Review of DSM5 Mental Disorders for NCMHCE Study

Key FeaturesDelusionsHallucinationsDisorganized Thinking (speech)Grossly Disorganized or Abnormal Motor Behavior (Including Catatonia)Negative Symptoms

1. Brief Psychotic Disorder2. Delusional Disorder3. (Schizotypal Personality Disorder)4. Schizophreniform Disorder5. Schizoaffective Disorder6. Schizophrenia7. Catatonia8. Substance/Medication-Induced Psychotic Disorder9. Psychotic Disorder Due to Another Medical Condition10. Other Specified Schizophrenia Spectrum and Other Psychotic

Disorder11. Unspecified Schizophrenia Spectrum and Other Psychotic

Disorder

Brief Psychotic1-30 days No mood disorderNo negative symptoms

SchizophreniformNo negative symptoms1-6 months

SchizophreniaNegative symptoms, unmotivated1 month period of psychosisPersisting 6 months

Schizoaffective Mood disorder

All have positive psychotic symptoms

S4. Assess & ReferTestsPNSS Positive & Negative Syndrome ScalesStructured Interview for Psychotic Symptoms

S4. TreatmentMedicationsAntipsychotics

TherapyBehavior TherapiesPsychosocial Therapies

Diagnosis IKey: Discomfort in close relationships, distorted thinking and perceptions, and eccentric behavior

Requires at least 5:1) Senses others are thinking of them2) Belief in superstitions and magical thinking and powers3) Odd perceptions4) Odd thinking and speech5) Suspiciousness and paranoia6) Constricted, inappropriate affect7) Odd behavior8) Lacks close friends9) Social anxiety related to paranoia

Diagnosis IICo-occurring:Delusional disorderSchizophreniform disordersSchizophrenia

Rule out:Autism Spectrum DisorderDisturbance is only part of a psychotic disorderBipolar or depressive disorder with psychotic featuresResult of medical problem

Diagnosis1. Presence of one or more of the following symptoms:DelusionsHallucinations Disorganized speech Grossly disorganized or catatonic behavior2. Lasts at least one day but less than one month Full return to premorbid level of functioningOften in response to a very stressful event, such as a death in the family

Rule OutMajor depressive or bipolar disorder with psychotic features Other psychotic disorder

S1. Find OutMedical historyAffective functioningCognitive functioningDevelopment of symptoms, duration and frequencyFamily historyPast traumaSubstance use history

S2. Refer or AssessMedical evaluation (heart, thyroid)Psychiatric evaluationTestsPNSS Positive & Negative Symptom ScalesStructured Interview for Psychotic SymptomsMental status exam

S4. TreatmentMedicationsAnti-psychotic

TherapyPsychoeducationHospitalization until positive symptoms under controlNAMI for community support

S5. MonitoringCompletion of homework assignmentsFrequency and severity of symptoms check list Medication compliance

S6. TerminationContinued medicationAnxiety support group

Diagnosis1. Presence of delusion only Non bizarre, plausible Internally consistent2. Long lasting, held strongly3. Specifiers Erotomanic Grandiose Jealous Persecutory Somatic Mixed Unspecified

Rule OutMajor depressive or bipolar disorder with psychotic features Other psychotic disorder

S1. Find OutMedical historyAffective functioningCognitive functioningDevelopment of symptoms, duration and frequencyFamily historyPast traumaSubstance use history

S2. Refer or AssessPsychiatric evaluationTestsStructured Interview for Psychotic SymptomsMental status exam

S4. TreatmentVery challenging since the patient sees no problemNon judgmental, empathetic stance

TherapyCBTMedicationsAnti-psychotics (for agitation)

Diagnosis1. Two or more of the following during 1 month period:

Delusions Hallucinations Disorganized speech Grossly disorganized/ catatonic

behavior Negative symptoms Symptoms similar to Schizophrenia

but duration is less2. Episode lasts at least 1 month but less than 6 months

Rule OutSchizoaffective disorderDepressive/Bipolar disorders with psychotic features Not attributed to substance use or medical condition

S1. Find OutMedical historyAffective functioningCognitive functioningDevelopment of symptoms, duration and frequencyFamily historyPast traumaSubstance use history

S2. Refer or AssessMedical evaluation (heart, thyroid)Psychiatric evaluationTestsPNSS Positive & Negative Symptom ScalesStructured Interview for Psychotic SymptomsMental status exam

S4. TreatmentMedicationsAntipsychotics

TherapyPsychoeducationBehavior TherapySocial Skills TrainingHospitalization until positive symptoms under controlNAMI for community support

Diagnosis I1. Requires 2 or more of the following for a significant time

during a 1 month period: Delusions, Hallucinations, Disorganized speech (frequent derailment or incoherence), Grossly disorganized or catatonic behavior, Negative symptoms2. Since onset of disturbance, level of functioning in work,

social relations, or self care is below what it was prior Or failure to achieve expected level if onset is in

childhood/adolescence3. Symptoms persist for at least 6 months Psychotic features typically emerge between the late

teens and the mid-30s

Rule OutSubstance or medically induced

Diagnosis IIPositive Symptoms are excesses in behavior: Hallucinations (critical voices) Delusions: Unrealistic beliefsDisorganized speech, inability to maintain conversationDisorganized or catatonic behavior can be bizarreNegative Symptoms are deficits in behavior (reduced function): Reduction of emotional expressionLack of motivation or energyLoss of enjoyment in activities (social interaction)Negative symptoms tend to be the most persistent

Four A’s of Schizophrenia: Inappropriate AffectLoosening of AssociationsAutistic ThoughtsAmbivalence

Common Delusions: GrandeurPersecutionReferenceSomaticControl

S1. To Find Out S2. Assess & ReferVeriPsych Blood Test (measures 51 biomarkers)TestsPNSS Positive & Negative Syndrome ScalesStructured Interview for Psychotic SymptomsMental status exam

S4. TreatmentMedicationsAntipsychotics (Abilify, Clozaril, Seroquel, Risperdal)

TherapyPsychoeducationSocial Skills TrainingHospitalization until positive symptoms under controlStress ManagementNAMI for community support

S5. MonitoringCompletion of homework assignmentsFrequency and severity of symptoms check list Medication compliance

S6. TerminationContinued medicationAnxiety support group

DiagnosisSymptoms of both schizophrenia and a mood disorder Uninterrupted period of illness where there is a major mood episode

(major depressive/manic) concurrent with Schizophrenic symptoms, or alternating▪ Delusions or hallucinations for 2 or more weeks in the absence of

major mood episode (depressive or manic) during the lifetime duration of illness

▪ Major mood symptoms are mostly presentSpecify type Bipolar Depressive

S4. TreatmentMedicationsMood stabilizers for bipolar type (Lithium, Depakote)

Also anticonvulsants Antidepressants for depression (Prozac, Lexapro)Antipsychotics

Therapy

Diagnosis1. Presence of 1 or both of the following: DelusionsHallucinations2. Symptoms developed during or soon after substance intoxication or withdrawal or after exposure to a medicationInvolved substance is capable of producing the psychotic symptomsAs shown from the history, physical examination or laboratory findings

Rule OutIndependent psychotic disorderDelirium

Diagnosis1. Prominent hallucinations or delusions2. Direct pathophysiological consequence of another medical conditionNot better explained by another mental disorderNot occurring exclusively during the course of a deliriumSpecify with delusions or hallucinations

S4. TreatmentResolve medical conditions

Catatonia Associated with Another Mental DisorderCatatonia Disorder due to Another Medical ConditionUnspecified Catatonia