Other psychotic disorders

Август 10, 2022

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Other psychotic disorders

Содержание

2. Other Psychotic Disorders Brief Psychotic Disorder Schizophreniform Disorder Schizoaffective Disorder Delusional Disorder Shared Psychotic Disorder Axis
3. Brief Psychotic Disorder Diagnostic Criteria: Presence of 1 or more of the following: Delusions Hallucinations Disorganized
4. Brief Psychotic Disorder Per definition- always full recovery! Good prognosis- 50-80% never develop any psychiatric disease.
5. Specifiers for Brief Psychotic Disorder With Marked Stressors= brief reactive psychosis Without Marked Stressors With Postpartum
6. Epidemiology Rare. Prevalence unknown. Most patients- young (20-30y), women, from developing countries Personality disorders Low SES
7. Clinical Presentation Typically- extreme emotional lability, bizzarre behavior, either screaming or complete mutism, severe impairment of
8. Good Prognostic Indicators No prodrome, acute onset Good premorbid level of functioning Few schizoid personality traits
9. DDX דליריום (במקום הראשAny substance (intoxication, withdrawal, secondary psychosis) Any other general medical condition Schizophreniform Delusional
10. Treatment Hospitalization Antipsychotics- usually good and fast response Psychotherapy to deal with the potential trigger and
11. SCHIZOPHRENIFORM DISORDER 2 or more of the following sx are present for at least a month:
12. Shizophreniform Disorder: Specifiers Without Good Prognostic Features With Good Prognostic Features – as evidenced by 2
13. Schizophreniform Disorder (cont.) Age- young adults Prevalence- 0.1-0.2% More affective diseases than in the families of
14. Treatment 3-6 months of neuroleptics. React faster and better than F20 ECT in patients with affective
16. Diagnostic Criteria for Schizoaffective Disorder Overlap of mood sx & psychotic sx 2 week period of
17. Schizoaffective Disorder (cont.) Prevalence- 0.5-0.8% Depressive type- more prevalent in the older patients Bipolar type- more
18. Schizoaffective Disorder (cont.) More F20 in the families of patients Prognosis- better than F20, worse than
19. DELUSIONAL DISORDER Diagnostic Criteria: A. Presence of 1 or more nonbizarre delusions (involve plausible situations, e.g.
20. Subtypes for Delusional Disorder Based on prominent delusional theme: Erotomanic: belief that another person, usually of
21. Delusional Disorder (cont.) Prevalence 0.3% Average age- 40y More prevalent in women. In women- more erotomanic
22. Delusional Disorder (cont.) Stable diagnosis: Therefore- a separate disease. Prognosis is good in women, good overall
23. Delusional Disorder (cont.) Treatment- extremely treatment- resistant. Most patients refuse treatment because they do not feel
24. Postpartum Psychosis (PPP) 1-2/1000 births Risk factors- personal or family HX of bipolar, schizoaffective or isolated
25. PPP- “the Rule of 50%” 50-60%- first childbirth 50%- no previous psychiatric HX that is- the
26. Clinical Presentation Acute onset- 2days- 2 weeks after childbirth. Almost all cases within 1 month Presenting
27. Treatment of PPP Always hospitalize! In many cases- compulsory hospitalization is imminent Since this is usually
28. Shared Delusional Disorder (Folie a Deux) A delusion develops in an individual in the context of
29. Shared Delusional Disorder (Folie a Deux) Extremely rare. Only case reports, no controlled studies Usually in
30. Culture- Bound Syndromes
31. Piblokto/Pibloktoq Region/Culture: Arctic and Subarctic Eskimos Piblokto = "arctic hysteria," prolonged, extreme excitement sometimes followed by
32. Amok (running amok)/Berserker Region/Culture: Southeast Asia, Scandinavia Violent, disorderly, or homicidal rage directed against other objects
33. Taijin Kyofusho Region/Culture: Japan Patients with taijin kyofusho (literally "the disorder of fear") experience extreme self-consciousness
34. Koro Region/Culture: Asia, Southeast Asia intense anxiety related to the belief that one's own genitalia are
35. Zar Region/Culture: Northern Africa, Middle East Attributed to spirit possession -- and not considered a pathology
36. Gururumba Region/Culture: New Guinea Gururumba describes an episode in which the afflicted person (usually a married
37. Axis II Disorders associated with Psychosis Stress + Predisposition Borderline and Schizotypal. In some cases- schizotypal
38. Test Yourself!
39. A 19 year old man is brou;ht to the physician by his parents after he called
40. A 20 year old woman is brought to the ER by her family after they were
41. A 40 year old woman is arrested by the police after she is found crawling through
43. Скачать презентацию

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Other Psychotic Disorders
Brief Psychotic Disorder
Schizophreniform Disorder
Schizoaffective Disorder
Delusional Disorder
Shared Psychotic Disorder
Axis II-

associated psychoses
Culture- bound syndromes

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Brief Psychotic Disorder
Diagnostic Criteria:
Presence of 1 or more of the following:

Delusions
Hallucinations
Disorganized speech
Grossly disorganized or catatonic behavior
Duration: at least a day, but less than a month
Diagnosis is given after person has fully recovered in less
than a month
No other medical cause, not secondary to substance

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Brief Psychotic Disorder
Per definition- always full recovery!
Good prognosis- 50-80% never develop

any psychiatric disease. Others- develop F20 or affective diseases

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Specifiers for Brief Psychotic Disorder
With Marked Stressors= brief reactive psychosis
Without Marked

Stressors
With Postpartum Onset: within 4 weeks postpartum

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Epidemiology
Rare. Prevalence unknown. Most patients- young (20-30y), women, from developing countries
Personality

disorders
Low SES
After natural disasters, severe stressors, emmigration

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Clinical Presentation
Typically- extreme emotional lability, bizzarre behavior, either screaming or complete

mutism, severe impairment of short- term memory (almost never recall the episode)
Assess as any secondary psychosis or delirium- always r/o organic cause!

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Good Prognostic Indicators
No prodrome, acute onset
Good premorbid level of functioning
Few schizoid

personality traits
Severe stressor before onset
Affective symptoms during the episode
Severe confusion and perplexity during the episode
No affective blunting
Short duration of symptoms
No relatives with F20
As a rule- the more dramatic, acute and “frightening” presentation- the better the outcome!

Brief Psychotic Disorder

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DDX
דליריום (במקום הראשAny substance (intoxication, withdrawal, secondary psychosis)
Any other general

medical condition
Schizophreniform
Delusional
Affective psychosis
Factitious and malingering
Short transient psychosis in personality disorder
Dissociative state

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Treatment
Hospitalization
Antipsychotics- usually good and fast response
Psychotherapy to deal with the potential

trigger and with the episode of psychosis

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SCHIZOPHRENIFORM DISORDER
2 or more of the following sx are present for

at
least a month: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, negative sx
B. R/O schizoaffective disorder, mood disorders, and the effects of a substance or general medical condition
C. An episode of the disorder (including prodromal, active, & residual phases) lasts at least a month but less than 6 months
D. Provisional diagnosis prior to 6 months

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Shizophreniform Disorder: Specifiers
Without Good Prognostic Features
With Good Prognostic Features – as

evidenced by 2 or more of the following:
acute onset of Sx (<4 weeks after prodrome)
confusion or perplexity at height of psychotic episode
good premorbid social and occupational functioning
absence of blunted or flat affect

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Schizophreniform Disorder (cont.)
Age- young adults
Prevalence- 0.1-0.2%
More affective diseases than in the

families of patients with schizophrenia
More affective psychoses than in the families of
patients with bipolar
DDX: like F20 (including F20)
Treatment- like F20
Prognosis- 60-80% develop F20 eventually. Others- complete recovery. More chances of F20 if multiple attacks in 6 months needed for diagnosis (=repeated)

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Treatment
3-6 months of neuroleptics. React faster and better than F20
ECT in

patients with affective or catatonic characteristics

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Diagnostic Criteria for Schizoaffective Disorder
Overlap of mood sx & psychotic sx
2

week period of psychotic sx without mood sx
Mood sx are prominent & enduring part of clinical picture (15-20% of the period of illness)
Specifiers:
Bipolar Type – disturbance includes manic or mixed episode
Depressive Type – disturbance includes major depressive episode

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Schizoaffective Disorder (cont.)
Prevalence- 0.5-0.8%
Depressive type- more prevalent in the older patients
Bipolar

type- more prevalent in the younger patients
The disease is more prevalent in women, in women- later onset, fewer negative signs, less blunting of affect, fewer antisocial characterystics than in men. Overall- better prognosis

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Schizoaffective Disorder (cont.)
More F20 in the families of patients
Prognosis- better than

F20, worse than affective diseases. The more “schizo” characterystics- the worse the prognosis
Treatment- mood stabilizers + antipsychotics. Carbamazepine- very affective in the depressive type
Beware of antidepressants- high chance of switch!
Prescribe only with mood stabilizers
Intractable manic symptoms- ECT

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DELUSIONAL DISORDER
Diagnostic Criteria:
A. Presence of 1 or more nonbizarre delusions

(involve plausible situations, e.g. being followed, poisoned, infected, loved at a distance, betrayed by a lover, or having a disease) of at least 1 month’s duration.
B. Criteria A for Schizophrenia has never been met (no hallucinations and if there are- only in the context of the dellusion)
C. Aside from impact of delusion(s), functioning is not markedly impaired and behavior is not obviously odd
or bizarre.
D. No prominent affective sx, if there are- only of short duration.
C. Not secondary to substance or another medical condition.

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Subtypes for Delusional Disorder
Based on prominent delusional theme:
Erotomanic: belief that another

person, usually of higher status, is in love with you
Grandiose: belief that you have inflated worth, power, knowledge, identity, or a special relationship to a prominent person
Jealous: belief that lover is unfaithful
Persecutory: belief that you’re being treated malevolently, e.g. cheated, conspired against, poisoned, spied on
Somatic: belief that you have a physical defect or some medical condition
Mixed: >1 of above themes; no 1 theme predominates
Unspecified: central theme doesn’t fit other types

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Delusional Disorder (cont.)
Prevalence 0.3%
Average age- 40y
More prevalent in women.
In women- more

erotomanic type. In men- more jealous type.
Most patients are married, working and generally functional.
More in immigrants, hearing impairment, low SES.
More delusional disorder in the families. No genetic association to affective diseases or F20. More cluster A personalities in the families.
Always r/o organic cause!

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Delusional Disorder (cont.)
Stable diagnosis: <25% develop F20, ,10% turn out to

be affective. 50% recover, 20% improve, 30% no change
Therefore- a separate disease.
Prognosis is good in women, good overall functioning, acute onset, onset younger than 30y, short duration, stress causative factors, types- paranoid/ somatic/erotomanic

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Delusional Disorder (cont.)
Treatment- extremely treatment- resistant. Most patients refuse treatment because

they do not feel or believe they are ill.
Resistant to antipsychotics. Best option- typicals.
The only psychotic illness in which psychotherapy is the primary treatment option- teach the patient to cope and live with the symptoms without trying to make the dellusion disappear.

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Postpartum Psychosis (PPP)
1-2/1000 births
Risk factors- personal or family HX of bipolar,

schizoaffective or isolated PPP
75% recurrence
85%- first presentation of bipolar. 10-15%-
first presentation of F20
Rare- single episode w/o recurrences (this is not the rule!)

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PPP- “the Rule of 50%”
50-60%- first childbirth
50%- no previous psychiatric HX

that is- the first presentation of illness
50%- family HX of any affective disease
At least 50% (up to 70%)- develop another episode of the underlining disease (usually mania) in the first year after childbirth

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Clinical Presentation
Acute onset- 2days- 2 weeks after childbirth. Almost all cases

within 1 month
Presenting symptom- severe sleep disturbance
Symptoms as in any brief psychotic disorder, although usually very extreme and delirium- like: Extreme agitation, very bizzarre and disorganized behavior, severe impairment of thought process, elated or irritable and labile mood, inappropriate affect, hallucinations in 25% (in all modalities, command hallucinations), delusions in 50% (usually bizzarre and mood- incongruent, centered on the newborn), suicidality (5%), extreme aggressiveness (4% infanticide), catatonia
Medical emergency!

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Treatment of PPP
Always hospitalize! In many cases- compulsory hospitalization is imminent
Since

this is usually the presentation of bipolar- treat as psychotic mania: mood stabilizers+ antipsychotics+ BZ
In severe cases (suicidality, aggressiveness, catatonia)- ECT
Sufficient sleep is important for recovery
Breastfeeding is usually impossible due to the severity of the mother’s condition. Dostinex- contraindicated!
Psychotherapy after recovery, diadic treatment, gradual release
If known bipolar or F20- institute maintenance treatment
Consider prophylaxis in subsequent pregnancies

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Shared Delusional Disorder (Folie a Deux)
A delusion develops in an individual

in the context of a close relationship with another person(s), who has an already-established delusion.
The delusion is similar in content to that of the person who already has the established delusion.
The disturbance is not better accounted for by another Psychotic Disorder (e.g., Schizophrenia) or a Mood Disorder With Psychotic Features and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

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Shared Delusional Disorder (Folie a Deux)
Extremely rare. Only case reports, no

controlled studies
Usually in two persons living in isolated environment and being in close relationship, where the primary psychosis patient usually has chronic psychiatric disease and is the dominant one, while the secondary patient has no previous psychiatric history and is a submissive one
Treatment always involves separation. Primary patient should be medically treated. Secondary patient usually recovers spontaneously after the
Separation
Prognosis in the primary patient- depending on the disease. Prognosis in the secondary patient- similar to delusional disorder

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Culture- Bound Syndromes

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Piblokto/Pibloktoq
Region/Culture: Arctic and Subarctic Eskimos
Piblokto = "arctic hysteria," prolonged, extreme excitement sometimes

followed by seizures and coma. A prodrome of irritability can occur, and during the episode patients frequently exhibit dangerous, irrational behavior (ie, property destruction, stripping naked)
Probably result from vitamin A toxicity; organ meat from Arctic food sources such as polar bears, seals, and walruses contains extremely high levels of the vitamin
Other potential causes of this syndrome include forms of malnutrition (eg, vitamin D or calcium deficiency) and the conditions associated with amok, including delirium and severe psychotic, mood, or personality disorders

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Amok (running amok)/Berserker
Region/Culture: Southeast Asia, Scandinavia
Violent, disorderly, or homicidal rage directed against other

objects or persons. The condition, which is often accompanied by amnesia and exhaustion, is typically incited by a perceived or actual insult and can occur as part of a brief psychotic episode or as an exacerbation of a chronic psychotic illness
Conditions such as intermittent explosive disorder; catatonic excitement; agitation and aggression under the influence of substances; and aggression associated with psychotic, mood, or personality disorders share features with amok

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Taijin Kyofusho
Region/Culture: Japan
Patients with taijin kyofusho (literally "the disorder of fear") experience extreme self-consciousness

regarding their appearance. Patients suffer from intense, disabling fear that their bodies are embarrassing or offensive to others
This culture-bound condition has overlapping features with social phobia and body dysmorphic disorder.

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Koro
Region/Culture: Asia, Southeast Asia
intense anxiety related to the belief that one's own

genitalia are shrinking or receding, resulting in possible death
The disorder has also been associated with the belief that perceived inappropriate sexual acts (eg, extramarital sex, sex with prostitutes, or masturbation) disrupt the yin/yang equilibrium, thought to be achieved during marital sex. Koro has also been thought to be transmitted through food

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Zar
Region/Culture: Northern Africa, Middle East
Attributed to spirit possession -- and not considered

a pathology locally -- people experiencing zar undergo dissociative episodes, including fits of excessive laughing, yelling, crying, and hitting their head against a wall. Patients are often apathetic and report developing long-term relationships with their possessor.
On the basis of its phenomenology, zar could be conceptualized as a recurrent brief psychotic episode, delusional disorder, dissociative condition, or potentially a substance-induced event.
Zar is an important example of how certain culture-bound syndromes can be seen as normal, or as a sign of being "selected," where other cultures would consider such symptoms pathologic.

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Gururumba
Region/Culture: New Guinea
Gururumba describes an episode in which the afflicted person (usually a

married man) begins burglarizing neighboring homes, taking objects that he considers valuable but which seldom are. He then runs away, often for days, returning without the objects and amnestic about the episode. Sufferers have been described as hyperactive, clumsy, and with slurred speech. This syndrome has features of a dissociative or conversion disorder but also could be a substance intoxication-related condition

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Axis II Disorders associated with Psychosis
Stress + Predisposition
Borderline and Schizotypal. In

some cases- schizotypal patients subsequently progress to F20
Possible- paranoid, antisocial (rarely)
Treatment includes antipsychotic and psychotherapy

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Test Yourself!

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A 19 year old man is brou;ht to the physician by

his parents after he called them from college, terrified that the Mafia was after him. He states he has eaten nothing for the past 6 days other than canned beans because “they are into everything – I can’t be too careful.” He is convinced that the Mafia has put cameras in his dormitory room and that they are watching his every move. He occasionally hears the voices of two men talking about him when no one is around. His roommate states that for the past 3 weeks the patient has been increasingly withdrawn and suspicious. Which of the following is the most likely diagnosis for this patient?
Delusional disorder
Schizoaffective disorder
Schizophreniform disorder
Schizophrenia
Brief psychotic disorder

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A 20 year old woman is brought to the ER by

her family after they were unable to get her to eat or drink anything for the past two days. The patient, although awake, is completely unresponsive both vocally and nonverbally. She actively resists any attempt to be moved. Her family states that for the previous 5 months she has become increasingly withdrawn, socially isolated, and bizarre, often speaking to people no one else could see. Which of the following diagnoses is the most likely in this patient?
Schizoaffective disorder
Delusional disorder
Schizophreniform disorder
Catatonia
PCP intoxication

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A 40 year old woman is arrested by the police after

she is found crawling through the window of a movie star’s home. She states that the movie star invited her into his home because the two are secretly married and “it just wouldn’t be good for his career if everyone knew.” The movie star denies the two have ever met, but notes that the woman has sent him hundreds of letters over the past 2 years. The woman has never been in trouble before, and lives an otherwise isolated and unremarkable life. Which of the following diagnoses is this patient likely to have?
Delusional disorder
Schizoaffective disorder
Bipolar I disorder
Cyclothymia
Schizophreniform disorder

Other psychotic disorders

Содержание

Other Psychotic DisordersBrief Psychotic DisorderSchizophreniform DisorderSchizoaffective DisorderDelusional DisorderShared Psychotic DisorderAxis II-

Brief Psychotic DisorderDiagnostic Criteria:Presence of 1 or more of the following:

Brief Psychotic DisorderPer definition- always full recovery!Good prognosis- 50-80% never develop

Specifiers for Brief Psychotic DisorderWith Marked Stressors= brief reactive psychosisWithout Marked

EpidemiologyRare. Prevalence unknown. Most patients- young (20-30y), women, from developing countriesPersonality

Clinical PresentationTypically- extreme emotional lability, bizzarre behavior, either screaming or complete

Good Prognostic IndicatorsNo prodrome, acute onsetGood premorbid level of functioningFew schizoid

DDXדליריום (במקום הראשAny substance (intoxication, withdrawal, secondary psychosis) Any other general

TreatmentHospitalizationAntipsychotics- usually good and fast responsePsychotherapy to deal with the potential

SCHIZOPHRENIFORM DISORDER2 or more of the following sx are present for

Shizophreniform Disorder: SpecifiersWithout Good Prognostic FeaturesWith Good Prognostic Features – as

Schizophreniform Disorder (cont.)Age- young adultsPrevalence- 0.1-0.2%More affective diseases than in the

Treatment3-6 months of neuroleptics. React faster and better than F20ECT in

Diagnostic Criteria for Schizoaffective DisorderOverlap of mood sx & psychotic sx2

Schizoaffective Disorder (cont.)Prevalence- 0.5-0.8%Depressive type- more prevalent in the older patientsBipolar

Schizoaffective Disorder (cont.)More F20 in the families of patientsPrognosis- better than

DELUSIONAL DISORDERDiagnostic Criteria: A. Presence of 1 or more nonbizarre delusions

Subtypes for Delusional DisorderBased on prominent delusional theme:Erotomanic: belief that another

Delusional Disorder (cont.)Prevalence 0.3%Average age- 40yMore prevalent in women.In women- more

Delusional Disorder (cont.)Stable diagnosis: <25% develop F20, ,10% turn out to

Delusional Disorder (cont.)Treatment- extremely treatment- resistant. Most patients refuse treatment because

Postpartum Psychosis (PPP)1-2/1000 birthsRisk factors- personal or family HX of bipolar,

PPP- “the Rule of 50%”50-60%- first childbirth50%- no previous psychiatric HX

Clinical PresentationAcute onset- 2days- 2 weeks after childbirth. Almost all cases

Treatment of PPPAlways hospitalize! In many cases- compulsory hospitalization is imminentSince

Shared Delusional Disorder (Folie a Deux)A delusion develops in an individual

Shared Delusional Disorder (Folie a Deux)Extremely rare. Only case reports, no