What are the diagnostic criteria for schizophreniform disorder?
Criteria A, D, and E of schizophrenia are met
An episode (including prodromal, active, and residual phases) lasts at least one month but less than six months. Diagnosis while still symptomatic must be "provisional."
Specify if "with good prognostic features" or "without good prognostic features."
What are the two differences between schizophrenia and schizophreniform disorder?
duration of schizophreniform disorder (all phases) is between one month and six months, and schizophrenia must continue for more than six months
impaired social or occupational functioning is not required for diagnosis
The duration for schizophreniform disorder lies between what two similar disorders?
brief psychotic disorder (one day to one month) and schizophrenia (more than six months)
Under what conditions would a schizophreniform diagnosis be given?
if someone had symptoms lasting 1-6 months but has already recovered
if someone is currently experiencing symptoms within the duration timeframe, they are considered "provisional" until symptoms persist for more than six months
To have schizophreniform disorder with good prognostic features, what is required?
Two or more of the following:
- onset of prominent psychotic symptoms within four weeks of first noticeable change in usual behavior or functioning
- confusion or perplexity at the height of psychotic episode
- good premorbid social and occupational functioning
- absence of blunted or flat affect
How many people will recover from their initial provisional diagnosis of schizophreniform disorder?
About one third. The rest will progress to diagnoses of schizophrenia or schizoaffective disorder.
What is the essential feature if schizoaffective disorder?
an uninterrupted period of illness during which, at some time, there is a major depressive, manic, or mixed episode concurrent with symptoms that meet criterion A for schizophrenia
In addition to a major depressive, manic, or mixed episode, what needs to be present for diagnosis of schizoaffective disorder?
delusions or hallucinations for at least two weeks in absence of prominent mood symptoms during the same period of illness
mood symptoms are present for a substantial portion of the total duration of the illness
symptoms not due to substance abuse or general medical condition
All four need to be present within single, uninterrupted period of illness (active or residual symptoms).
The phase of the illness with concurrent mood and psychotic symptoms is characterized by the full criteria being met for the active phases of ________, AND either _________, _________, or ________.
schizophrenia; major depressive episode; manic episode; mixed episode
How long must symptoms be present to be considered schizoaffective disorder?
Psychotic symptoms: at least one month, with hallucinations or delusions lasting at least two weeks
Major depressive episode (if present): at least two weeks
Manic or mixed episode (if present): at least one week
(either major depressive or manic/mixed episode must be present)
What is the typical symptom pattern for schizoaffective disorder?
pronounced auditory hallucinations or persecutory delusions for two months
psychotic symptoms and full major depressive episode together for three months
major depressive episode recovery, but psychotic episodes persist for one month
abatement of symptoms
If the total time psychotic symptoms are present is four years, and the total time mood symptoms are present is six weeks, can it be schizoaffective disorder?
Mood symptoms must be concurrently present for a substantial portion of the time that psychotic symptoms are present. (This example would be schizophrenia w/additional diagnosis of depressive disorder NOS)
What are the subtypes of schizoaffective disorder?
bipolar type and depressive type
What would constitute bipolar type schizoaffective disorder?
a manic or mixed episode as part of the symptom presentation (though major depressive episodes may also occur)
What would constitute depressive type schizoaffective disorder?
if only major depressive episodes are part of symptom presentation (manic/mixed can't be present)
What other features are common with schizoaffective disorder?
poor occupational functioning
difficulties with self-care
increased suicide risk
restricted range of social contact
increased risk for development of pure mood disorder
What other diagnoses might be confused with schizoaffective disorder?
mood disorder with psychotic features
psychotic disorder due to a general medical condition
substance-induced psychotic disorder
psychotic disorder NOS
What is the difference between schizoaffective disorder and schizophrenia?
In schizoaffective disorder, a mood episode must be concurrent with active schizophrenic symptoms, mood symptoms must be present for a significant portion of the total duration, and delusions or hallucinations must be present for two or more weeks without mood symptoms.
In schizophrenia, mood symptoms are brief (in relation to duration), do not meet full criteria for mood episodes, or occur only during prodromal or residual phases.
What is the essential feature of delusional disorder?
the presence of one or more nonbizarre delusions persisting for at least one month
In addition to nonbizarre delusions, what other features must be present in delusional disorder?
patient cannot have had symptoms meeting schizophrenia criterion A
Auditory or visual hallucinations must not be prominant, but tactile/olfactory hallucinations can be present if related to delusional theme
apart from impact of delusions/their ramifications, functioning not markedly impaired and behavior is not obviously odd or bizarre
duration of possible mood episodes are brief in relation to total duration of delusional periods
not due to direct effects of substances or general medical condition
How are delusions typically deemed "bizarre"?
not derived from ordinary life experiences
What are some examples of nonbizarre delusions?
being loved at a distance
being deceived by a spouse or lover
What are the seven subtypes of delusional disorder?
Explain the erotomanic type of delusional disorder.
The central theme of the delusion is that someone is in love with the individual.
- concerns romantic love/spiritual union rather than sexual attraction
- "lover" is usually higher status than "lovee" (movie star, boss, etc.)
- efforts to contact "lover" are common
- most "lovees" are female in clinics. In forensics, most are male.
- some people try to rescue "lover" from imagined danger
Describe grandiose type delusional disorder.
When central theme of delusion is the conviction of having a great, unrecognized talent or insight, or having made an important discovery.
- may have delusions of having relationship with person of importance
- may have delusions of being a prominent person (the real person is seen as an imposter)
- may have religious content (message from god, etc.)
When would the jealous subtype of delusional disorder be applied?
when the central theme of the person's delusion is that a lover is being unfaithful
- arrived at without due cause
- based on incorrect inferences supported by perceived "evidence" (clothes on floor, unmade bed)
- person usually confronts lover or tries to intervene in believed infidelity (following lover, investigating imagined lover, etc.)
When does the persecutory type of delusional disorder apply?
when the central theme of the delusion involves a person believing he/she is being:
- conspired against
- spied on
- maliciously maligned
- obstructed in the pursuit of long-term goals
- often believed to be remedied through legal action (querulous paranoia)
- individuals are often resentful and angry, may resort to violence
When would you apply the somatic subtype to delusional disorder?
central theme of delusion involves bodily functions or sensations
- they are emitting foul odor from skin, mouth, rectum, or vagina
- infestation of insects on or in the skin
- internal parasite
- body parts are misshapen/ugly
- organs/body parts are not functioning
When does the mixed subtype of delusional disorder apply?
when no delusional theme predominates
When does the unspecified subtype apply to delusional disorder?
when the dominant delusional belief cannot be clearly determined or is not otherwise described in the specific types