SCHIZOPHRENIFORM DISORDER

Definition:

Schizophreniform Disorder is a condition with a sudden onset and benign course associated with mood symptoms and clouding of consciousness. It is an acute psychotic disorder that has rapid onset and lacks a long prodromal phase.

Epidemiology

Most common in adolescents and young adults Less than as half as common as schizophrenia Lifetime prevalence rate = 0.2% 1-year prevalence rate = 0.1%

Epidemiology

Relatives are at high risk of having other psychiatric disorders:

Likely

to have mood disorders than the relatives of patients with schizophrenia. Likely to have psychotic mood disorders than the relatives of patients with bipolar disorders.

Etiology

Cause: still unknown It is said to be heterogeneous Some group of patients have a disorder similar to schizophrenia and some are similar to mood disorder.

Etiology

Under brain imaging, patients has a relative activation deficit found in the inferior prefrontal region of the brain. A limit to the left hemisphere and also found impaired striatal activity suppression limited on the said area during the activation procedure. Central Nervous System (CNS) factors may lead to either schizophrenia long-termed course or schizophreniform foreshortened course. Under computed tomography (CT) and magnetic resonance imaging (MRI), it indicated that the enlarged cerebral ventricles in schizophreniform disorder are not associated with other outcome.

Etiology
Electrodermal activity A biological measurement that proved a difference between schizophrenia and schizophreniform disorder.

Hyporesponsive skin conductances occurs in schizophrenic patients born on winter and spring months but this association was absent in patients with schizophreniform.

Classifications
A.

Schizophreniform disorder with good prognostic features Schizophreniform disorder without good prognostic features

B.

Schizophreniform disorder with good prognostic features are considered if its proved by two of the following:

Onset of prominent psychotic symptoms within 4 weeks of the first noticeable change in usual behavior of functioning Confusion or perplexity at the height of the psychotic episode Good premorbid social and occupational functioning Absence of blunted or flat affect

Diagnosis
DSM-IV-TR Diagnostic Criteria for Schizophrenifrom Disorder
A. Criteria A, D, and E of schizophrenia are met: B. An episode of the disorder (including prodromal, active, and residual phases) lasts at least 1 month but less than 6 months.

CRITERIA A: Characteristic Symtoms: Two (or more) of the following, each present for signidicante portion of time during a 1month period (or less if successfully treated): 1. delusions 2. hallucinations 3. disorganized speech ( e.g., frequent derailment or incoherence) 4. grossly disorganized or catatonic behavior 5. negative

CRITERIA D: Schizoaffective and Mood Disorder Exclusion: Shizoaffective Disorder and Mood Disorder with Psychotic Features have been ruled out because either: 1. No Major Depressive Episode, Manic Episode, or Mixed Episode have occurred concurrently with the active-phase symptoms; or 2. If mood episodes have occurred during activephase symptoms, their total duration has been brief relative to the duration of the active and residual periods.

CRITERIA E:

Substance or General Medical Condition exclusion:

The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

Clinical Features

A functional impairment at the time of an episode; unlikely to report a progressive decline in social and occupational functioning Presence of two or more psychotic symptoms (hallucinations, delusions, disorganized speech and behavior, or negative symptoms) Presence of emotional turmoil and confusion Patients with schizophreniform return to their baseline state within 6 months.

Course and Prognosis

Schizophreniform is an illness lasting more than 1 month but less than 6 months Between 60% to 80% - progression to schizophrenia 20 % - currently unknown Patients who experience single episode are more likely to continue on their own lives after, while some will experience second or third episode.

Treatment

Hospitalization Antipsychotic Drugs Can be treated within 3-6 months course

Lithium (Eskalith), carabamazepine (Tegretol), and valporate (Depakene)

Psychotherapy Electroconvulsive Therapy for patients with marked catatonic and depressed features

SCHIZOAFFECTIVE DISORDER

Definition

Schizoaffective disorder has features of both mood disorders and schizophrenia. Patients with the said disorder tend to have one of these six categories:
1.

2.
3. 4.

5.
6.

Patients with schizophrenia who have mood symptoms Patients with mood disorder who have symptoms of schizophrenia Patients with both mood disorder and schizophrenia Patients with third psychosis unrelated to schizophrenia and mood disorder Patients whose disorder are continuum between schizophrenia and mood disorder Patients with some combination of the above

Definition

In ICD-10, schizoaffective disorder is defined as a distinct entity and is applicable to patients who exhibit co-occurring mood symptoms and schizophrenic-like mood-incongruent psychosis.

Definition

In DSM-IV-TR, they created a stricter time frame of 1-months duration. They required an uninterrupted period of illness with occurrence of either Major Depressive Episode, Manic Episode, or a Mixed Episode concurrent symptoms that meet the Criterion A for Schizophrenia.

Epidemiology

Lifetime prevalence = less than 1%; possibly 0.5% to 0.8% Depressive Type more common in old people Bipolar Type more common in younger adults Prevalence is older in men than in women (particularly married women) Age of onset is earlier in men than in women Men are more likely to show antisocial behavior and have a markedly flat or inappropriate affect

Etiology

Cause - still unknown There is a more likely possibility that it is a heterogeneous group; may be a type of schizophrenia, a type of mood disorder, or the simultaneous expression of each.

Genetic studies have shown that the relatives of patients with schizoaffective disorder are more likely to have schizophrenia.

Classifications
A.

Bipolar Type
o

The disturbance includes a manic or a mixed episode (or it can be manic or a mixed episode and major depressive episodes).

B.

Depressive Type
o

The disturbance only includes major depressive episodes.

Diagnosis
DSM-IV-TR Diagnostic Criteria for Schizoaffective Disorder

A. An

uninterrupted period of illness during which, at some time, there is either a major depressive episode, a manic episode, or a mixed episode concurrent with symptoms that meet Criterion A for schizophrenia. (Note: The major depressive episode must include Criterion A1: depressed mood.

B. During the same period of illness, there have been

delusions of hallucinations for at least 2 weeks in the absence of prominent mood symptoms.

Diagnosis
C. Symptoms that meet criteria for a mood episode are present for a substantial portion of the total duration of the active and residual periods of the illness.

D. The disturbance is not due to the direct physiological effects of a substance (e.g., drug of abuse, a medication) or a general medical condition.

Clinical Features

Delusions and hallucinations Hyperactive to depressed mood History of substance use with or without positive results on a toxicology screening test Suspicion of a neurological abnormality

Course and Prognosis

Patients might have a course similar to episodic mood disorder, chronic schizophrenic course, or some intermediate outcome. An outcome of affective or mood disorders have better prognosis than schizoaffective or an outcome of schizophrenia which results to a worse prognosis. Patients with schizoaffective disorder have a nondeteriorating course and they respond to lithium better.

Treatment

Mood Stabilizers

In manic episodes, patients should be treated aggressively with the said dosages in middle to high therapeutic blood concentration range. In maintenance phase, the dosage can be reduced in low to middle range to avoid conflicting effects on organ systems.

Lithium and carbamazepine (Tegretrol) Superior for schizoaffective disorder, depressive type is the carbamazepine. While the two agents gave no difference for the bipolar type. Antipsychotic agents Important in the treatment of psychotic symptoms of schizoaffective disorder.

Treatment

Antidepressants Serotonin reuptake inhibitors (e.g., fluoxetine[Prozac] and sertraline [Zoloft])

Tricyclic Drug For agitated and insomniac patients

Electroconvulsive Therapy (ECT) For all cases of intractable mania Psychosocial Treatment A combination of family therapy, skills training, and cognitive rehabilitation

DELUSIONAL DISORDER

False beliefs Incorrect inference about external reality Most interesting psychiatric symptoms Difficult to treat Non bizarre delusions at least one month Situations can occur in real life, they are possible

Epidemiology

Rareness Changing definitions Rarer than Schizophrenia Rarely seek help

Incidence of Delusional d/o is 1 to 3 cases for every 100,000 Mean age onset is 80 but ranges from 18 to 90 Female patients - erotomania Male - Paranoid delusions

Etiology

Cause unknown Heterogeneous group of conditions with delusions Long term follow-up - stable

Biological Factors

Non-psychiatric medical conditions, substances including clear cut biological factor Pxs personality and brain Limbic system and basal ganglia (intact cerebral functioning) Neurological diseases and no intellectual impairment - complex delusion

Psychodynamic factors

Socially isolated, achieved less Hypersensitive persons and specific ego mechanisms
Reaction

formation Projection Denial

Freuds contribution

Part of healing process Projection - main defense mechanism in paranoia Demonstrate the role of projection

Paranoid Pseudocommunity
Norman Cameron described seven situations that favor the development of the delusional disorder: 1. Increased expectation of receiving sadistic treatment 2. Situations that increase distrust and suspicion 3. Social isolation 4. Situations that increase envy and jealousy 5. Situations that lower self-esteem 6. Situations that can cause the person to see their own defects in others 7. Situations that increase the potential for rumination over probable meanings and motivations.

Exceed limit - anxious and withdrawn Realize something is wrong, seek explanation, delusion as solution Projected fears and wisher to justify a pxs aggression

Other psychodynamic factors

Lack of trust Erik Erickson trust vs Mistrust

Defense mechanisms

Reaction formation, denial, projection Reaction formation - aggression, dependence needs, feelings of affection Denial - painful reality Projection- anger to others

Other relevant factors

Social, sensory isolation, socioeconomic deprivation and personality disturbance Deaf, visually impaired, immigrants - delusion formation Elderly Risk factors: Age, sensory impairment, family history, social isolation, personality features and recent immigration

Classification Types of Delusional d/o

Persecutory type
Anyone

close to you is being attacked/harmed Classic symptom Assaultive and homicidal

Jealous type
Infidelity
Conjugal

paranoia Partner is unfaithful Othello syndrome - multiple concerns Separation or death Violence Motive for murder Physical and verbal abuse

Eromatic type
Higher

status is in love Delusional conviction Solitary, withdrawn. Dependent and sexually inhibited Poor levels of social and occupational funtioning Ket to diagnose a patient, seen also in pxs with schizophrenia, mood d/o, other organic d/o

 Women

unattractive Low level jobs Single Less sexual contact Select secret lovers Paradoxical conduct

Somatic type
Appearance or functioning of the body Monosymptomatic hypochondrical psychosis Fixed, unarguable Fears of illness Hyperalertness and high anxiety Types

Infestation Dysmorphophobia Foul body odors/halitosis/Olfactory reference syndrome

Grandiose type
Inflated

worth, power, knowledge, identity, special relationship with a famous person

Mixed type
Two or more delusional themes

Unspecified type
Predominant delusion cannot be subtyped Delusions of misidentification Capgras syndrome - illusion of doubles Familiar person has been replaced with an impostor Can change themselves - intermetamorphosis Assume the guise of strangers - Fregolis phenomenon

Jules Cotard - Nihilistic delusional d/o or Cotard syndrome Losing possesions, status, strenght, heart, blood and intestines Rare syndrome Precursor to a schizophrenic episode

Shared psychotic d/o

Shared

paranoid d/o, induced psychotic d/o. folie a deux, folie impose, double insanity By Lasegue and Farlet Transfer of delusions

Diagnostic criteria for shared psychotic disorder: (1) A delusion develops in an individu al in the context of a close relationship with ano ther person who has an alread y established d elusion. (2) The content of the delusion is similar in content to that of the person who already has the establishe d delusion. (3) The disturb ance is not better accounted for by another psychotic disorder or a mood disorder with physiologica l effects of a substance or a general medication condition.

First person - ill Second person - less intelligent, more gullible, more passive, lacks self esteem Separates - 2nd person abandon delusion Old age, low intelligence, sensory impairment, cerebrovascular disease, alcohol abuse

Genetic predisposition to idi opathic psychoses has als o been suggested as a possibl e risk factor. Diagnostic cri teria for induced delusion al disorder: (1) The individ ual must develop a delusion or delusiona l system originally held by someone else with the disorder classified as schizophrenia, schizotypal disorder, persistent delusional disorder and or acute and transient psychotic disorders. (2) The pe ople concerned m ust have an unsually close relationship with one another and relatively they should be isolated from ot her people. (3) The individu als must not have held the belief in question before contact with the other person and person must have not suffered fr om any disorder, persistent delusion al disorder or acute and transient psychotic disorders in the past.

Folie simultanee - Psychotic simultaneously, share the same delusion Sister- sister, husband- wife, mother - child

Diagnosis
A. Nonbizarre delusionswhich involves situations that involves the real life B. Criterion A for schizophrenia has never been met. Tactile and olfactory hallucinationsmay be present in a patient with delusional disorder if they are related to the delusional theme. C. Apart from the impact of delusions, functioning is not markedly impaired and the behavior is not obviously odd or bizarre. D. If the mood episodes occur concurrently with the delusions the total duration has been brief relative to the duration of the delusional periods. E. Disturbance is not casused by the direct physiological effects of a substance which are drug abuse or medication or a genereal medication condition.

The following types are based on the predomin ant delusional theme: Eromatica type- This delusion that another person wh o has higher status is in love with the person Grandiose type- Delusions are of one inflated worth, power, knowledge, identity, special relati onship to one who is famous. Jealous type- Are delusions that ones partne unfaithful. r is

Persecutory type- Beliefs that a person is malevolently treated in some way Somatic type- Belief that one has a defect physically or general me dical condition. Mixed type- A delusion tha t is more than one of the above types but has no them e that predominates. Unspecified type

Differential diagnosis Medical conditions

Eliminate medical d/o potential cause of delusion

Potential medical etiologies of delusion al syndromes: Neurodegenerative disorders - Alzheimers disease, Picks disease, Basal ganglia calcification. Multiply sclerosis, Metachromatic leukodystrophy Other central nervous s ystem disorders Brain tumo rs epilepsy, complex partia l seizure disorder , head trauma, anoxic brain i njury, fat metabolism Vascular disease Atherosclerotic va scular disease associated with diffuse temporopari etal or subcortica l lesions, hypertensive enc ephalopathy, subarachnoi d hemorrhage, tempor al arteritis Infectious disease Human immunodeficiency virus o r acquired immune d eficiency syndrome, encephaliti s lethargica, Creutzfeldt-Jakob disease, syphilis, malaria , acute viral encepha litis Metabolic disorder Hypercalcemia, hyponatremia , hypoglycemia, uremia, hepatic encephalopathy, porphyria Endocrinopat hies Addisonss disease, Cushings syndrome, hyperor hypo thyroidism, panhypopit uitarism Vitamin deficiencies Vitamin B12 d eficiency, thiamin e deficiency, niacin defici ency Medications Adrenocorticotropic hormones, anabolic steroids, corticosteroids, cimetidine, antibiotics, disulfiram, antich olinergic agents Substances Amphetamines, cannabis, hal lucinogens cocaine, alcohol,

Toxins Mercury, arsenic, manganese, thallium

Subcortical pathology - complex delusions occur frequently Prevalent delusions - Anosogonia and reduplicative paramnesia Capgras syndrome - CNS lesions, vit B12 deficiency, hepatic encephalopathy, diabetes and hypothyroidism

Delirium, dementia and substancerelated d/o

Delirium - consciousness or impaired cognitive abilities Alcohol abuse Result in delusional syptoms is the intoxication with sympathometics, marijuana

Other disorders

Malingering and factitious d/o Nonfactitious - schizophrenia, mood d/o, OCD, somatoform d/o and paranoid personality d/o Lack the impaired funstioning Somatic type - Depressive order

Clinical Features Mental status

Well groomed, well dressed Eccentric, odd, suspicious and hostile Normal except for a remarkably abnormal delusional system Clinicians - allies

Moods, feelings, affect

Mood

is consistent with the content of the delusion

Perceptual disturbance
Does not have a sustained hallucination Tactile or olfactory hallucinations can be present

Thought
D/o

in thought - key symptom Being possible Complex and simple Pxs beliefs should be checked

Diagnostic criteria for delusional disorders:

A. Ones delusion or a set of delusions other than those schizophrenic in criterion G1(1)b or d for the paranoid, hebephrenic or catatonic schizophrenia must be present. The most common examples are persecutory, grandiose, hypochondriacal, jealous or erotic delusions. B. The delusion in A should be present for at least 3 months. C. General criteria for a person with schizophrenia are not fulfilled. D. There are no persistent in any modality. There may be a transitory or occasional auditory hallucinations that are not in the third person. E. Depressive symptoms are present intermittently provided that delusions persist at times when there is no mood disturbance. F. The most commonly used exclusion clause. There should be no evidence of any primary or secondary organic mental disorder listed under organic, including symptomatic, mental disorders, or a psychotic disorder due to a psychoactive substance use.

 Specification of possible subtypes These types may be specified if desired, persecutory, litigious, self referential, grandiose, hypochondriacal , jealous and eromatic.

Sensorium and cognition

Orientation

No abnormality Unless it is of a specific person, time, place

Memory Intact

Impulse control
Ideation or plans to act on their delusional material by suicide, homicide and other forms of violence Tx should not hesitate about violent plans

Judgement and insight

No

insight about their condition Hospital by family, employers and police Past, present and planned behaviors Reliability Reliable in information

Course and prognosis

Stressors are recent immigartion, social conflict Below average intelligence Extroverted, dominant and hypersensitive

Treatment

Resistant to treatments and interventions focused on managing the d/o Goals- establish diagnosis and decide appropriate interventions and managing complications Success - effectiveness and therapeutic doctor-px relationship

Diagnosis and Management of Delusional Disorder:

Rule out other causes of the paranoid features Confirm the absence of the other psychopathology Assess the consequences of the delusion-related behavior

o Demoralization o Despondency o Anger, Fear o Depression o Impact of research for medical diagnosis, legal solution, proof of infidelity

Assess anxiety and agitation Assess potential for violence and suicide Assess need for hospitalization Institute pharmacological and psychological therapies Maintain connection through recovery

Psychotherapy

Trust the tx Individual therapy Neither agree nor challenge the pxs delusion Persistent questioning avoided Tx on time Regular appointments Overgratification - increase hotility and suspiciousness

Disparging remarks Clarify contents Empathize with px internal experience Entertain possibility of doubt about their perceptions Weakness and inferiority with depression

Family members involved - allies Good outcome - pxs mistrust of the others Social adjustment

Hospitalization

Outpatients Consider hospitalization (1) A complete medical evaluation is needed to determine whether a nonpsychiatric medical condition caused the delusional symptoms. (2) Patients needs to be assessed in their ability to control their violent impulses. (3) Patients behavior about the delusion may have affected their ability to function.

Pharmacotherapy

Emergencies - antipsychotic drugs Refuse the medication Fails to respond to drugs after 6 weeks, different type should be given Pimozide No response - discontinued Maintenance - low dosages

BRIEF PSYCHOTIC DISORDER

Brief Psychotic Disorder

Definition
sudden onset of psychotic symptoms which lasts 1 day/more but < 1 month

acute & transient psychotic syndrome

Brief Psychotic Disorder

Epidemiology
exact incidence & prevalence is not known/uncommon occurs more on younger patients (20s & 30s) than older patients most frequently in patients from low socioeconomic classes and in those who have experienced disasters/major cultural changes age of onset: industrialized settings > developing countries greater risk on persons who have gone through major psychosocial stressors

Brief Psychotic Disorder

Etiology
unknown cause may have a biological/psychological vulnerability for the development of psychotic symptoms, particularly those with borderline, schizoid, schizotypal, or paranoid qualities psychotic symptoms are defense against a prohibited fantasy, the fulfilment of unwanted wish, or an escape from a stressful psychosocial situation

Brief Psychotic Disorder

Diagnosis (DSM-IV-TR)
based primarily on the duration of the symptoms last at least 1 day > 1 month not associated with mood disorder, substancerelated disorder, or psychotic disorder caused by a general medical condition

Brief Psychotic Disorder

DSM-IV-TR Diagnostic Criteria for Brief Psychotic Disorder A. Presence of one (or more) of the following symptoms: (1) delusions (2) hallucinations (3) disorganized speech (e.g., frequent derailment or incoherence) (4) grossly disorganized or catatonic behavior Note: Do not include a symptom if it is culturally sanctioned response team B. Duration of an episode of the disturbance is at least 1 day but less than 1 month, with eventual full return to premorbid level of functioning. C. The disturbance is not better accounted for by a mood disorder with psychotic features, schizoaffective disorder, or schizophrenia and is not due to the direct physiological effects of a substance (e.g., drug abuse, medication) or a general medical condition Specify if: With marked stressor(s) (brief reactive psychosis): if symptoms occur shortly after and apparently in response to events that, singly or together, would be markedly stressful to almost anyone in similar circumstances in the persons culture Without marked stressor(s): if psychotic symptoms do not occur shortly after, or are not apparently in response to events that, singly or together, would be markedly stressful to almost anyone in similar circumstances in the persons culture With postpartum onset:

Brief Psychotic Disorder

Clinical Features
always include at least one major symptom of psychosis, usually with an abrupt onset labile mood, confusion, & impaired attention are common at the onset characteristic symptoms include emotional volatility, strange or bizarre behavior, screaming or muteness, & impaired memory for recent events

Brief Psychotic Disorder

Clinical Features

in Scandivanian & other European literature: symptom patterns include acute paranoid reactions, & reactive confusion, excitation, & depression in United States: paranoia is often the predominant symptom in disorder in French psychiatry: bouffe dlirante is similar to brief psychotic disorder

Brief Psychotic Disorder

Course & Prognosis

course is less than 1 month

BPD patients generally has good prognoses; 50 - 80% patients have no further major psychiatric problems

Brief Psychotic Disorder

Good Prognostic Features for Brief Psychotic Disorder *Patients with the features listed are unlikely to have subsequent episodes, & schizophrenia or a mood disorder is unlikely to develop later Good premorbid adjustment Few premorbid schizoid traits Severe precipitating stressor Sudden onset of symptoms Affective symptoms Confusion & perplexity during psychosis Little affective blunting Short duration of symptoms Absence of schizophrenic relatives

Brief Psychotic Disorder

Treatment
Hospitalization acute psychotic patient may need brief hospitalization for both evaluation & protection evaluation requires close monitoring of symptoms & assessing level of danger to self & others while clinicians wait for the setting of the drugs to have their effects, seclusion, physical restraints, or one-to-one monitoring of the patient may be necessary

Brief Psychotic Disorder

Treatment Pharmacotherapy 2 major classes of drugs: antipsychotic drugs (haloperidol/serotonin-dopamine agonist & benzodiazepines) benzodiazepines can be effective for a short time & are associated with fewer adverse effects than the antipsychotic drugs clinicians should avoid long-term use of any medication in treatment of the disorder or if not; may have to reconsider diagnosis

Brief Psychotic Disorder

Treatment Psychotherapy use in providing an opportunity to discuss the stressors & psychotic episode major topics are exploration & development of coping strategies associated issues include helping patients deal with loss if self-esteem & to regain selfconfidence family involvement in treatment process may be crucial to a successful outcome

Brief Psychotic Disorder PSYCHOTIC DISORDER NOT OTHERWISE SPECIFIED (NOS)

-variety of clinical presentations that do not fit within current diagnostic rubrics

Autoscopic Psychosis
visual hallucination (symptom) of all or part of the persons own body phantom; a hallucinatory perception & is usually colorless & transparent; because it imitates the persons movement, it is perceived as though appearing in a mirror; appears suddenly & without warning

Brief Psychotic Disorder PSYCHOTIC DISORDER NOT OTHERWISE SPECIFIED (NOS)

DSM-IV-TR Diagnostic Criteria for Psychotic Disorder Not Otherwise Specified This category includes psychotic symptomatology (i.e., delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior) about which there is inadequate information to make a specific diagnosis or about which there is contradictory information, or disorders with psychotic symptoms that do not meet the criteria for any specific psychotic disorder. Examples include: 1. Postpartum psychosis that does not meet criteria for mood disorder with psychotic features, brief psychotic disorder, psychotic disorder due to a general medical condition, or substance-induced psychotic disorder. 2. Psychotic symptoms that have lasted for less than 1 month but that have not yet remitted, so that the criteria for brief psychotic disorder are not met 3. Persistent auditory hallucinations in the absence of any other features 4. Persistent nonbizarre delusions with periods of overlapping mood episodes that have been present for a substantial portion of the delusional disturbance 5. Situations in which the clinician has concluded that a psychotic disorder is present, but is unable to determine whether it is primary, due to a general medical condition, or substance induced

Brief Psychotic Disorder PSYCHOTIC DISORDER NOT OTHERWISE SPECIFIED (NOS)

Epidemiology
Autoscopic Psychosis

autoscopy is a rare phenomenon & onset varies although the data are limited, sex, age, heredity, & intelligence do not seem to be related to the occurrence of the syndrome

Brief Psychotic Disorder PSYCHOTIC DISORDER NOT OTHERWISE SPECIFIED (NOS)

Etiology
unknown cause biological hypothesis is that abnormal, episodic activity in areas of the temporoparietal lobes is involved with the sense of self, perhaps combined with abnormal activity in parts of the visual cortex psychological theories have associated the syndrome with personalities characterized by imagination, visual sensitivity, & possibly, narcissistic personality disorder traits may likely experience the phenomena during periods of stress

Brief Psychotic Disorder PSYCHOTIC DISORDER NOT OTHERWISE SPECIFIED (NOS)

Course & Prognosis

neither progressive or incapacitating affected persons usually maintain some emotional distance from the phenomenon, an observation that suggests a specific neuroanatomical lesion

Brief Psychotic Disorder PSYCHOTIC DISORDER NOT OTHERWISE SPECIFIED (NOS)

Postpartum Psychosis
aka puerperal psychosis an example of psychotic disorder NOS that occurs in women who have recently delivered a baby characterized by mothers depression, delusions, & thoughts of harming either her infant or herself

Brief Psychotic Disorder

PSYCHOTIC DISORDERS DUE TO A GENERAL MEDICAL CONDITION AND SUBSTANCEINDUCED PSYCHOTIC DISORDER
-evaluation of patient with psychotic disorder requires consideration of the possibility that the psychotic symptoms result from a general medical conditions such as brain tumor or the ingestion of substance such as phencyclidine (PCP)

Epidemiology
most often encountered in patients who abuse alcohol or other substances on a long-term basis delusional syndrome that may accompany complex partial seizure is more common in women than in men

Brief Psychotic Disorder PSYCHOTIC DISORDERS DUE TO A GENERAL MEDICAL CONDITION AND SUBSTANCE-INDUCED PSYCHOTIC DISORDER

Etiology
physical hallucinations such as cerebral neoplasms, particularly of the occipital or temporal areas, can cause hallucinations sensory deprivation, as in people who are blind & deaf, can also result in hallucinatory / delusional experiences common causes of psychotic disorders are psychoactive substances (alcohol, indole hallucinogens, such as lysergic acid diethylamide, amphetamine, cocaine, mescaline, PCP, steroids,

Brief Psychotic Disorder PSYCHOTIC DISORDERS DUE TO A GENERAL MEDICAL CONDITION AND SUBSTANCE-INDUCED PSYCHOTIC DISORDER

Diagnosis
--when the diagnosis is used, the mental condition, along with the predominant symptoms pattern should be included (e.g., psychotic disorder due to brain tumor, with delusions) DSM-IV-TR Diagnostic Criteria for Psychotic Disorder Due to a General Medical Condition A. Prominent hallucinations or delusions B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct physiological consequence of a general medical condition. C. The disturbance is not better accounted for by another mental disorder. D. The disturbance does not occur exclusively during the course of a delirium. Code based on predominant symptom: With delusions: if delusions are the predominant symptom With hallucinations: if hallucinations are the predominant symptom

Brief Psychotic Disorder PSYCHOTIC DISORDERS DUE TO A GENERAL MEDICAL CONDITION AND SUBSTANCE-INDUCED PSYCHOTIC DISORDER

Diagnosis
--should include the type of substance use when the disorder began (e.g., during intoxication/withdrawal), and the clinical phenomena (e.g., hallucinations/delusions) DSM-IV-TR Diagnostic Criteria for Substance-Induced Psychotic Disorder A. Prominent hallucinations or delusions. Note: Do not include hallucinations if the person has insight that they are substance induced B. There is evidence from the history, physical examination, or laboratory findings of either (1) or (2):

(1) the symptoms in Criterion A developed during, or within a month of, substance intoxication or withdrawal (2) medication use is etiologically related to the disturbance

C. The disturbance is not better accounted for by a psychotic disorder that is not substance induced. Evidence that the symptoms are better accounted for by a psychotic disorder that is not substance induced might include the following: the symptoms precede the onset of the substance use (or medication use); the symptoms persist for a substantial period of time (e.g., about a moth) after the cessation of acute withdrawal or severe intoxication, or are substantially in excess of what would be expected given the type or amount of the substance used or the duration of use; or there is other evidence that suggests the existence of an independent non-substance-induced psychotic disorder ((e.g., a history of recurrent non-substance-related episodes) D. The disturbance does not occur exclusively during the course of a delirium. Specify if:

With onset during intoxication: if criteria are met for intoxication with the substance and the symptoms develop during the intoxication syndrome With onset during withdrawal: if criteria are met for withdrawal from the substance and the symptoms develop during, or shortly after, a withdrawal of syndrome

Brief Psychotic Disorder PSYCHOTIC DISORDERS DUE TO A GENERAL MEDICAL CONDITION AND SUBSTANCE-INDUCED PSYCHOTIC DISORDER

Clinical Features
Hallucinations
-can occur in one/more sensory modalities: Tactile hallucinations - (e.g., sensation of bugs crawling on the skin) are characteristic of cocaine use Auditory hallucinations - associated with psychoactive substance abuse, can also occur in persons who are deaf Olfactory hallucinations - result from temporal lobe epilepsy Visual hallucinations - can occur in persons who are blind because of cataracts - often take the form of scenes involving diminutive (liliputian) human figures/small animals Rare musical hallucinations - typically features religious songs Alcohol-related hallucinations - threatening, critical/insulting third-person voices speak about the patients & may tell them to harm either themselves/others -such patients are dangerous & are at significant risk for suicide/homicide -experienced in a state of full wakefulness & alertness -shows no significant changes in cognitive functions

Brief Psychotic Disorder PSYCHOTIC DISORDERS DUE TO A GENERAL MEDICAL CONDITION AND SUBSTANCE-INDUCED PSYCHOTIC DISORDER

Clinical Features Delusions no change in the level of consciousness, although mild cognitive impairment maybe observed appear confused, dishevelled, or eccentric, with tangential or even incoherent speech

Brief Psychotic Disorder PSYCHOTIC DISORDERS DUE TO A GENERAL MEDICAL CONDITION AND SUBSTANCE-INDUCED PSYCHOTIC DISORDER

Treatment
involves identifying the general medical condition or the particular substance involved directed towards patients immediate behavioral control hospitalizations is necessary to evaluate patients and ensure their safety antipsychotic agents (e.g., haloperidol) may be necessary for immediate & short-term control of psychotic/aggressive behavior benzodiazepines may also be useful for controlling agitation & anxiety

CULTURE-BOUND SYNDROMES

Culture-Bound Syndrome

Definition
The term culture-bound syndrome usually denotes specific arrays of behavioral & experiential phenomena that tend to present themselves preferentially in particular sociocultural contexts and that are readily recognized as illness behavior by most participants in that culture. usually in the form of healing rituals performed by someone to whom the community assigns a therapeutic role assessment must start with recognition that each human society has an indigenous body of beliefs & practices directed at explaining & treating disease & disorder & that patients internalize that worldview during the process of enculuration they share their experiences & deal with distress through

Culture-Bound Syndrome

Epidemiology
claims have repeatedly been made that AfricanAmericans, Hispanics, Asians, & other minorities experience higher levels of psychological distress & disorder than the mainstream population lifetime rates for phobic disorder were significantly higher among African American respondents, with young Hispanics showing a higher prevalence of alcohol abuse Mexican-Americans with low acculturation status are reported to display low prevalence for most psychiatric disorders

Culture-Bound Syndrome

Course & Prognosis

limited data on the longitudinal course of patients with culture-bound syndromes that suggest that some of them develop clinical features compatible with a diagniosis of schizophrenia, bipolar disorder, cognitive disorder, or other psychotic disorders

Culture-Bound Syndrome

Treatment
determining whether the symptomatology represents a culturally appropriate adaptive response to a situation clinicians are well advised to: (1) know/search out the demographics of the local population or area being served (2) recognize that always a local pattern exists of conceptualization, naming, vocabulary, explanation, & treatment of patterns of distress that afflict a community, including mental disorders, and (3) talk with the family & learn about local customs/search out other modes of documentation

Culture-Bound Syndrome
Treatment

when taking history here are some useful questions: (1) what do you think has caused your problem? (2) why do you think it started when it did? (3) what do you think your sickness does to you? how does it work? (4) how severe is your sickness? will it have a short/long course? (5) what kind or treatment do you think you should receive? insight into the dynamics of the patients world facilitates the clinicians efforts to adapt his/her techniques and opens the possibility of direct intervention in the lives of patients, who may be willing to cooperate when they feel understood

Culture-Bound Syndrome

Treatment Therapies cognitive & cognitive behavior therapies may achieve some modicum of freedom from cultural bias to the degree that cognitive therapists work with pathogenic beliefs of the patient, whatever cultural origin of such beliefs its application to minority populations experiencing anxiety & depressive disorders may be an area of promising cross-cultural research

Culture-Bound Syndrome
Treatment Indigenous Healers several researches have reported on their success in the use of indigenous & traditional healers in the treatment of psychiatric patients, especially those whose psychotic conditions are substantially connected to culture-specific beliefs (e.g., fear of voodoo death) decisions about involving indigenous healers should be individualized & planned thoughtfully, taking into consideration the setting, the thoughtfulness & flexibility of the available healers, the type of psychopathology, & the patients characteristics

Culture-Bound Syndrome
Examples of Culture-Bound Syndromes amok - a dissociative episode characterized by a period of brooding followed by an outburst of violent, aggressive, or homicidal behavior directed at persons & objects use of this term were from Malaysia; similar behavior pattern found in Laos, Philippines, Polynesia, Papua New Guinea & Puerto Rico ataque de nervios - commonly reported symptoms include uncontrollable shouting, attacks of crying, trembling, heat in chest rising into the head, & verbal or physical aggression bilis & colera (aka muina) - underlying cause is anger/rage -symptoms can include acute nervous tension, headache, trembling, screaming, stomach disturbances, & in more severe cases, loss of consciousness bouffe dlirante - syndrome observed in West Africa & Haiti -French term refers to a sudden outburst of agitated & aggressive behaviour, marked confusion, & psychomotor excitement brain fag - term initially used in West Africa to refer a condition experienced by students in response to the challenges of schooling -symptoms include difficulties in concentrating, remembering, & thinking

Culture-Bound Syndrome
Examples of Culture-Bound Syndromes dhat - term used in India to refer to severe anxiety & hypochondriacal concerns associated with the discharge of semen, whitish discoloration of urine, & feelings of weakness & exhaustion falling-out or blackout - episodes that occur primarily in southern United States and Caribbean groups -characterized by sudden collapse, preceded by feelings of dizziness or swimming in the head -eyes are usually open, but the person claims an inability to see ghost sickness - a preoccupation with death & the deceased (sometimes associated with witchcraft), frequently observed among members of many American Indian tribes -symptoms include bad dreams, weakness, feeling of danger, loss of appetite, fainting, dizziness, fear, anxiety, hallucinations, loss of consciousness, confusion, feelings of futility, & sense of suffocation hwa-byung (aka wool-hwa-byung) - a Korean folk syndrome literally translated into English as anger syndrome -symptoms include insomnia, fatigue, panic, fear of impeding death, dysphoric affect, indigestion, anorexia, dyspnea, palpitations, generalized aches & pains, & feeling of a mass in the epigastium koro - term probably of Malaysian origin, that refers to an episode of sudden & intense anxiety that the penis (or, in women, the vulva & nipples) will recede

Culture-Bound Syndrome
Examples of Culture-Bound Syndromes latah - hypersensitivity to sudden fright, often with echopraxia, echolalia, command obedience, & dissociative or trancelike behavior -has been found in many parts of the world (silok in Philippines) locura - term used by Latinos in the US & Latin America to refer to a severe form of chronic psychosis -symptoms exhibited include incoherence, agitation, auditory & visual hallucinations, inability to follow rules of social interaction, unpredictability, & possibly violence mal de ojo - a concept widely found in Mediterranean cultures & elsewhere in the world -a Spanish phrase translated into English as evil eye -children are especially at risk -symptoms include fitful sleep, crying without apparent cause, diarrhea, vomiting & fever in a child or infant nervios - a common idiom of distress among Latinos in the US & Latin America - symptoms include headaches & brain aches, irritability, stomach disturbances, sleep difficulties, nervousness, easy tearfulness, inability to concentrate, trembling & tingling sensations piblokto - an abrupt dissociative episode accompanied by extreme excitement of up to 30mins duration & frequently followed by convulsive seizures & coma lasting up to 12hours -observed primarily in Arctic & subarctic Eskimo communities

Culture-Bound Syndrome
Examples of Culture-Bound Syndromes qi-gong psychotic reactions - acute, time-limited episodes characterized by dissociative, paranoid, or other psychotic/nonpsychotic symptoms that may occur after participation in the Chinese folk health-enhancing of qi-gong (exercise of vital energy) rootwork - set of cultural interpretations that ascribe illness to hexing, witchcraft, sorcery, or evil influence of another person -symptoms may include generalized anxiety & gastrointestinal complaints (e.g., vomiting), weakness, dizziness, the fear of being poisoned, & sometimes fear of being killed (voodoo death) -found in the southern US among both African-American & EuropeanAmerican populations & in Caribbean societies sangue dormido (sleeping blood) - found among Portuguese Cape Verde Islanders -includes pain, numbness, tremor, paralysis, convulsions, stroke, blindness, heart attack, infection, & miscarriages Shenjing shuariuo (neurasthenia) - in China a condition characterized by physical & mental fatigue, dizziness, headaches, other pains, concentration difficulties, sleep disturbance, & memory loss shen-kuei - Chinese folk label describing marked anxiety or panic symptoms with accompanying somatic complaints for which no physical cause can be demonstrated -symptoms include dizziness, backache, fatigability, general weakness, insomnia, frequent dreams, & complaints of sexual dysfunction, such as premature ejaculation and are attributed to excessive semen loss

Culture-Bound Syndrome
shin-byung - Korean folk label for a syndrome in which initial phases are characterized by anxiety & somatic complaints (general weakness, dizziness, fear, anorexia, insomnia, gastrointestinal problems) spell - trance state in which persons communicate with deceased relatives or spirits -culture-specific syndrome is seen among African-Americans & EuropeanAmericans from the southernUS susto (soul loss) - folk illness prevalent among some Latinos in the US & among people in Mexico, Central America, & South America -is an illness attributed to a frightening event that causes the soul to leave the body & results in unhappiness & sickness -typical symptoms include appetite disturbances, inadequate or excessive sleep, troubled sleep/dreams, feelings of sadness, lack of motivation to do anything, & feelings of low self-worth taijin kyofu sho - culturally distinctive phobia in Japan -refers to intense fear that ones body, its parts or its functions, displease, embarrass, or are offensive to other people in appearance, odor, facial expressions, or movements zar - general term in Ethiopia, Somalia, Egypt, Sudan, Iran & other North African & Middle Eastern societies to the experience of spirits possessing a person -persons possessed by a spirit may experience dissociative episodes that may include shouting, laughing, hitting the head against a wall, singing, or weeping

mana nagyud tawn, hhaahayyYAY! haha