Saturday, January 19, 2013

DSM Categories: Schizophrenia and Psychotic Disorder

DSM Category 1: Schizophrenia
            Diagnostic Features:
A.    Two or more of the following each being present for a significant portion of time during a one-month period
1.)  Delusions
2.)  Hallucinations
3.)  Disorganized speech
4.)  Grossly disorganized or catatonic behavior
5.)  Negative Symptoms
Note: Only one criterion is required if numbers 1-2 are overwhelming and impede normal functioning.
B.    Social occupational dysfunction: One or more areas of major functioning are affected due to regression
C.   Duration: Continuous disturbance for at least 6 months, with 1 month of Criterion A Symptoms and may include prodromal or residual symptoms
D.   Schizoaffective and Mood Disorder Exclusion: Ruled out due to no major depressive, manic or mixed episodes occurred with active phase symptoms or mood episodes occurred during active phase symptoms for a brief period of time.
E.    Substance/General Medical Exclusion: Disturbance that is not due to drug abuse or a medical condition
F.    Relationship to a Pervasive Developmental Disorder (PDD): If there exists an autism spectrum disorder there must exhibit prominent delusions or hallucinations for at least 1 month.
Associated Features:
1.    Inappropriate Affect
2.    Depression, Anxiety, or Anger
3.    Loss of Interest or Pleasure
4.    Disturbances in Sleep Pattern
5.    Changes in Eating Routine
6.    Abnormal Psychomotor Activities
7.    Concentration, Attention, and Memory Difficulties
8.    Poor Insight towards Illness (manifestation rather than coping)
9.    Depersonalization, Derealization and Somatic Concerns
10. Phobias
11. Motor Abnormalities
12. Short life expectancy (suicide, stress, etc.)
13. Assaultive and Violent Behavior
14. Substance Abuse (Rates of comorbidity are high with Substance-Related Disorder)
15. Other Comorbid Disorders- Anxiety disorders, obsessive-compulsive disorder, panic disorder, schizotypal disorder, schizoid disorder, paranoid personality disorder, etc.
16. An increase has been found due to prenatal and childhood factors, exposure to illness, famine, obstetric complications, etc.
Specific Culture, Age, and Gender Features:
Cultural differences should be considered for example delusions in one culture might not be seen as delusions in another. Hallucinations may be acceptable in other cultures (religion, sorcery, witchcraft, etc.). Disorganized speech may be due to not speaking in one’s native tongue. Be cautious of cultural bias and insensitivity.
Onset occurs between late teens and mid-thirties, early onset is rare.  Children’s hallucinations and delusions are less elaborate, where as adults most commonly experience visual hallucinations. 
Proportion of late onset cases is greater in women.  Schizophrenia differs in men and women.  For men the age of onset is 18-25 years old and for women onset is around 25-35 years old.  Women may experience a late life second peak, however women have a better premorbid functioning than men.  Women express more affective symptomatology, paranoid delusions and hallucinations.  Men have more negative symptoms; therefore women tend to have a better prognosis.  There is a higher incidence of schizophrenia in men than in women.
A worldwide condition that affects 0.5%-1.5% of adults. Also more prevalent in urban born adults rather than rural born adults. 
May be variable, for instance it could become progressively worse over time, go into remission (complete remission is not common), or be consistently chronic. Positive and Negative symptoms exist.
Familial Pattern:
First degree biological relatives are 10 times more likely to have schizophrenia.  There exist a stronger correlation in identical twins rather than fraternal twins.  Schizophrenia is more likely to appear in biological relatives of individuals with schizophrenia, as well as other mental disorders. 
Differential Diagnosis:
·      Psychotic Disorder due to a general medical condition
·      Delirium
·      Dementia
·      Substance Induced Psychotic Disorder
·      Substance Induced Delirium
·      Substance Induced Persisting Dementia
·      Substance Related Disorders
·      Mood Disorders with Psychotic Features
·      Schizoaffective Disorder
·      Depressive Disorder Not Otherwise Specified
·      Bipolar Disorder Not Otherwise Specified
·      Mood Disorder with Catatonic Disorders
·      Schizophreniform Disorder
·      Brief Psychotic Disorder
·      Delusional Disorder
·      Psychotic Disorder Not Otherwise Specified
·      Pervasive Developmental Disorder
·      Childhood Presentations combining disorganized speech (From a communication disorder)
·      Attention Deficit Hyperactivity Disorder
·      Schizotypal, Schizoid, Paranoid Personality Disorder
Schizophrenia Subtypes
            Subtype 1: Paranoid Type
            Subtype 2: Disorganized Type
            Subtype 3: Catatonic Type
            Subtype 4: Undifferentiated Type
            Subtype 5: Residual Type
            Subtype 6: Schizophreniform Disorder
            Subtype 7: Schizoaffective Disorder
                        Bipolar Type
                        Depressive Type
            Subtype 8: Delusional Disorder
                        Erotomanic Type
                        Grandiose Type
                        Jealous Type
                        Persecutory Type
                        Somatic Type
                        Mixed Type
                        Unspecified Type
            Subtype 9: Brief Psychotic Disorder
            Subtype 10: Shared Psychotic Disorder
            Subtype 11: Psychotic Disorder due to General Medical Condition
                        With Delusions
                        With Hallucinations
            Subtype 12: Substance Induced Psychotic Disorder
                        With Delusions
                        With Hallucinations
            Subtype 13: Psychotic Disorder Not Otherwise Specified (NOS)

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