Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
DSM-IV TR
Psychotic Symptoms
Presence of Delusions and Hallucinations Severely disorganized behavior, speech and thought Also occurs in Mood Disorders May be associated with substance use May be due to medication side effects May be due to Delirium, GMC
DSM-IV TR
Subtypes of Schizophrenia
Pure types are less common Mixtures of symptoms more common Catatonic type rare Disorganized type *speech, behavior, affect Paranoid type *diagnosis of exclusion Undifferentiated type Residual type
Case Study
Young female, poor functioning Lives with parents, unemployed Two previous hospitalizations Antipsychotics recently reduced Can control behavior of others Others can read her mind and being watched Multiple voices, threatening in nature Low energy, motivation, unable to think Unable to care for herself Depressed, decreased appetite and sleep
DSM-IV-TR
DSM-IV-TR Diagnosis
Axis I 295.30 Schizophrenia, Paranoid type Interepisode Residual Symptoms Depressive Disorder NOS Axis II V71.09 No diagnosis Axis III None Axis IV - ? Less contact with BF Axis V GAF 30
DSM-IV-TR
DSM-IV-TR Criteria for Schizophreniform Disorders A B Criteria A, D and E of schizophrenia are met Episode last *one month to six months (provisional or not). - without good prognostic features - with * good Prognostic features (two or more) Absence of blunted or flat effect Good premorbid features Confusion on perplexity at the height of episode *onset of psychotic symptoms within 4 weeks ( behavior or functioning).
DSV-IV-TR
1. 2. 3. 4.
Case History
30 year old lawyer Disheveled, hypervigilant, easily startled. Seems to be responding to voices. Has been well until 3 months ago. Excellent vocational and social activity. GF broke up recently, began to follow her. Problems with attendance, punctuality, productivity. Criticized by his boss. Thought he was unduly criticized and humiliated. Voices faggot, a jerk off. Convinced office staff were scheming against him. Believed his life was in danger. Considered buying a gun/police protection. Depressed, poor sleep, no biological features. Not hyperactive, energetic or expansive mood. No H/O substance use/GMC. Responded to treatment as an inpatient.
DSM-IV TR
DSM-IV-TR Diagnosis
Axis I 295.40 Schizophreniform disorder Good prognosis two features Axis II V71.09 No diagnosis. Axis III None Axis IV Breakup with girlfriend Axis V GAF 30 Admission GAF 60 Discharge GAF 90 Highest level past year Differential Diagnosis: - Schizophrenia - Depression with psychotic symptoms - Brief psychotic disorder - Psychosis due to GMC/substance use DSM-IV TR
Schizoaffective Disorder
DSM-IV-TR Criteria 295.75 A. An uninterrupted period of illness with MDE, Manic Episode or mixed Episode with criteria A for schizophrenia. B. *Delusions or Hallucinations for two weeks in the absence of prominent mood symptoms. C. Criteria for a mood episode are present, during the active and residual phase of the illness. D. Not due to effects of substance or GMC. Specify Type Bipolar Type Disturbance includes Manic or Mixed Episode or Depressive episode. Depressive Type Disturbance only include MDE DSM-IV-TR
TV is controlling her, others can read her mind. Also, prominent manic symptoms for 3 wks. Shopping sprees, not sleeping, pacing for much of the night. Convinced that God, too, was talking to her. Someone was touching and arousing her sexuality. Hardly slept for 3 nights prior to admission. Hyperactive, disruptive, excites and irritable. Hypersexual, convinced she would heal everyone. Treated with Fluphenazine & Lico3. Improved within the next 6 months. DSM-IV-TR
DSM-IV-TR Diagnosis
Axis I Schizoaffective Disorder Bipolar Type Axis II V71.09 No diagnosis
Axis III
Axis IV
None
Brother in jail, separation from husband
DSM-IV TR
Differential Diagnoses
- Schizoaffective Disorder least reliable diagnosis in DSM-IV. - ?Mood symptoms are of sufficient duration and severity. - Mood Disorder with Psychotic features. - Schizophrenia. - Brief Psychotic Disorder. - Schizophreniform Disorder - Due to substance use/GMC.
DSM-IV TR
Delusional Disorder
DSM-IV-TR Diagnostic Criteria 297.1 A Nonbizarre delusions (involving situations that occur in real life) of at least one month duration. B *Criterion A for Schizophrenia has never been met. C Functioning or behavior not markedly impaired. D If mood episodes have occurred, they are brief. E Not related to effects of substances or GMC. Specify Type: - Eratomanic Type - Grandoise Type - Jealous Type - Persecutory Type - Somatic Type - Mixed Type - Unspecified Type
DSM-IV TR
DSM-IV-TR
DSM-IV-TR Diagnosis
Axis I 297.1 Delusional Disorder, Somatic Type 311 Depressive Disorder NOS Axis II V71.09 No Diagnosis Axis III None Axis IV Social Isolation, Inability to work Axis V GAF = 30 (current) GAF = 40 (Highest in past year)
DSM-IV-TR
Specify: with marked stressors without marked stressors with Post partum onset (within 4 weeks postpartum)
DSM-IV-TR
DSM-IV-TR
Differential Diagnosis Substance induced Psychosis Delirium Substance intoxication ONLY Substance withdrawal ONLY Psychotic symptoms may NOT be substance induced 1. Symptoms predates substance use. 2. Symptoms persist after intoxication/withdrawal (usually 4 weeks) 3. Not related to type or amount of substance used. 4. Family history of Primary Psychotic Disorder - Dual Diagnoses - Recurrent flashbacks involving LSD - Substance may precipitate symptoms in vulnerable patients
DSM-IV-TR
DSM-IV-TR Criteria for Psychotic Disorders Nos.-298.9 Psychotic symptomology Inadequate information to make specific diagnosis Contradictory information Symptoms do not meet criteria for ANY specific Psychotic Disorder Multiple examples: 1)Delusions with periods of overlapping ME 2) Post Partum Psychosis 3) Psychotic Disorders with less than one month duration with no remission 4) Psychotic Disorder with unknown etiology 5) Persistent Auditory Hallucinations DSM-IV-TR