|
 Schizophrenia
 Schizophreniform
Disorder
 Schizoaffective
Disorder
 Delusional
Disorder
Brief
Psychotic Disorder
An overview: psychotic disorders are
still quite often misunderstood by individuals not involved in the
care of such patients or not personally exposed to patients with the
disorders. Psychotic disorders are chracterized by a difficulty with
reality testing - differentiating what is real from what is imagined,
and the disorders may be characterized by false belief systems
referred to as delusions and often by auditory and/or visual
hallucinations. The individuals capacity to deal with their work is
severely impaired during the occurrence of their disorders. While
extreme environmental situations may produce psychotic symptoms, it is
generally accepted that many of the psychotic disorders are
attributable to a defect in brain chemistry and the way in which the
brain processes its electrochemical impulses.
Schizophrenia
- have two or more of the following symptoms for a significant period
of time during a one month period. These include delusions or false
beliefs that govern their decision making, hallucinations which are
faulty sensory perceptions such as seeing, hearing (etc) stimuli that
exist only in their fantasy, disorganized speech which is difficult to
comprehend, chaotic or catatonic behavior and/or negative symptoms
such as blunting of their emotional expression. Social and
occupational functioning is severely impaired as may be their capacity
for self-care. The symptoms are not due to a medical disorder, and the
symptoms are not due primarily to a mood disorder.
There are chiefly five subtypes of
schizophrenia:
1. Paranoid Type: preoccupation with delusions (false beliefs) or
auditory hallucinations (perception of hearing voices which can be
condemning or commanding).
2. Disorganized Type: disorganized speech, behavior and flat (blunt)
affect (emotional expression) or inappropriate (to the context)
emotional expression.
3. Catatonic Type: (can include) motoric immobility (statue like body
position), stupor or cataplexy (patient can be put into position which
they then maintain), or excessive agitation and without purpose,
mutisim and/or negativism (refusing to respond to commands), peculiar
voluntary body movements or grimacing, echolalia/echopraxia (repeating
that which is said)
4. Undifferentiated Type: none of the symptoms are sufficient to be
assigned exclusively to the first three types listed above, yet the
patient meets the criteria for schizophrenia
5. Residual Type: an absence of paranoid, disorganized or catatonic
symptoms but continuing evidence of schizophrenia by the presence of
negative symptoms and often accompanied by odd beliefs and unusual
perceptual experiences.
There are specifiers used after the
patient has had symptoms of schizophrenia for at least one year after
the onset of active-phase symptoms. These are described as episodice
with interepisode residual symptoms when there are significant
residual symptoms even between the episodes of schizophrenia. This can
be further refined to prominent negative symptoms if the symptoms
between episodes are negative. There is a specifier for no
interepisode residual symptoms. A patient can have continuous symptoms
or sontinuous symptoms with prominent negative symptoms. Or the
patient may have a single schizophrenic episode in partial remission
and with prominewnt negative symptoms. A patient can also have a
single schizophrenic episode which is in full remission.
Schizophreniform
Disorder is characterized by symptoms lasting at least a
month but less than six months. The symptoms are identical (delusions,
hallucinations, disorganized speech, disorganized behavior and
negative symptoms). Like schizophrenia, one must be certain that the
disorder is not due to a medical condition or drugs and that it is not
part of a schizoaffective disorder. Schizophreniform Disorder is often
accompanied by the specifier of having good prognostic features or
without good prognostic features. Good prognosis is characterized by
absence of the previously discussed flat/blunt emotions, having
previously good social and occupational functioning,
confusion/perplexity associated with the height of the episode, and
onset of psychotic symptoms within the first four weeks of initial
symptoms. Thus, good prognosis is often associated with the
acute/suddenness of the onset.
Schizoaffective
disorder is diagnosed when there has been an
uninterrupted period of symptoms of schizophrenia which, as noted, may
include delusions, hallucinations, disorganization of speech,
disorganized or catatonic behavior and negative symptoms such as
(affective flattening) blunted emotional expression. The patient
displays these symptoms along with mood symptoms of a major depressive
episode, a manic episode or a mixed episode and that during the period
of the illness the patient has experienced delusions or hallucinations
in the absence of these prominent mood symptoms. As with all
schizophrenic and other psychotic disorders, it is imperative to be
certain that these symptoms are not related to medication intake, drug
abuse, or a physical disorder. And in schizoaffective disorder, there
is a further subdivision of Bipolar and Depressive Types. The mood
episode of the disorder are present for a substantial period of the
active and residual periods of the illness.
Delusional
Disorder involves potentially real life situations that
are, however, unreal in the life of the patient. Thus, a person may,
indeed, be poisoned, famous or followed, but this is not reality for
the patient. These patients are not odd, eccentric or bizarre as we
see in schizophrenia but instead falsely believe that important people
are in love with them (Erotomanic Type) or that they (the patients)
themselves are powerful, knowledgeable, or wealthy (Grandiose Type),
that the person is being malevolently treated (Persecutory Type), that
their sexual partner is unfaithful (Jealous Type), that they have a
physical defect or medical condition (Somatic Type) or that they have
symptoms of two or more of these subtypes (Mixed Type). Outside of
their delusional beliefs, the individual may have an overall
appearance of being functional with minimal impairment.
Brief
Psychotic Disorder refers to symptoms lasting at least
one day, but less than one month, and may include delusions,
hallucinations, disorganized speech and either disorganized or
catatonic behavior. This needs to be differentiatef from those who
have a mood disorder such as major depressive disorder or bipolar
disorder which sometimes presents with psychotic symptoms. A brief
psychotic disorder may arise within four weeks of childbirth or caused
by marked psychological stressors or can occur in the absence of a
stressor. It is important to validate that this is not the result of a
physical condition or substance use.
In Shared
Psychotic Disorder (also called Folie a Deux) a delusion
or false belief system develops in an individual who is closely
involved with another individual who is demonstrably delusional. The
second individual's delusion is similar, if not identical, to that of
the individual with whom they are involved. They essentially share the
same delusional system. This can apply to couples, and it can apply to
groups of individuals. This must be differentiated from those who are
abusing similar psychoactive substances and.or who were, for example,
schizophrenic before entering the relationship with the delusional
individual.
Psychotic
Disorders Due to [specific general medical condition] are
characterized by hallucinations or delusions and can be the result of
metabolic, neoplastic, or structural accident of the either the
central nervous system or organ systems which impact the nervous
system. History, laboratory findings and/or physical exam are used to
determine the medical condition giving rise to the symptoms, and,
ideally, a means of addressing the medical problem.
Substance-Induced
Psychotic Disorder can occur With Onset During Intoxication by
the drug or With Onset During Withdrawal from the drug. The symptoms
occur within a month of the intoxication or withdrawal, and drug (and
not a disease process) must be known to be the cause of the symptoms.
Many drugs are capable of producing hallucinations and/or delusions
when initiated or withdrawn. These include alcohol, amphetamines,
cocaine, inhalants, sedatives, hypnotics (sleep agents), anxiolytics
("minor tranquilizers") and numerous other compounds.
|
