Schizophrenia and Schizoaffective Disorder DSM-IV-TR TM Russell L. Smith, M.S., LPA, HSP-PA, CCBT,...
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Transcript of Schizophrenia and Schizoaffective Disorder DSM-IV-TR TM Russell L. Smith, M.S., LPA, HSP-PA, CCBT,...
Schizophrenia
and Schizoaffective Disorder
DSM-IV-TRTM
Russell L. Smith, M.S.,LPA, HSP-PA, CCBT, MAC, FABFCE, NCP
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000
In Schizophrenia, “Psychotic” refers to
delusions, any prominent
hallucinations, disorganized speech, or disorganized or catatonic
behavior.
Subtypes
295.30 Paranoid 295.10 Disorganized 295.20 Catatonic 295.90 Undifferentiated 295.60 Residual
Course Specifiers
Episodic With Interepisode Residual Symptoms
Episodic With No Interepisode Residual Symptoms
Continuous Single Episode in Partial
Remission* Single Episode in Full
Remission* Other Or Unspecified Pattern
*With Prominent Negative Symptoms can be added ...
Range of Emotional & Cognitive Dysfunction*
Perception Inferential thinking Language &
communication Behavioral monitoring Affect Fluency & productivity of
thought & speech Hedonic capacity Volition & drive Attention* Associated with impaired
occupational or social functioning
Positive Symptoms
Reflect an excess or distortion of normal functions
“psychotic dimension ” Thought content Perception
“disorganization dimension ” Language & thought
processes Self-monitoring of
behavior
Negative Symptoms
A decrease or loss of normal functions
Range & intensity of emotional expression
Fluency & productivity of thought and speech
Initiation of goal-directed behavior
SchizophreniaDiagnostic Criterion A A. Characteristic symptoms:
two or more ... for significant portion of 1-month (or less if successfully treated):
1. Delusions2. Hallucinations3. Disorganized speech (e.g., frequent
derailment or incoherence)4. Grossly disorganized or catatonic
behavior5. Negative symptoms, i.e., affective
flattening, alogia, or avolition
Note: Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person’s behavior or thoughts, or two or more voices conversing with each other.
SchizophreniaDiagnostic Criterion B
B. Social/Occupational Dysfunction ...
• ... for a significant portion of time since onset ...
• one or more major areas of functioning such as work, interpersonal relations, or self-care ... markedly below level prior to onset
• If onset in childhood or adolescence ... failure to achieve expected level of interpersonal, academic, or occupational achievement
SchizophreniaDiagnostic Criterion C
C. Duration• Continuous signs persist for at
least 6 months at least one month meet
Criterion A (less than month if effectively treated)
may include prodromal or residual symptoms
• may be manifested by only negative symptoms or two or more symptoms listed in Criterion A presented in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).
SchizophreniaDiagnostic Criterion D
D. Schizoaffective and Mood Disorder have been
ruled out because either• there has been no Major
Depressive, Manic, or Mixed Episodes, or
• if mood episodes have occurred during the active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods.
SchizophreniaDiagnostic Criterion E
E. Substance/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)
• The disturbance is not due to a general medical condition.
SchizophreniaDiagnostic Criterion F
F. Relationship to Pervasive Developmental Disorder
• If there is a history of Autism Disorder or another Pervasive Developmental Disorder ...
the additional diagnosis of Schizophrenia is made only if prominent delusions or hallucinations are also present ...
for at least one month (or less if successfully treated).
295.30 Paranoid Type
Preoccupation with one or more delusions or frequent auditory hallucinations.
None of the following is prominent:• disorganized speech• disorganized or catatonic
behavior• flat or inappropriate affect.
295.10Disorganized Type
All of the following are prominent: disorganized speech disorganized behavior flat or inappropriate affect.
The criteria are not met for Catatonic Type.
295.20 Catatonic Type
At least two of the following: motoric immobility as
evidenced by catalepsy (including waxy flexibility) or stupor
excessive motor activity (purposeless and not influenced by external stimuli)
extreme negativism or mutism peculiarities of voluntary
movement as evidenced by posturing, stereotyped movements, prominent mannerisms, or prominent grimacing
echolalia or echopraxia
295.90 Undifferentiated Type
... the presence of symptoms that meet Criterion A of Schizophrenia but that do not meet criteria for the Paranoid, Disorganized, or Catatonic Type.
295.60 Residual Type
Absence of prominent delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior.
There is continuing evidence of the disturbance ... presence of negative symptoms,
or two or more of the symptoms
listed in Criterion A but in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).
Schizophrenia:Features
Cultural & Socioeconomic Beliefs & Religion Language, Emotional Expression &
Nonverbal style Industrial vs Developing
Men: Onset 18-25 years ... more negative symptoms (flat affect, avolition, social withdrawal)
Women: Onset 25 to mid-30s (3% to 10% onset after 40) ... better permorbid functioning, more affective symptoms, paranoid delusions, and hallucinations
295.70 Schizoaffective Disorder
A. An uninterrupted period of illness during which, at least 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.
B. During the same period of illness, there have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms.
295.70 Schizoaffective Disorder
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. Not due to drug of abuse, medication or a general medical condition.
Specify Type:Bipolar Type: ... if Manic or Mixed Episodes (or Manic or Mixed and Major Depressive Episodes)Depressive Type: Major Depressive Episodes
TO BE OR NOT
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