ID OTHER PSYCHOTIC. DISORDERS schizophrenia are complex ai cinations, 2) inquiry for ae e have been present, then determining duration of illness, 3) inquiry for the gant they nptom phase, as well as the residual recto" Of the quiry to determine deterioration in level of Prodromay n of affective, behavioral, and cognitive pr qioeing, cting delusions and hallucinations are . ing manic and depressive syndromes sepa , respectively. Many of the . ilar to the schizotypal personality disorder criter. are on pages 110-113. s cited, to the DSM-5 manual to full aoe ‘ophrenia, delusional. disorder, eniform . ychotic disorder and schizoaffective disorder. The common thread to these disorders is the presence of psychosis. The specific delusions and hallucinations are defined in the glossary. Unlike the other sections of this guide, the questions do not follow the DSM-IV diagnostic algorithms. Instead, | briefly summarize features of these disorders, and then highlight differential age considerations for five pairs of disorders. f Schizophrenia is generally a chronic illness beginning before the age of 5 | in which the individual does not return to his or her premorbid level of functioning. Prominent hallucinations or delusions are usually present. The person must be ill at least six months, though they need not be actively psychotic all of the time. Three phases of the illness are defined. The prodome phase includes attenuated forms of active phase symptoms (ea. ‘odd beliefs, ideas of reference, unusual perceptual experiences), a symptoms, and/or a deterioration in function prior to the onset of the nae psychotic phase. The active phase symptoms (delusions, re disorganized speech, grossly disorganized behavior, or negative a ‘month. such as avolition and flat affect) must be present for at at a ae uel The residual phase follows the active phase. The features 0! rales i and prodromal phases include functional impairment, and ae sync affect, cognition, and communication. If a manic or cence 0 occurs, its duration is brief relative to the duration of the ae é schizophrenia. (DSM-5 does not indicate how short the aa 40-20% must be to be considered “brief.” | define brief as not more the active phase of the illness.)Psychotic Disorders 25 ition of schizophrenia has 5 criteria. Criterion A, or the a aplenty requires the presence of two of the following features tive Phase fe month (and at least 1 of these must be from the first 3 items): forat easter cinations, disorganized speech, grossly disorganized or aeusions spavior, and negative symptoms. Criterion 8 refers to social or ton nal impairment, and Criterion C refers to the sixmonth duration of Hore. Criteria D and E exclude the diagnosis if there is significant der pathology, or if the disturbance is due to the effects of street lication, or medical illness. coup disturbat mood disol drugs, medi aH nal Dit is also usually a chronic illness. The delusions last at jecst a month and usually involve situations that can occur in real life such fs infidelity, being followed, or illness. If hallucinations are present they are fot prominent and are related to the delusion. Functional impairment is finked to the delusional system. Often functioning is not markedly and pevasively impaired as it is in schizophrenia. If a manic or depressive syndrome occurs, its duration is brief relative to the duration of the delusion. Brief Psychotic Disorder requires the presence of one or more of the folowing for at least one day but less than a month: delusions, hallucinations, disorganized speech, or grossly disorganized or catatonic behavior. Onset is usually sudden, impairment can be severe during the episode, but the individual returns to his or her normal self. Schizophreniform Disorder lasts at least one month, but less than six months, and is characterized by delusions, prominent hallucinations, or the other active phase features of schizophrenia. Thus, Criterion A of schizophrenia is met except for the duration of the episode. A manic or depressive syndrome, if present, is present for only a minority of the duration of the psychotic symptoms. Thus, the criteria are similar to those of schizophrenia except the illness duration is less than six months, and there ‘So social or occupational impairment requirement. When the symptoms are current, and the episode duration is less than 6 months, the diagnosis should be qualified as provisional because it is not yet clear if the patient will phrenia. ? phrenia, but the duration felative to the duration of for the majority of ‘illness. However, for at hallucinations but notentcineiore can soeeuer tn Wrdluis wh tort however, they are not prominent and are related to theme. Similarly, disorganized speech, grossly daea” catatonic behavior, and negative symptoms are sua r delusional disorder, Thus, criterion A of schizophrenia ie nase Nonbizarre delusions can occur in schizophrenia: however not. the only peychotic symptom. The Individual wih aafeteam 2dcitionally experiences either prominent hallucinations, of m disturbed affect, thought processes, or behavior. The impai associated with delusional disorder is usually circumscribed, whereos the impairment associated with schizophrenia is more global. Schizophrenia_vs. Schizoatfective Disorder: The psychotic symptoms are the same. In schizoaffective disorder a manic or depressive episode must be present, and the mood syndrome has been present for the majority cof the time. However, to be diagnosed with schizoaffective disorder there must be at least two ‘weeks in which the delusions or hallucinations are present but prominent mood symptoms are not. Ps ods (or only ig but without promina® rent and type of PS or the number and severity of moos = the distl M rap in time. fective Disorder _vs. Moo isorder_with Features: In a psychotic mood isorder, there are no pel very brief ones) characterized by psychosi mood symptoms. You cannot rely on the cont two disorders. Rather, yychotic and mood symptoms ovePsychotic Disorders ZF Schizophrenia_vs. Schizophreniform Disorder: The symptom inclusion criteria are the same. The primary difference is that schizo- phrenia lasts for more than six months (including the prodromal, active and residual phases), whereas in schizophreniform disorder the pathology (i.e., all three phases) has lasted less than six months. Schizophreniform Disorder vs. Brief Psychotic Disorder: Both fefer to psychotic disorders of brief duration. The psychotic symptom inclusion criteria are similar, but not identical. The psychosis inclusion criteria are broader for brief psychotic disorder (any one of: delusions, hallucinations, disorganized speech) versus criterion A of schizophrenia which requires at least two of five features. Schizophreniform disorder lasts at least a month, whereas brief psychotic disorder lasts less than a month.— notice that they are referring to you, intended specifically for you?) IF YES: What have you noticed? Does it seem like strangers on the st i ‘ talking about you? "eet re taking speci Pet to, IF YES: Is it a feeling you have, or are you pret z talking about/referring to you? Y Sure that thy ay IF PRETTY SURE: How do you know? Do things seem especially arranged for you? | IF YES: In what way? | DELUSION OF PERSECUTION Is anybody against you, following you, giving you a hard time, oF tying tp hurt you? IF YES: Tell me about that. Do you feel like there's a plot to hurt you? } IF YES: Who's involved? Why would they want to hurt you? | THOUGHT BROADCASTING Do you ever think of something so strongly that people could hear yout thoughts? ’ iret IF YES: So, people can hear what you are thinking even when you! talking? ‘ ou'te thinking? 1 your mind and know what phe? Je? Who? t, or just some people Jo they road, or dt d your pe you're thinking?Delusions and Hallucinations 29 FHOUGHT WITHDRAWAL es ‘Are your thoughts ever taken out of your head? IF DOESN'T UNDERSTAND QUESTION: Does someone or some force reach into your head and remove or steal your thoughts? IF YES TO EITHER QUESTION: Tell me about it. _ THOUGHT INSERTION THOUS Are there ever thoughts in your head that have been put in there from the outside? IF YES: Tell me about it. (I'm not referring to talking to someone who makes a suggestion or gives you advice. Instead, I'm referring to thoughts getting inserted into your head from the outside. Does this ever happen?) SS DELUSION OF GUILT (Also see Major Depression section, page 40.) Do you think you've done something terrible an IF YES: | know it will be hard to talk about, guilty about? for bad things going on in the world like starvation, d deserve to be punished? but what do you feel soict ‘SOMATIC DELUSION Are you concerned that you have a serious physical iness tata hasn't found, or that something is wrong with your body? IF YES: What do you think is wrong? Why do you think that? Are you sure? a RRR eR TEE HALLUCINATI ONS Lankewkawncenensheeeee® jan 522° 5 or other things that other people did yy did this cout? 0 did it start?Delusions and Hallucinations 31 Al pDITORY HALLUCINATIONS ae heard noises, or sounds, or voices that other people didn't hear? fl Have YES: What did you hear? Do the voices seem to come from inside or outside your heard? IF INSIDE: But you hear it with your ears? How many voices do you hear? ‘Are they male or female? Do you recognize them? Do you ever hear two or more voices talking to each other? Do the voices ever talk about what you're doing or thinking? IF YES: Do they ever keep up a running commentary on what you're doing or thinking just like a sports announcer describes a ball game? How long ago did the voices start? Do you hear them every day? How often during the day do you hear them? Do they influence your behavior? Do they tell you to do things? epee TACTILE HALLUCINATIONS Do you ever notice strange sensations in your body or on your skin? Do you ever feel something creeping or crawling on your body, or something push or punch you but no one is there? IF YES: Like what? When did it happen the first time? How often has it happened? "ACTORY AND GUSTATORY HALLUCINATIONS symptoms like an memory loss?