Other than primary psychotic disorders what other types of psychiatric illness often manifest psychotic symptoms

1. Brief psychotic disorder (<1 month of symptoms)

2. Schizophreniform disorder (1 to 6 months of symptoms)

3. Schizophrenia (>6 months of symptoms)

4. Schizoaffective disorder

5. Delusional disorder

6. Shared psychotic disorder

• Mood disorders: Major depression or manic episodes may include psychotic symptoms, but only during a mood disturbance.

• Substance use: Acute intoxication (especially with cocaine, lysergic acid diethylamide [LSD], phencyclidine [PCP], and amphetamines) or withdrawal (especially alcohol). Anytime a patient has tactile hallucinations, you should think about drugs.

• Personality disorders: May be associated with brief (not sustained) periods of psychosis.

• Cognitive disorders: Both delirium and dementia demonstrate psychosis. Often delirium will have visual hallucinations in addition to clouded sensorium.

• Psychosis due to a general medical conditions such as Vitamin B12 deficiency, Multiple Sclerosis (MS), Systemic Lupus Erythematosus (SLE), uremia, etc.

• Narcolepsy: May have hypnagogic and hypnopompic hallucinations.

Schizophrenia

Which of the primary psychotic disorders is the most common?

Schizophrenia. The incidence in the adult population is around 1%.

What are the DSM-IV-TR criteria for Schizophrenia?

Two or more characteristic symptoms:

• Hallucinations

• Disorganized speech

• Grossly disorganized behavior

• Negative symptoms

And social/occupational dysfunction And disturbance lasting 6+ months (including any prodrome or residual)

And not due to Schizoaffective disorder or General Medical Condition or substance use

What are negative symptoms?

What are considered the positive symptoms of schizophrenia?

Negative symptoms (think deficits) include affective flattening, alienation (social withdrawal), alogia (poverty of speech), and avolition (lack of motivation).

Usually this refers to the hallucinations, delusions, bizarre behavior, and thought disorder.

What is a "first-rank" symptom?

A particularly bizarre delusion, or hallucinations consisting of either a voice running commentary on the patient's activities or two voices conversing. A first-rank symptom may satisfy both symptom requirements of the DSM-IV-TR criteria above.

How does the criterion of disorganized speech, (also referred to as thought disorder) manifest in schizophrenia?

Abnormalities in thought processes and thought formation

Give at least two examples of abnormal • Word salad: Words and phrases are thought formation. combined together in incoherent manner.

• Neologisms: Creation of new words.

• Echolalia: Repeating the same word over and over (almost like a mental stutter).

• Loose associations: Illogical shifting between unrelated or obliquely related topics.

• Thought blocking.

• Circumstantial and tangential thought: Circumstantial thought eventually gets to the point; tangential never does.

Normal Circumstantial Tangential

What is meant by the prodromal and residual phases of schizophrenia?

How long must you have symptoms for before schizophrenia can be diagnosed?

These are periods of time before and after active psychotic periods, respectively. These periods are generally characterized by attenuated symptoms of the active phase, eg, social withdrawal, peculiar behavior, or odd affect.

During these periods a person would seem strange but would not necessarily meet criteria for psychotic.

At least 6 months including prodromal and residual phases, but they must have at least 1 month of active characteristic symptoms (above), as well as decline in function.

How does schizophreniform disorder differ from schizophrenia?

The duration is <6 months, but is at least 1 month. It also does not require a decline in function.

What would you call psychosis lasting <1 month?

Brief Psychotic Disorder (which lasts over 24 hours, but <1 month).

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