Thought Disorders

Thought Disorders DSM IV  Psychotic symptoms for 1 month  Two or more of following: Prominent Hallucinations Bizarre Delusions Disorganized Speech Disorg or catatonic behavior Negative sx – flat affect, etc  Some sx (chronic phase) for at least six months – negative sx  Decr level of fx  No prominent mood sx  No organic cause for sx Characteristics  Subtypes Paranoid Catatonic Disorganized Undifferentiated Residual  Often quiet, passive child  Abnormal EOM  Tics  Decr fine motor skills  Abnormal motor tone  Ventricular enlargement  Decr frontal lobe metabolism  Some tendency toward left-sided abnormalities in EEG When psychotic, projective test (Rorshach) abnormal Mood disorders with psychotic symptoms Personality Disorders  If psychotic symptoms are brief relative to mood symptoms  Can mimic schizophrenia  Pts with borderline, paranoid, schizoid, and schizotypal personality disorders all may have brief periods of psychotic symptoms  Prominent halluc’s or delusions  Due to a gen med condition  Evidence from hx, phys exam, or lab findings that the hallucinations or delusions are the direct physiologic consequence of the general medial condition  Not better accounted for by another mental disorder Prevalence/Age/Course  LP = 1%  Men = women  Late teens/early adulthood  Chronic deteriorating course of exacerbations and remisions  50% attempt suicide, 10% succedd Genetics  Concordance MT = 45% DT = 12%  Probably inherit predisposition to develop psychotic symptoms  Psychoticism – limbic/temporal lobe  Negative symptoms – left frontal lobe  Disorganized speech – right frontal lobe  Antipsychotics tx of choice Schizophrenia Psychotic Disorders due to a General Medical Condition  Disturbance does not occur exclusively during the course of delirium SubstanceInduced Psychotic Disorders  Prominent halluc’s or delusions  Due to direct physiologic effect of a substance  Evidence from hx, PE, or lab findings that:  H/D developed during intox or withdrawal or  H/D develop w/in a month of intoxication or withdrawal  Medication use is etiologically related to the disturbance  Disturbance is not better accounted for by a non-substance induced psychotic disorder  Disturbance does not occur exclusively during the course of delirium  Should be listed according to substance of abuse  Intoxication: Alcohol Amphetamines Cannabis Cocaine Hallucinogens Inhalants Opiates PCP Sedatives Hypnotics Anxiolytics  Withdrawal: Alcohol Sedatives Hypnotics Anxiolytics Schizopreniform Disorder  Similar to schizophrenia  Total duration of illness: One month to six months  Impaired social and occupational fx during some part of illness is not required Good prognosis if:  Onset of prominent psychotic sx w/in four weeks of first noticealbe change in fx  Confusion or perplexity at height of psychotic episode  Good premorbid fx  Absence of blunted or flat affect  Prognosis is better than schizophrenia but worse than mood disorders  LP = 0.2%  1/3 of pts recover w/in 6 month period and receive schizophreniform as final dx  2/3 of pts progress to a dx of schizophrenia or schizoaffective disorder  Less common that schizophrenia  Age of onset is early adulthood  Incr risk for schizophrenia in FDR of pts with schizoaffective disorders  Relatives of pts with schizoaffective disorder are not at incr risk for mood disorder Schizoaffective Disorder  Uninterrupted period of illness  Mood sx concurrent with psychotic symptoms typical of schizophrenia  At least 2 weeks with H/D with prominent mood symptoms  Cannot dx schizophrenia  Cannot dx mood disorder  Not due to drug/med, or general Delusional Disorder medical condition  Non-bizarre delusions  Last for at least one month  Fx is not markedly impaired  Behavior is not obviously odd except for delusions  Not due to drug/med, or general medical condition  Cannot dx if criteria for schizophrenia has ever been met  Sudden onset of at least one: Delusions Hallucinations Disorganized speech Disorg or catatonic behavior  At least 1 day but less than 1 mo.  Eventual return to premorbid level of fx  Not better accounted for by a mood disorder w/ psychotic features, schizoaffective, or schizophrenia  Not due to drug/meds or general medical condition  Delusion develops in an individual b/c of close relationship with an already-delusional person  Second person shares the beliefs of the primary case in whole or part  Not better accounted for by another psychotic disorder or a mood disorder w/ psychotic features  Not due to drug/meds, or general medical condition  Includes psychotic symptoms  Inadequate info to make a dx  Symptoms do not meet criteria for any specific psychotic disorder Subtypes:  Erotomanic  Grandiose  Jealous  Persecutory  Somatic  Mixed  Unspecified  P = 1-2% of admissions to in-pt facilities  0.03% of population  Age of onset is middle or late adult life  Persecutory is most common  Age of onset is late 20’s or 30’s Brief Psychotic Disorder Shared Psychotic Disorder Folie a Deux  Prevalence is rare  May be more common is women than in men Psychotic Disorder Not Otherwise Specified  Psychotic symptoms have lasted for less than a month but have not yet remitted, so dx of brief psychotic disorder cannot be made  Persitent auditory halluc’s in the absence of any other features  Persistent non-bizzarre delusions w/ overlapping mood episodes that have been present for a sunstantial portion of the delusional disturbance  Various culture-bound syndromes AMOK  Dissociative episode  Period of brooding followed by outburst of violent, aggressive, or homicidal behavior  Precepitated by perceived slight or insult  Idiom of distress  Uncontrollable shouting  Attacks of crying, trembling, heat in chest rising to the head  Verbal or physical aggression  Dissociatve experiences, seizurelike fainting episodes, and suicidal gestures may be prominent  General sense of “being out of control”  Freq occurs as a direct result of a stressful event relating to the family  Severe anxiety and hypochondrial concerns assoc w/ discharge of semen, whitish discoloration of urine, and feeling of weakness and exhaustion  Episode of sudden and intense anxiety that the penis will recede into the body and possibly cause death  Hypersensitivity to sudden fright  Echopraxia, echolalia, command obedience, dissociative, and trancelike behavior  Malaysia  Seems to be prevalent only in males Ataque de Nervios  Latinos from Caribbean  Many Latin American and Latin Mediterranen groups DHAT  India Koro  Malaysia  South and East Asia Latah Startle Matching Reaction  Malaysia  Indonesia  Most prevalent in middle-aged women Mal de Ojo  Evil eye  Children are especially at risk  Fitful sleep, crying, diarrhea, vomiting and fever in a child or infant  Abrupt dissociative episode  Extreme excitement of up to 30 minutes duration  May tear off clothing, break furniture, shout obscenities, eat feces, flee from shelters  Freq followed by convulsive seizures and coma lasting up to 12 hours  Person may be withdrawn/irritable for hrs or days before attack  Usually has complete amnesia for the attack  Cannabalistic syndrome  Person believes he may be transformed into a giant monster who eats flesh  Often preceded by depression or a ppt factor  May manifest homicidal or suicidal  Many Meditaerranean cultures Piblokto  Artic and sub-Artic Eskimo communities Windigo  Northeast and Central Canada primarily among North American Indians  May exist in a subculture that believes in witchcraft