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Chapter 8 Schizophrenia Spectrum and Other Psychotic Disorders

Terms in this set (17)

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5), to meet the criteria for diagnosis of schizophrenia, the patient must have experienced at least 2 of the following symptoms[1] :

Disorganized speech
Disorganized or catatonic behavior
Negative symptoms

At least two of the five symptoms must be present for at least one month. One of the two symptoms must be delusions, hallucinations, or disorganized speech. Negative symptoms, which impair function the most, are now official.
Criterion B "Level of functioning... is markedly below the level achieved prior to the onset". This is not a criterion for schizoaffective disorder.
Criterion C discusses the six-month duration that distinguishes "schizophrenia" from "schizophreniform disorder" (one to six months) and "brief psychotic disorder" (one day to six months).

Criterion D makes the distinction between schizophrenia and schizoaffective disorder (primarily psychosis and limited mood symptoms in schizophrenia). This is repeated multiple times under the entry for schizoaffective disorder.

Criterion E asks the reader to please rule out psychosis due to drugs or a medical condition.

Criterion F makes the distinction between schizophrenia and an "autism spectrum disorder or a communication disorder".

Continuous signs of the disturbance must persist for at least 6 months, during which the patient must experience at least 1 month of active symptoms (or less if successfully treated), with social or occupational deterioration problems occurring over a significant amount of time. These problems must not be attributable to another condition.
the presence of either bizarre or non-bizarre delusions which have persisted for at least one month. Non-bizarre delusions typically are beliefs of something occurring in a person's life which is not out of the realm of possibility. For example, the person may believe their significant other is cheating on them, that someone close to them is about to die, a friend is really a government agent, etc. All of these situations could be true or possible, but the person suffering from this disorder knows them not to be (e.g., through fact-checking, third-person confirmation, etc.). Delusions are deemed bizarre if they are clearly implausible, not understandable, and not derived from ordinary life experiences (e.g., an individual's belief that a stranger has removed his or her internal organs and replaced them with someone else's organs without leaving any wounds or scars). Delusions that express a loss of control over mind or body are generally considered to be bizarre and reflect a lower degree of insight and a stronger conviction to hold such belief compared to when they are non-bizarre. Accordingly, if an individual has bizarre delusions, a clinician will specify "with bizarre content" when documenting the delusional disorder.

People who have this disorder generally don't experience a marked impairment in their daily functioning in a social, occupational or other important setting. Outward behavior is not noticeably bizarre or objectively characterized as out-of-the-ordinary.

The delusions can not be better accounted for by another disorder, such as schizophrenia, which is also characterized by delusions (which are bizarre). The delusions also cannot be better accounted for by a mood disorder, if the mood disturbances have been relatively brief. The lifetime prevalence of delusional disorder has been estimated at around 0.2% .
Symptoms of Schizotypal Personality Disorder

Schizotypal personality disorder is characterized by a pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

Ideas of reference (excluding delusions of reference)
Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or "sixth sense"; in children and adolescents, bizarre fantasies or preoccupations)
Unusual perceptual experiences, including bodily illusions
Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped)
Suspiciousness or paranoid ideation
Inappropriate or constricted affect
Behavior or appearance that is odd, eccentric, or peculiar
Lack of close friends or confidants other than first-degree relatives
Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self
Because personality disorders describe long-standing and enduring patterns of behavior, they are most often diagnosed in adulthood. It is uncommon for them to be diagnosed in childhood or adolescence, because a child or teen is under constant development, personality changes and maturation. However, if it is diagnosed in a child or teen, the features must have been present for at 1 year.