Schizophrenic Disorders

7 Key excerpts on "Schizophrenic Disorders"

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  Psychopathology and Psychotherapy

  DSM-5 Diagnosis, Case Conceptualization, and Treatment

  • Len Sperry, Jon Carlson, Jill Duba Sauerheber, Jon Sperry(Authors)
  • 2014(Publication Date)
  • Routledge

    (Publisher)

  So what exactly is Schizophrenia and the psychotic process? In brief, Schizophrenia is a syndrome consisting of a highly altered sense of inner and outer reality to which individuals respond in ways that impair their lives. This altered sense of reality, which is the core of this disorder, shows itself in disturbances of speech, perception, thinking, emotion, and physical activity. The most common form of psychosis is Schizophrenia. The term literally means “splitting of the mind,” which in popular parlance connotes a “split personality” or multiple personality. Technically, however, Schizophrenia refers to the incongruity between different mental functions; that is, between thought content and feeling, or between feeling and overt activity. For example, an individual diagnosed with Schizophrenia may talk of being sad or terrified by a specific event, while laughing or showing no affect whatsoever. The case of John Nash and the other case examples in this chapter demonstrate these and other clinical features and dynamics.

  This chapter consists of sections which describe the following psychotic disorders: Schizophrenia and Schizophreniform Disorder; Delusional Disorder; Schizoaffective Disorder; Brief Psychotic Disorder; and Substance- and Medication-Induced Psychotic Disorders. The plan for each section is to begin with a clinical description of the disorder and its DSM-5 characterization. Next, a biopsychosocial-Adlerian conceptualization of that disorder is provided. This is followed by a brief discussion of treatment considerations. Finally, a case example rounds out the discussion of the disorder. However, before turning to specific psychotic disorders, the chapter begins with a general Adlerian conceptualization of psychosis and the psychotic process.

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  A Guide to Psychiatric Services in Schools

  Understanding Roles, Treatment, and Collaboration

  • Shawna S. Brent(Author)
  • 2012(Publication Date)
  • Routledge

    (Publisher)

  The most serious of the psychotic disorders is schizophrenia. Closely related to this illness is schizophreniform disorder, which is similar but is used as a diagnosis if the symptoms have been present for fewer than 6 months. Another psychotic disorder is brief psychotic disorder, which is the presence of one of the psychotic symptoms (delusions, hallucinations, disorganized speech, or grossly disorganized behavior) for more than 1 day but less than 1 month (American Psychiatric Association [APA], 2000 p. 332). A final common diagnosis is psychotic disorder, not otherwise specified, which implies some psychotic symptoms, but the symptoms do not meet full criteria for any other psychotic illness.

  The first section of this chapter will focus on illnesses where psychosis is the primary problem. The second and third sections will focus on psychosis in the context of a mood disorder, and the fourth section focuses on psychosis in the context of a substance abuse disorder.

  SCHIZOPHRENIFORM DISORDER AND SCHIZOPHRENIA

  Characteristics

  The primary distinction between schizophreniform disorder and schizophrenia is the time the symptoms have been present. A person is first diagnosed with schizophreniform disorder when the psychotic symptoms have been present for 1 month but fewer than 6 months. After 6 months if the symptoms persist, the diagnosis changes to schizophrenia.

  Two or more of the characteristic symptoms must be present for either illness: delusions, hallucinations, disorganized speech (also termed thought disorder), grossly disorganized or catatonic behavior, or negative symptoms such as affective flattening, alogia, or avolition. The symptoms must cause significant functional impairment and cannot occur exclusively during a mood disorder or be a direct result of a substance (APA, 2000, p. 310).

  The term formal thought disorder can be used when discussing the psychotic symptoms in schizophrenia. When an individual has a thought disorder, there is a lack of connection with the words and thoughts that the person expresses. A person with schizophrenia can have disorganized thoughts where there is no connection between the words in the sentence. In the most severe form of schizophrenia, the term word salad

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  Selecting Effective Treatments

  A Comprehensive, Systematic Guide to Treating Mental Disorders

  • Lourie W. Reichenberg, Linda Seligman(Authors)
  • 2016(Publication Date)
  • Wiley

    (Publisher)

  After the births of each of her children, Calista became depressed and began taking prescription painkillers to “numb out.” She started sleeping all day and using drugs and alcohol to escape. It was at this time that she had the car accident, and her parents, who were worried about the safety of Calista and her children, insisted she seek counseling. Calista was diagnosed with delusional disorder, grandiose type, continuous, with bizarre content.

  Delusions, hallucinations, and thought disorders are the hallmark traits of schizophrenia spectrum and other psychotic disorders. DSM-5 takes a spectrum approach to the psychotic disorders and organizes the category based on increasing degree of psychopathology. Clinicians are encouraged to consider lesser disorders (e.g., schizotypal personality disorder, delusional disorder) first, before moving up the psychosis pathway to time-limited conditions (brief psychotic disorder, schizophreniform disorder), or before considering a diagnosis of full-blown schizophrenia or schizoaffective disorder, which may involve catatonia, disorganized motor behavior, and negative symptoms (i.e., flat affect, diminished speech, anhedonia).

  All the schizophrenia spectrum disorders can be quickly assessed to determine severity of symptoms with the Clinician-Rated Dimensions of Psychosis Symptom Severity included in DSM-5 (American Psychiatric Association [APA], 2013, p. 743) although this is not a requirement for diagnosis. The two-page assessment is a handy rater of symptoms of hallucinations, delusions, disorganized speech, abnormal psychomotor behavior, negative symptoms, impaired cognitions, depression, and mania.

  Now we turn to a description of the following disorders included in this chapter:

  • Schizotypal personality disorder
  • Delusional disorder
  • Brief psychotic disorder
  • Schizophreniform disorder
  • Schizophrenia
  • Schizoaffective disorder
  • Substance/medication-induced psychotic disorder
  • Psychotic disorder due to another medical condition
  • Catatonia specifier
  • Other specified and unspecified schizophrenia disorders

  Schizotypal Personality Disorder

  Considered to be one of the schizophrenia spectrum disorders, schizotypal personality disorder is listed in this chapter. The full criteria are discussed in detail in the chapter on personality disorders.

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  First Person Accounts of Mental Illness and Recovery

  • Craig W. LeCroy, Jane Holschuh(Authors)
  • 2012(Publication Date)
  • Wiley

    (Publisher)

  1 Schizophrenia and Other Psychotic Disorders INTRODUCTION

  We begin this book with the first person accounts (FPAs) written by people who have been diagnosed with or have experienced the symptoms of a psychotic disorder. The Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR ) groups together under this category disorders that involve a variety of serious symptoms that have considerable impact on people’s daily lives. Of these disorders, schizophrenia is the prototype. Earlier versions of the DSM took a unitary approach that conceptualized psychopathology on a continuum; neurosis reflected a higher level of functioning and psychosis signified the greatest impairment in functioning. Arieti’s (1974) concept of a “break with reality” defined psychosis more narrowly and is why the first signs/symptoms or episode of schizophrenia has been termed a first break. Psychosis represented an inability to distinguish between internal and external stimuli. The break with reality referred to this loss of ability to reality test, or to tell whether, for example, the voices a person hears are real and are being heard by others or not. This way of thinking about psychosis has endured. In neurotic disorders as defined by the first two DSM s, this capacity remained intact. Beginning with DSM-III, the manual abandoned the unitary approach and, instead, defined psychopathology as discrete or distinct categories of disorders and developed a core set of criteria for each disorder.

  People who have been diagnosed with any of the psychotic disorders may experience problems in perception (hallucinations in any of the five sensory areas, but most often auditory or visual hallucinations), delusions or false beliefs, disorganized speech (and thought), and/or disorganized or catatonic behavior. While these psychotic symptoms are common across the disorders in this category, such symptoms are not thought of as the core parts of every disorder in this section, and there is variation in the symptoms that are considered psychotic for different disorders in this category. In schizophrenia, schizophreniform disorder, schizoaffective disorder , and brief psychotic disorder , the following are psychotic symptoms: delusions, any hallucinations (with or without accompanying insight) that are prominent, disorganized speech, and disorganized or catatonic behavior. In substance-induced psychotic disorder and psychotic disorder due to a general medical condition, only delusions and hallucinations with no insight are considered to be psychotic. In delusional disorder and shared psychotic disorder

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  Adult Psychopathology and Diagnosis

  • Deborah C. Beidel, B. Christopher Frueh(Authors)
  • 2018(Publication Date)
  • Wiley

    (Publisher)

  DSM-5 were met because these difficulties lasted longer than 6 months. In addition, with respect to the D and E diagnostic criteria for schizophrenia, other diagnoses were ruled out (e.g., mood disorders, substance abuse, developmental disorders). In addition to illustrating some of the symptoms and characteristic impairments of schizophrenia, this vignette illustrates that people with this illness are often able to lead rewarding and productive lives, usually with the help of pharmacological and psychological treatments, as well as social supports, despite continued symptoms and impairment due to the illness.

  Summary

  Schizophrenia is a severe, long-term psychiatric illness characterized by impairments in social functioning, the ability to work, self-care skills, positive symptoms (hallucinations, delusions), negative symptoms (social withdrawal, apathy), and cognitive impairments. Schizophrenia is a relatively common illness, afflicting approximately 1% of the population, and tends to have an episodic course over the lifetime, with symptoms gradually improving over the long term. Most evidence indicates that schizophrenia is a biological illness that may be caused by a variety of factors, such as genetic contributions and early environmental influences (e.g., insults to the developing fetus).

  Despite the biological nature of schizophrenia, environmental stress can either precipitate the onset of the illness or symptom relapses. Schizophrenia can be reliably diagnosed with structured clinical interviews, with particular attention paid to the differential diagnosis of affective disorders. There is a high comorbidity of substance use disorders in persons with schizophrenia, which must be treated if positive outcomes are to accrue. Psychological assessment of schizophrenia is most useful when it focuses on behavioral, rather than dynamic, dimensions of the illness. Thus, assessments and interventions focused on social skill deficits and family functioning have yielded promising treatment results. Biological assessments are useful at this time, primarily for descriptive rather than clinical purposes. Finally, there are a great many issues related to gender and racial or ethnic factors that remain unexplored.

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  Psychiatry of Intellectual Disability

  A Practical Manual

  • Julie P. Gentile, Paulette Marie Gillig(Authors)
  • 2012(Publication Date)
  • Wiley-Blackwell

    (Publisher)

  Self-stimulation is seen in individuals with pervasive developmental disorders, such as autism, Asperger's syndrome, and Pervasive Developmental Disorder Not Otherwise Specified. If the clinician does not know the individual well, differentiating these symptoms is challenging but possible. Because schizophrenia and other psychotic disorders are typically first experienced after childhood, and usually after adolescence, the clinician should look for a change from the baseline of the individual (see Clinical Vignette #2).

  Disorganized symptoms appear with the onset of schizophrenia. If an individual has always had the self-stimulating behavior, or a habit of waving his or her arms in the air, this would not be considered a disorganized symptom of emerging schizophrenia.

  Additionally, autistic disorder and autism spectrum disorders can be difficult to distinguish from psychotic disorders. Autism, meaning “withdrawing into the self,” was even one of Bleuler's “Four As” used to describe Schizophrenia. Autistic disorder is described as a failure in varying degrees since childhood of social relatedness and communication, e.g. poor eye contact, delayed and pedantic speech, and restricted behaviors. Individuals with psychotic disorders can have difficulties with social relatedness but, to qualify as a symptom of a psychotic disorder, a change from the baseline is required. The symptoms of a psychotic disorder also tend to wax and wane more than those of autism.

  Exclusion from Scientific Literature

  With the exception for journals devoted to intellectual or developmental disabilities, individuals with ID are usually excluded from major studies (e.g. the NIMH 2005 CATIE study, Lieberman, 2005) that looked at the effectiveness of antipsychotic medications in people with schizophrenia.

  People with ID are also excluded from major drug trials and all but completely ignored in the psychotherapy literature. This places more importance on the literature that is published, and Matson et al

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  Controversies and Dilemmas in Contemporary Psychiatry

  • Dusan Kecmanovic(Author)
  • 2017(Publication Date)
  • Routledge

    (Publisher)

  In other words, since they have different meaning, symptoms which appear in the context of psychosis cannot be compared to psychotic symptoms which are experienced by otherwise healthy people. Those who put these two kinds of phenomena on the same footing cloud the boundary between madness and sanity and, in fact, make it even more unclear. They do not see psychosis as an illness, i.e., as a negative condition, which is opposite to health. Thereby they deconstruct madness. One final point. Josef Parnas, Pierre Bovet, and Dan Zahavi (2002) point at the serious deficiency of the contemporary operationalist psychopathology—“a lack of descriptions of subtle pathology….” In tune with the spirit of clinical phenomenology, and of the works by Eugène Minkowski and Wolfgang Blankenburg in particular, they analyzed autism which “reflects a profoundly changed existential pattern” of schizophrenic patients. As it is known, autism is considered one of the main features of Schizophrenic Disorder. They stress out that autism encompasses three key characteristics: a disturbance in the realm of self, a unique disturbance of intentionality, and an impaired dimension of intersubjectivity. Briefly, “I,” “the world,” and “We,” as three inseparable instances, are affected in the schizophrenic autism. The changes that occur in a schizophrenic patient are profound and disturbing indeed. The world is no longer “pregiven as a tacit, unnoticed and unquestionable foundation of experience.” The patient perceives it as strange. “Everything may become a matter of deliberation … there is no evident and easy way to choose a dress, or to be sure of one’s own opinion during a conversation or a dispute.” The patient does not perceive themselves as the protagonist of their own actions, thoughts, and even movements. “There is an increasing gap or distance between the sense of self and experiencing” (2002). The patient feels as if they were someone else; also, the world looks strange to them

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