *Disorganised or Abnormal Motor Behaviour (Catatonia) *Negative Symptoms | DELUSIONS: fixed beliefs; not amenable to change in conflicting evidence. Themes: ~Persecutory - belief going to be harmed, harassed, by an individual, organisation or other group. ~Referential - belief that certain gestures, comments, environmental cues, directed at oneself. ~Grandiose - individual believes has exceptional abilities, wealth or fame. ~Erotomanic - individual believes falsely another is in love with him/her. ~Nihilistic - involve conviction that major catastrophe will occur. ~Somatic - preoccupations regarding health and organ function. Delusions: bizarre, implausible, not understandable, do not derive from ordinary life experiences. Delusions: express a loss of control over mind or body - thought withdrawal; thought insertion; delusions of control. |
| HALLUCINATIONS: Perception-like experiences, occur without external stimulus. Vivid, clear, full force, impact normal perceptions & not under voluntary control. Occur in - Sensory modality & Auditory: most common in Schizophrenia and related. Experienced as voices, familiar or unfamiliar; distinct from own thoughts. Hallucinations occur in clear context: HYPNAGOGIC - occur falling asleep or waking up. HYPNOPOMPIC - within a range of normal experiences. Hallucinations may be normal part of religious experiences in some cultures. | DISORGANISED THINKING: Individuals speech; switch from one topic to another (derailment or loose associations). Answers to questions obliquely related or unrelated (tangentiality). Speech may be severely disorganised, incomprehensible, resembles receptive aphasia ("word salad"). Substantially impair effective communication. - Less severe disorganised thinking or speech occur during prodromal & residual periods of schizophrenia. |
| GROSSLY DISORGANISED OR ABNORMAL MOTOR BEHAVIOUR (INCLUDING CATATONIA): Ranging from childlike 'silliness' to unpredictable agitation. Problems in any form of goal-directed behaviour, leading to difficulties in performing daily activities. CATATONIC: decrease in reactivity to environment. Ranges from resistance to instructions (negativism); maintaining rigid, inappropriate or bizarre posture; to complete lack of verbal & motor responses (mutism & stupor). Include purposeless & excessive motor activity without obvious cause (catatonic excitement). Other features: stereotyped movements, staring, grimacing, mutism and echoing of speech. May occur in other mental disorders. | NEGATIVE SYMPTOMS: Morbidity associated with schizophrenia but less prominent in other psychotic disorders. Two symptoms prominent in schizophrenia: diminished emotional expression & avolition. ~Diminished emotional expression - reductions in expression of emotions in face, eye contact, intonation of speech, movements of hands, head and face that normally give emotional emphasis to speech. ~Avolition - decrease in motivated self-initiated purposeful activities. Other Negative Symptoms: ~Alogia - diminished speech output. ~Anhedonia - decreased ability to experience pleasure from positive stimuli. ~Asociality - lack of interest in social interactions; associated with avolition, but may be manifestation of limited opportunities for social interactions. |
| DELUSIONAL DISORDER Diagnostic Criteria: A. Presence of one (or more) delusions - Duration: 1 month or longer. B. Criterion A for schizophrenia never been met. NOTE: Hallucinations- not prominent & are related to delusional theme. C. Apart from delusions - functioning is NOT markedly impaired & behaviour is NOT obviously bizarre or odd. D. If manic or major depressive episodes occurred - been brief relative to duration of delusional periods. E. Disturbance is NOT attributable to physiological effects of substance or another medical condition. - NOT better explained by another mental disorder as body dysmorphic or obsessive-compulsive disorder. | SUBTYPES SPECIFY Whether: Central theme of the delusion *Erotomanic type - another person is in love with individual. *Grandiose Type - conviction of having some great (unrecognised) talent or insight or having made some important discovery. *Jealous type - individual's delusion that his/her spouse or lover is unfaithful. *Persecutory type - individuals belief of being conspired against, cheated, spied on, followed, poisoned or drugged, harassed, or obstructed in pursuit of long-term goals. *Somatic type - delusion involves bodily functions or sensations. *Mixed type - applies when NO ONE delusional theme predominates. Unspecified type - dominant delusional belief CANNOT be clearly determined or is NOT described in the specific types. |
| (delusional disorder...part 2) SPECIFY IF: *Mixed bizarre content - Delusions are deemed bizarre if clearly implausible, NOT understandable, & NOT derived from ordinary life experiences. SPECIFY IF: Course Specifiers only used AFTER 1 YEAR DURATION: *First episode in ACUTE Episode - time period in which symptom criteria are FULFILLED. *First episode in PARTIAL Remission - time period during which an improvement AFTER a previous episode is maintained & defining criteria only PARTLY FULFILLED. *First episode in FULL Remission - period of time AFTER a previous episode during which NO disorder-specific symptoms are present. *Multiple episodes, currently in acute episode. *Multiple episodes, currently in partial remission. *Multiple episodes, currently in full remission. | (delusional disorder...part 3) CONTINUOUS: Symptoms fulfilling diagnostic symptom criteria are remaining for majority of the illness course, with subthreshold symptom periods being very brief relative to the overall course. UNSPECIFIED. SPECIFY CURRENT SEVERITY: Severity is rated by quantitative assessment of PRIMARY symptoms of psychosis, including - delusions, hallucinations, disorganised speech, abnormal psychomotor behaviour & negative symptoms. NOTE: Diagnosis of delusional disorder can be made WITHOUT using this severity specifier. |
| DIAGNOSTIC FEATURES (pg92 delusional disorder) *CRITERION A: Presence of 1 or more delusions persists for at least 1 month. *CRITERION B: A diagnosis is NOT given if individual has ever had a symptom presentation that met Criterion A for schizophrenia. *CRITERION C: Impairments in psychosocial functioning may be more circumscribed than those seen in other psychotic disorders, as schizophrenia & behaviour is NOT obviously bizarre or odd. *CRITERION D: If mood episodes occur concurrently with delusions, Total Duration of these MOOD episodes is BRIEF relative to total duration of delusional periods. *CRITERION E: Delusions are NOT attributable to physiological effects of a substance (e.g. cocaine) or another medical condition (e.g. Alzheimer's) & NOT better explained by another mental disorder (as body dysmorphic or obsessive-compulsive disorder). IN ADDITION: The assessment of cognition, depression & mania symptom domains is VITAL for making critically important distinctions between various schizophrenia spectrum & other psychotic disorders. | ASSOCIATED FEATURES (pg 92 delusional disorder) *Social, marital or work problems can result from delusional beliefs. *Individuals with this disorder may be able to factually describe that others view their beliefs as IRRATIONAL but UNABLE to accept this themselves i.e. may be 'factual insight' but no true insight). *Many develop IRRITABLE or DYSPHORIC MOOD - usually understood as a reaction to their delusional beliefs. *Anger & violent behaviour can occur with persecutory, jealous & erotomanic types. *May engage in litigious or antagonistic behaviour. Legal difficulties can occur, particularly in jealous & erotomanic types. |
| BRIEF PSYCHOTIC DISORDER DIAGNOSTIC CRITERIA: A. Presence of one or more of the following symptoms. At least one must be (1, 2 or 3): 1. DELUSIONS; 2. HALLUCINATIONS; 3. DISORGANISED SPEECH; 4. GROSSLY DISORGANISED OR CATATONIC BEHAVIOUR. NOTE: DO NOT include a symptom if it is a cultural response. B. DURATION of an episode of disturbance is at least 1 DAY but LESS than 1 MONTH - eventual FULL Return to PREMORBID level of functioning. C. Disturbance is NOT better explained by major depressive or bipolar disorder with psychotic features or another psychotic disorder (as schizophrenia or catatonia) & NOT attributable to physiological effects of a substance or another medical condition. | (Brief Psychotic Disorder...part 1) SPECIFY IF: *WITH marked stressor (brief reactive psychosis): if symptoms occur in response to events (singly or together), markedly stressful to almost anyone in SIMILAR circumstances in individual's culture. *WITHOUT marked stressor: if symptoms DO NOT OCCUR in response to events (singly or together), markedly stressful to almost anyone in similar circumstances in culture. *WITH POSTPARTUM ONSET: Onset is DURING pregnancy or within 4 WEEKS postpartum. SPECIFY IF: WITH CATATONIA SPECIFY CURRENT SEVERITY: Severity is rated by a quantitative assessment of primary symptoms of psychosis, including: delusions, hallucinations, disorganised speech, abnormal psychomotor behaviour & negative symptoms. Each symptom rated for its current severity (most severe in the last 7 days) on a 5-point scale. NOTE: Diagnosis of Brief Psychotic disorder can be made WITHOUT using this severity specifier. |
| DIAGNOSTIC FEATURES (Brief Psychotic Disorder) *CRITERION A - Essential Feature: disturbance that involves the SUDDEN ONSET of at least ONE of POSITIVE psychotic symptoms: delusions, hallucinations, disorganised speech, or grossly abnormal psychomotor behaviour, including catatonia. *CRITERION B - SUDDEN ONSET - change from a nonpsychotic state to a clearly psychotic state WITHIN 2 WEEKS, usually WITHOUT a prodrome. An Episode of disturbance LASTS AT LEAST 1 DAY but LESS than 1 MONTH & eventually a FULL RETURN to PREMORBID level of functioning. *CRITERION C - disturbance is NOT better explained by depressive or bipolar disorder with psychotic features (by schizoaffective disorder or schizophrenia) & NOT attributable physiological effects of a substance (e.g. hallucinogen) or another medical condition (e.g. subdural hematoma). IN ADDITION: the assessment of cognition, depression & mania symptom domains is VITAL for critically important distinctions between the various schizophrenia spectrum or other psychotic disorders. | ASSOCIATED FEATURES (Brief Psychotic Disorder) *Individuals typically experience emotional turmoil or overwhelming confusion. *RAPID shifts from one INTENSE affect to another. *Disturbance is BRIEF, LEVEL OF IMPAIRMENT may be SEVERE. *Supervision may be REQUIRED to ensure that nutritional & hygienic needs are met. Individual is protected from consequences of poor judgement, cognitive impairment or acting on basis of delusions. *Appears to be an INCREASED RISK of suicidal behaviour, particularly during ACUTE episode. |
| SCHIZOPHRENIFORM DISORDER DIAGNOSTIC CRITERIA A. TWO (or more), EACH PRESENT for significant portion of time DURING 1-MONTH (LESS if successfully treated). At least ONE of these must be (1, 2 or 3): 1. DELUSIONS; 2. HALLUCINATIONS; 3. DISORGANISED SPEECH; 4. GROSSLY DISORGANISED or CATATONIC BEHAVIOUR; 5. NEGATIVE SYMPTOMS. B. An episode lasts at least 1 MONTH but LESS than 6 MONTHS. When diagnosis must be made WITHOUT waiting for recovery, should be qualified as 'PROVISIONAL'. C. Schizoaffective disorder & depressive or bipolar disorder with psychotic features have been RULED OUT because - 1) NO major depressive or manic episodes have occurred concurrently with Active-phase symptoms or 2) if Mood episodes have occurred during active-phase symptoms, they have been present for MINORITY of Total Duration of ACTIVE & RESIDUAL periods of illness. D. Disturbance is NOT attributable to physiological effects of a substance or another medical condition. | (Schizophreniform Disorder...continued) SPECIFY IF: *WITH good prognostic features: Specifier requires presence of at least TWO features: Onset of prominent psychotic symptoms WITHIN 4 WEEKS of FIRST noticeable CHANGE in usual behaviour or functioning; & absence of blunted or flat affect. *WITHOUT good prognostic features: specifier is applied if TWO or MORE of the above features have NOT been present. SPECIFY IF: WITH Catatonia SPECIFY CURRENT SEVERITY: Severity is rated by a quantitative assessment of primary symptoms of psychosis, including: delusions, hallucinations, disorganised speech, abnormal psychomotor behaviour & negative symptoms. NOTE: Diagnosis of schizophreniform disorder can be made WITHOUT using this severity specifier. |
| DIAGNOSTIC FEATURES (pg97 schizophreniform disorder) *CRITERION A: Characteristic symptoms of schizophreniform are IDENTICAL to those of schizophrenia. *CRITERION B: Distinguished by its DIFFERENCE IN DURATION: total duration of illness, including prodromal, active & residual phases is at least 1 MONTH but LESS than 6 MONTHS. Duration requirement is INTERMEDIATE between 'brief psychotic disorder', which lasts MORE than 1 DAY & REMITS by 1MONTH. Schizophrenia lasts for at least 6 months. ~Diagnosis is made under two conditions: 1) when an episode of illness lasts between 1 & 6 months and individual has already recovered; 2) when an individual is symptomatic for LESS than the 6 months duration required for diagnosis of schizophrenia but has NOT YET recovered - diagnosis should be noted "schizophreniform disorder (provisional)"- uncertain if individual will recover from disturbance within 6-month period. If DISTURBANCE PERSISTS BEYOND 6months - DIAGNOSIS should be CHANGED to SCHIZOPHRENIA. ~ANOTHER feature is a LACK of CRITERION requiring impaired social & occupational functioning. | ASSOCIATED FEATURES (pg98 schizophreniform disorder) *Currently there are NO laboratory or psychometric tests for schizophreniform disorder. *There are MULTIPLE BRAIN regions where - neuroimaging, neuropathological & neurophysiological research indicated abnormalities. ~NONE are diagnostic. |
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