PSYCHOPATHOLOGY - SLK756

PSYCHOTIC DISORDERS
*Delusions
*Hallucinations
*Disorganised Thinking (Speech)
*Disorganised or Abnormal Motor Behaviour (Catatonia)
*Negative Symptoms

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.

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.

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.

(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.

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.

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.

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.

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.

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.