Sisay Y.

Psyc 325 1
 “Break with Reality”
 It is a collection of symptoms
 Caused by a variety of conditions that affect the
functioning of the brain.
 Includes hallucinations, delusions and thought
disorder
 Psychotic disorders include:
◦ Schizophrenia
◦ Delusional disorder
◦ Schizophreniform disorder
◦ Brief psychotic disorder
◦ Schizoaffective disorder
◦ Shared psychotic disorder

2
 Schizophrenia- severe mental disorders
characterized by the breakdown of integrated
personality functioning, withdrawal from reality,
emotional blunting and distortion, and
disturbances in thought and behavior.
 The term schizophrenia is Greek in origin
meaning "split mind”.
 In Western culture, some people have come to
believe that schizophrenia refers to a split-
personality disorder. These are two very different
disorders, and people with schizophrenia do not
have separate personalities.
 It is a life-long disease that cannot be cured, but
usually can be controlled with proper treatment.

3
 Schizophrenia is a severe, and disabling mental
illness. People suffering from schizophrenia may
have the following symptoms:
◦ Delusions, false personal beliefs held with conviction in
spite of reason or evidence to the contrary, not
explained by that person's cultural context
◦ Hallucinations, perceptions (can be sound, sight, touch,
smell, or taste) that occur in the absence of an actual
external stimulus (Auditory hallucinations, those of voice
or other sounds, are the most common type of
hallucinations in schizophrenia.)
◦ Disorganized thoughts and behaviors
◦ Disorganized speech
◦ Catatonic behavior, in which the affected person's body
may be rigid and the person may be unresponsive

4
 People diagnosed with schizophrenia usually experience a
combination of positive symptoms (i.e. hallucinations, delusions,
racing thoughts), negative symptoms (i.e. apathy, lack of
emotion, poor or non-existant social functioning), and cognitive
symptoms (disorganized thoughts, difficulty concentrating
and/or following instructions, difficulty completing tasks,
memory problems).
 Schizophrenia is characterized by profound disruption in
cognition and emotion, affecting the most fundamental human
attributes: language, thought, perception, affect, and sense of
self.
 The array of symptoms, while wide ranging, frequently includes
psychotic manifestations, such as hearing internal voices or
experiencing other sensations not connected to an obvious
source (hallucinations) and assigning unusual significance or
meaning to normal events or holding fixed false personal beliefs
(delusions).

5
 No single symptom is definitive for diagnosis; rather,
the diagnosis encompasses a pattern of signs and
symptoms, in conjunction with impaired occupational
or social functioning
 The diagnostic process usually involves the
elimination of other possible disorders showing
similar symptoms
 Schizophrenia varies in severity from person to
person. Some people have only one psychotic
episode while others have many episodes during a
lifetime but lead relatively normal lives between
episodes.
 Schizophrenia symptoms seem to worsen and
improve in cycles known as relapses and remissions.

6
7
 Lifetime prevalence is about 1% worldwide
 Gender ratio about equal (may be slightly higher
in males)
 Sex differences in onset, presentation, and
course
◦ Males diagnosed earlier than women (males age 15-25
years, females age 25 – 35 years)
◦ Women tend to have more mood symptoms
 Disorder may onset abruptly or gradually
◦ Most have a prodromal period  social withdrawal, lose
interest in work/school, deterioration of functioning
 Life expectancy is lower than non-Sz because of
suicide or accidents
 Commoner in urban areas, lower SEGs,
immigrants?

8
9
10
 There are five basic subtypes of schizophrenia:
 Paranoid schizophrenia: People with this type are
preoccupied with false beliefs (delusions) about
being persecuted or being punished by someone.
Their thinking, speech and emotions, however,
remain fairly normal.
 Disorganized schizophrenia: People with this
type often are confused and incoherent, and have
jumbled speech. Their outward behavior may be
emotionless or flat or inappropriate, even silly or
childlike. Often they have disorganized behavior
that may disrupt their ability to perform normal
daily activities such as showering or preparing
meals.

11
 Catatonic schizophrenia: People with this subtype are
generally immobile and unresponsive to the world around
them. They often become very rigid and stiff, and unwilling
to move. Occasionally, they have peculiar movements or
assume bizarre postures. Or, they might repeat a word or
phrase just spoken by another person. People with
catatonic schizophrenia are at increased risk of
malnutrition, exhaustion, or self-inflicted injury.
 Undifferentiated schizophrenia: This subtype is diagnosed
when the person's symptoms do not clearly represent one
of the other three subtypes.
 Residual Schizophrenia: In this type of schizophrenia, the
severity of schizophrenia symptoms has decreased.
Hallucinations, delusions, or other symptoms may still be
present but are considerably less than when the
schizophrenia was originally diagnosed.

12
 Signs and symptoms of schizophrenia may
include:
◦ Delusions — personal beliefs not based in reality, such
as paranoia that you're being persecuted or conspired
against
◦ Hallucinations — sensing things that don't exist, such as
imaginary voices
◦ Incoherence in thought and speech
◦ Lack of emotions or inappropriate display of emotions
◦ A persistent feeling of being watched
◦ Trouble functioning at work or in social situations
◦ Social isolation
◦ Difficulty with personal hygiene
◦ Clumsy, uncoordinated movements

13
 The symptoms of schizophrenia fall into three
broad categories:
◦ Positive symptoms are unusual thoughts or perceptions,
including hallucinations, delusions, thought disorder,
and disorders of movement.
◦ Negative symptoms represent a loss or a decrease in the
ability to initiate plans, speak, express emotion, or find
pleasure in everyday life. These symptoms are harder to
recognize as part of the disorder and can be mistaken
for laziness or depression.
◦ Cognitive symptoms (or cognitive deficits) are problems
with attention, certain types of memory, and the
executive functions that allow us to plan and organize.
Cognitive deficits can also be difficult to recognize as
part of the disorder but are the most disabling in terms
of leading a normal life.

14
 Positive Symptoms of Schizophrenia
◦ Delusions are firmly held erroneous beliefs due to
distortions or exaggerations of reasoning and/or
misinterpretations of perceptions or experiences.
 Grandiosity = belief that one has special importance
 Persecutory = belief that one is the subject of a master
plot; feeling of being mistreated
 Nihilistic = belief that something does not exist (e.g.,
one’s brain; part of the world)
 Religious = involves some religious theme (e.g. “I am
saving the world”)
 Bizarre = belief in something that could not be true
based on the person’s culture

15
 Different types of delusions include the following
 Persecutory – Belief that others are out to get them, and
believe being tormented, followed, tricked, spied on, or
subjected to ridicule.
◦ E.g., man who believe that whole neighborhood plus TV networks
are part of a large communication system that monitors his every
action to harass him. Neighbors run machines that generate the
harassing voices he hears, believes neighbors put special nails in
the bottom of his new shoes, etc.
 Somatic – Something is wrong or changed about one’s
body.
◦ e.g., one’s insides are rotting, “my kidneys are stolen by aliens”

16
 Control – Your feelings, impulses, thoughts or
actions are under the control of
someone/something else (can be another person,
an animal, a plant, an alien, etc).
 Grandiose – belief that one has exaggerated
power, abilities, importance. Often religious in
content. (belief that one is god, is on a mission
from god, etc.)
◦ E.g., “I can cure cancer by touching their forehead.”
 Delusions of reference – events occur in
reference to you.
◦ e.g., newscaster is talking just to you. Lyrics are for you.

17
 Thought broadcasting – thoughts are being
broadcasted so others can hear them.
◦ e.g.,” they are broadcasting my thoughts on the radio”
◦ NOT that others can read your thoughts, but that they can
actually hear them like they would a real voice.
 Insertion – some thoughts aren’t your own but are
put there by someone/something else
 Withdrawal – thoughts taken out of your head.
◦ NOT just lost, but some external force actually removing
the thoughts.
 Guilt –common in depression- Belief that one has
done something wrong, terrible, sinful, unforgivable.

18
 Hallucinations are distortions or
exaggerations of perception in any of the
senses, although auditory hallucinations
(“hearing voices” within, distinct from one’s
own thoughts) are the most common,
followed by visual hallucinations.
◦ Auditory- Most common type of hallucination
◦ Visual- Second most common type of hallucination
◦ Other senses (olfactory, tactile, gustatory)

19
• Disorganized speech/thinking, also described as “thought
disorder” or “loosening of associations,” is a key aspect of
schizophrenia.
• Disorganized thinking is usually assessed primarily based
on the person’s speech. Therefore, tangential, loosely
associated, or incoherent speech severe enough to
substantially impair effective communication is used as an
indicator of thought disorder by the DSM-IV.
◦ Clang association = rhyming words
◦ Neologism = made-up words or phrases
◦ Word salad = words/speech with no message
◦ Derailment = deviation in the train of thought
◦ Knight’s move = going from point A to point C without
making a connection through point B

20
 Question Answer
Question Answer
Goal directed and linear
Tangential

Question Answer

Loosening of associations
Other terms:
Neologisms
Clang associations Question Answer

Word salad Incoherence

21
 Grossly disorganized behavior includes difficulty in goal-
directed behavior (leading to difficulties in activities in
daily living), unpredictable agitation or silliness, social
disinhibition, or behaviors that are bizarre to onlookers.
Their purposelessness distinguishes them from unusual
behavior prompted by delusional beliefs.
 Catatonic behaviors are characterized by a marked
decrease in reaction to the immediate surrounding
environment, sometimes taking the form of motionless
and apparent unawareness, rigid or bizarre postures, or
aimless excess motor activity.
 Other symptoms sometimes present in schizophrenia but
not often enough to be definitional alone include affect
inappropriate to the situation or stimuli, unusual motor
behavior (rocking), depersonalization, derealization, and
somatic preoccupations.

22
 Negative Symptoms of Schizophrenia include:
◦ Affective flattening is the reduction in the range and
intensity of emotional expression, including facial
expression, voice tone, eye contact, and body language.
◦ Alogia, or poverty of speech, is the lessening of speech
fluency and productivity, thought to reflect slowing or
blocked thoughts, and often manifested as short, empty
replies to questions.
◦ Avolition is the reduction, difficulty, or inability to initiate
and persist in goal-directed behavior; it is often mistaken
for apparent disinterest. (examples of avolition include: no
longer interested in going out and meeting with friends, no
longer interested in activities that the person used to show
enthusiasm for, no longer interested in much of anything,
sitting in the house for many hours a day doing nothing.)
◦ Anhedonia is inability to experience pleasure

23
 Negative symptoms- In this case, the word negative does
not mean "bad," but reflects the absence of certain normal
behaviors in people with schizophrenia. Other negative
symptoms include:
◦ Lack of emotion and expression or emotions, thoughts and moods
that do not fit with situations or events (for example, crying
instead of laughing at a joke).
◦ Withdrawal from family, friends and social activities.
◦ Reduced energy.
◦ Lack of motivation.
◦ Loss of pleasure or interest in life.
◦ Poor hygiene and grooming habits.
◦ Problems functioning at school, work or other activities.
◦ Moodiness (being very sad or very happy, or having swings in
mood).
◦ Catatonia (a condition in which the person becomes fixed in a
single position for a very long time).

24
 Positive symptoms are those that appear to reflect an
excess or distortion of normal functions.
 The diagnosis of schizophrenia, according to DSM-IV,
requires at least 1-month duration of two or more positive
symptoms, unless hallucinations or delusions are
especially bizarre, in which case one alone suffices for
diagnosis.
 Negative symptoms are those that appear to reflect a
diminution or loss of normal functions. These often persist
in the lives of people with schizophrenia during periods of
low (or absent) positive symptoms.
 Negative symptoms are difficult to evaluate because they
are not as grossly abnormal as positives ones and may be
caused by a variety of other factors as well (e.g., as an
adaptation to a persecutory delusion).

25
 Cognitive symptoms- are subtle and are often
detected only when neuropsychological tests are
performed. They include the following:
◦ poor "executive functioning" (the ability to absorb and
interpret information and make decisions based on that
information),
◦ inability to sustain attention, and
◦ problems with "working memory" (the ability to keep
recently learned information in mind and use it right
away)
 Cognitive impairments often interfere with the
patient's ability to lead a normal life and earn a
living. They can cause great emotional distress.

26
 A. Characteristic symptoms: Two (or more) of the
following, each present for a significant portion of
time during a 1-month 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 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.

27
 B. Social/occupational dysfunction: For a significant
portion of the time since the onset of the disturbance, one
or more major areas of functioning such as work,
interpersonal relations, or self-care are markedly below
the level achieved prior to the onset (or when the onset is
in childhood or adolescence, failure to achieve expected
level of interpersonal, academic, or occupational
achievement).
 C. Duration: Continuous signs of the disturbance persist
for at least 6 months. This 6-month period must include at
least 1 month of symptoms (or less if successfully treated)
that meet Criterion A (i.e., active-phase symptoms) and
may include periods of prodromal or residual symptoms.
During these prodromal or residual periods, the signs of
the disturbance may be manifested by only negative
symptoms or two or more symptoms listed in Criterion A
present in an attenuated form (e.g., odd beliefs, unusual
perceptual experiences).
28
 D. Schizoaffective and Mood Disorder exclusion:
Schizoaffective Disorder and Mood Disorder With
Psychotic Features have been ruled out because
either (1) no Major Depressive, Manic, or Mixed
Episodes have occurred concurrently with the
active-phase symptoms; or (2) if mood episodes
have occurred during active-phase symptoms,
their total duration has been brief relative to the
duration of the active and residual periods.
 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) or a general medical
condition.

29
 F. Relationship to a Pervasive Developmental Disorder: If there is
a history of Autistic 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 a month (or less if successfully treated).
 Classification of longitudinal course (can be applied only after at
least 1 year has elapsed since the initial onset of active-phase
symptoms):
◦ Episodic With Interepisode Residual Symptoms (episodes are defined
by the reemergence of prominent psychotic symptoms); also specify
if: With Prominent Negative Symptoms
◦ Episodic With No Interepisode Residual Symptoms
◦ Continuous (prominent psychotic symptoms are present throughout
the period of observation); also specify if: With Prominent Negative
Symptoms
◦ Single Episode In Partial Remission; also specify if: With Prominent
Negative Symptoms
◦ Single Episode In Full Remission
◦ Other or Unspecified Pattern

30
 Total duration must be at least 6 months

Prodrome Active
Prodrome Active Phase
Phase Residual
Residual Phase
Phase

Prodrome
Prodrome Active Phase Residual
Active Phase Residual Phase
Phase

Pro-
Pro-
drome
Active
Active Phase
Phase Residual
Residual Phase
Phase
drome

The active phase must last at least 1 month

31
 Reading Assignment on Sexual Disorders
◦ Read about the following kinds of sexual disorders
 Fetishism
 Sexual sadism
 Sexual Masochism
 Voyeurism
 Exhibitionism
 Pedophilia
 Sexual Desire Disorders
 Sexual Arousal Disorders
 Orgasmic Disorders
 Sexual Pain Disorders

32
 Following, we will discuss the five subtypes of
schizophrenia, these are
◦ Paranoid Schizophrenia
◦ Disorganized Schizophrenia
◦ Catatonic Schizophrenia
◦ Residual Schizophrenia
◦ Undifferentiated Schizophrenia
 In addition to this, we will also discuss three
other psychotic disorders, these are:
◦ Brief Psychotic Disorder
◦ Schizophreniform Disorder
◦ Schizoaffective Disorder

33
 Paranoid schizophrenia is the most common type of
schizophrenia in most parts of the world.
 The clinical picture is dominated by relatively stable, often
paranoid, delusions, usually accompanied by
hallucinations, particularly of the auditory variety, and
perceptual disturbances.
 Disturbances of affect, volition, and speech, and catatonic
symptoms, are not prominent.
 Examples of the most common paranoid symptoms are:
◦ delusions of persecution, reference, exalted birth, special mission,
bodily change, or jealousy;
◦ hallucinatory voices that threaten the patient or give commands,
or auditory hallucinations without verbal form, such as whistling,
humming, or laughing;
◦ hallucinations of smell or taste, or of sexual or other bodily
sensations; visual hallucinations may occur but are rarely
predominant.

34
 When people have delusions, they believe
something to be true that essentially no one else
in their culture believes.
 A person with paranoid schizophrenia
misinterprets experiences and then holds on to
those interpretations despite evidence or
reasoning to the contrary.
 Delusions are commonly focused on the
perception of being persecuted and often result
in the mistrust of other people:
◦ The FBI is spying on me.
◦ Someone is poisoning my food.
◦ My thoughts are being broadcast over the radio.

35
 Thought disorder may be obvious in acute states, but
if so it does not prevent the typical delusions or
hallucinations from being described clearly.
 Affect is usually less blunted than in other varieties of
schizophrenia, but a minor degree of incongruity is
common, as are mood disturbances such as
irritability, sudden anger, fearfulness, and suspicion.
 "Negative" symptoms such as blunting of affect and
impaired volition are often present but do not
dominate the clinical picture.
 The course of paranoid schizophrenia may be
episodic, with partial or complete remissions.
 The onset tends to be later than in the hebephrenic/
disorganized and catatonic forms.

36
 A type of Schizophrenia in which the
following criteria are met:
 A. Preoccupation with one or more delusions

or frequent auditory hallucinations.

 B. None of the following is prominent:

disorganized speech, disorganized or

catatonic behavior, or flat or inappropriate
affect.

37
 Disorganized Schizophrenia is characterized by prominent
disorganized behavior and speech, and flat or
inappropriate emotion and affect.
 This type of schizophrenia is also known as hebephrenia,
and is named after the Greek goddess of youth, Hebe, in
reference to the typical age of onset in puberty.
 Unlike the paranoid subtype of schizophrenia, delusions
and hallucinations are not the most prominent feature,
although fragmentary delusions and hallucinations may be
present.
 Furthermore, the criteria for the catatonic subtype of
schizophrenia must not have been met.
 The emotional responses of people diagnosed with this
subtype can often seem strange or inappropriate to the
situation.

38
 Inappropriate facial responses may be common and
behavior is sometimes described as 'silly'. Complete
lack of expressed emotion is sometimes seen, as is
an apparent indifference, anhedonia (the lack of
pleasure), and avolition (a lack of motivation).
 Some of these features are also present in other
types of schizophrenia, but they are most prominent
in Disorganized Schizophrenia.
 This form of schizophrenia is typically associated
with early onset (often between the ages of 15 and
25 years) and is thought to have a poor prognosis
because of the rapid development of 'negative'
symptoms and decline in social functioning.
 Patients with disorganized schizophrenia are usually
active but in an aimless, nonconstructive manner.

39
 The distinguishing psychotic features of disorganized
schizophrenia include:
 Disorganized thinking. can't form logical and coherent thoughts.
It is also evident in people's speech patterns. They may not be
able to stay on track, their speech may "wander aimlessly"
through a topic, or they may jump from one unrelated idea to
another. If the thinking is severely disorganized, a person may
speak in ungrammatical phrases or use made-up words. These
same patterns are evident in written communication.
 Grossly disorganized behavior. As the word "grossly" suggests,
the disorganized behavior of schizophrenia is severe and causes
significant impairment in a person's ability to function in regular
daily activities. Examples of such behaviors include childlike
silliness, sudden displays of agitation (swearing or shouting "out
of the blue"), wearing many layers of clothes on a warm day,
inappropriate sexual behavior in public, urinating in public and
neglecting personal hygiene.

40
 Absent or inappropriate emotional expression. When people
show a complete absence of emotional expression (flat
affect), their faces seem blank. They don't make eye contact
or display observable body language. Although a person with
flat affect may occasionally show some emotion, the range of
expressions is usually very limited. Sometimes people with
disorganized schizophrenia express emotions that are
inappropriate to the situation, such as laughing when
something bad happens.

41
 While the prominent signs and symptoms of
disorganized schizophrenia are related to
thought processes, behaviors and emotions,
people with this subtype of schizophrenia
may exhibit other psychotic behaviors:
◦ Hearing voices or experiencing other sensory
events that aren't real (hallucinations)
◦ Holding untrue beliefs about reality (delusions)
◦ Little verbal communication with other people
◦ Inability to initiate and execute plans

42
 A type of Schizophrenia in which the
following criteria are met:
 A. All of the following are prominent:
 (1) disorganized speech

(2) disorganized behavior

(3) flat or inappropriate affect
 B. The criteria are not met for Catatonic Type.

43
 People with catatonic schizophrenia display
extreme inactivity or activity that's disconnected
from their environment or encounters with other
people (catatonic behavior). These episodes can
last for only minutes or up to hours.
 Catatonic schizophrenics are usually withdrawn
and isolated from friends, family, and society.
They engage in purposeless behavior, and may
exhibit unusual flexibility or postures.
 Men with catatonic schizophrenia usually
experience their initial catatonic episode in their
teens or 20s, while women usually experience
first episodes in their 20s or early 30s.

44
 The distinguishing psychotic features of catatonic
schizophrenia include:
 Physical immobility. People may be completely immobile
and appear to be unaware of their surroundings (catatonic
stupor). They may exhibit a partial immobility known as
"waxy flexibility." For example, if a person's arm is moved
into a certain position, it will stay there for some time.
 Excessive mobility. These motor activities — such as
frenzied pacing, turning around in circles, flailing arms or
legs or making loud noises — appear to have no purpose
or motivating factors. This kind of behavior is called
catatonic excitement.
 Extreme resistance. Without any apparent motivation,
people with catatonic schizophrenia may not respond to
instruction, may resist any attempt to be moved or may
not speak at all. This kind of behavior is called negativism.

45
 Peculiar movements. People may assume
inappropriate or unusual postures, grimace
(showing ugly facial expressions) for long periods
or adopt unusual mannerisms. They may also
exhibit habits known as stereotyped behaviors,
such as repeating words, obsessively following a
routine or always arranging objects exactly the
same way.
 Mimicking speech or movement. A person may
repeatedly say a word just spoken by someone
else (echolalia) or repeatedly copy a gesture or
movement made by someone else (echopraxia).

46
 Although the dominant symptoms of catatonic
schizophrenia are the catatonic behaviors, people
with this subtype of the disorder also experience
some of the other primary signs and symptoms
of schizophrenia:
◦ Hearing voices or experiencing other sensory events that
aren't real (hallucinations)
◦ Holding untrue beliefs about reality (delusions)
◦ Disorganized thinking
◦ Grossly disorganized, irrational behavior
◦ Absent or inappropriate emotional expression
◦ Inability to initiate and execute plans

47
 A type of Schizophrenia in which the clinical picture
is dominated by at least two of the following:
 (1) motoric immobility as evidenced by catalepsy
(including waxy flexibility) or stupor
(2) excessive motor activity (that is apparently
purposeless and not influenced by external stimuli)
(3) extreme negativism (an apparently motiveless
resistance to all instructions or maintenance of a
rigid posture against attempts to be moved) or
mutism
(4) peculiarities of voluntary movement as evidenced
by posturing (voluntary assumption of inappropriate
or bizarre postures), stereotyped movements,
prominent mannerisms, or prominent grimacing
(5) echolalia or echopraxia

48
 Residual schizophrenia occurs in chronic
sufferers after the disappearance of positive
symptoms. It usually lasts for one year and is
characterized by negative symptoms.
 Residual schizophrenics have little interest in life
and will not engage in eye contact or
conversation.
 Residual- “leftover” symptoms
◦ Symptoms present, but in milder form
◦ Unusual ideas that are not fully delusional
◦ Unusual sensory perceptions that are not full blown
hallucinations
◦ Negative symptoms: social withdrawal, inactivity, flat
affect

49
 A type of Schizophrenia in which the
following criteria are met:
 A. Absence of prominent delusions,
hallucinations, disorganized speech, and
grossly disorganized or catatonic behavior.
 B. There is continuing evidence of the
disturbance, as indicated by the presence of
negative symptoms or two or more symptoms
listed in Criterion A for Schizophrenia,
present in an attenuated form (e.g., odd
beliefs, unusual perceptual experiences).

50
 The undifferentiated subtype is diagnosed when
people have symptoms of schizophrenia that are not
sufficiently formed or specific enough to permit
classification of the illness into one of the other
subtypes.
 The symptoms of any one person can fluctuate at
different points in time, resulting in uncertainty as to
the correct subtype classification.
 Other people will exhibit symptoms that are
remarkably stable over time but still may not fit one
of the typical subtype pictures.
 In either instance, diagnosis of the undifferentiated
subtype may best describe the mixed clinical
syndrome.

51
 Undifferentiated schizophrenia is a difficult
diagnosis to make with any confidence
because it depends on establishing the slowly
progressive development of the characteristic
“negative” symptoms of schizophrenia
without any history of hallucinations,
delusions, or other manifestations of an
earlier psychotic episode, and with significant
changes in personal behavior, manifest as a
marked loss of interest, idleness, and social
withdrawal.

52
 A type of Schizophrenia in which symptoms
that meet Criterion A are present, but the
criteria are not met for the Paranoid,
Disorganized, or Catatonic Type.

53
 Schizoaffective disorder is a psychiatric diagnosis
describing a situation where both the symptoms of
mood disorder and psychosis are present.
 The disorder usually begins in early adulthood, and is
more common in women.
 Most commonly, the mood disorder accompanying
the schizophrenic features is either bipolar disorder
(bipolar-type schizoaffective) or depression
(depressive-type schizoaffective).
 Therefore, there are two sub-types of schizoaffective
disorder: the bipolar type and the depressive type.
 Psychotic symptoms must be preceded or followed by
2 weeks of delusions or hallucinations without
prominent mood symptoms

54
 Generally, people who have this condition
experience psychotic symptoms — such as
hallucinations, disorganized thinking and
paranoid thoughts — as well as a mood
disturbance such as depressed or manic mood.
 They tend to be very antisocial and shunned by
the people around them.
 Hallucinations or delusions occur for at least two
weeks before or after the mood episode
 Psychotic features and mood disturbances may
occur at the same time or may appear on and off
interchangeably.

55
 Signs and symptoms of schizoaffective
disorder may include:
◦ Strange or unusual thoughts or perceptions
◦ Paranoid thoughts and ideas
◦ Delusions — having false, fixed beliefs
◦ Hallucinations, such as hearing voices
◦ Unclear or confused thoughts (disorganized
thinking)
◦ Bouts of depression
◦ Manic mood, or a sudden increase in energy and
behavioral displays that are out of character
(continued next page)
56
◦ Irritability and poor temper control
◦ Thoughts of suicide or homicide
◦ Irrelevant or incoherent speech
◦ Lack of response, or an extreme agitation that's not
influenced by the environment (catatonic behavior)
◦ Deficits in attention and memory
◦ Lack of concern about hygiene and physical
appearance
◦ Changes in energy and appetite
◦ Sleep disturbances, such as difficulty falling asleep
or staying asleep

57
 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 or
hallucinations for at least 2 weeks in the absence of prominent mood
symptoms.
 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., a drug of abuse, a medication) or a general medical
condition.
 Specify type:
◦ Bipolar Type: if the disturbance includes a Manic or a Mixed Episode (or a Manic
or a Mixed Episode and Major Depressive Episodes)
Depressive Type: if the disturbance only includes Major Depressive Episodes

58
 As the name suggests, brief psychotic disorder is a
short-term illness with psychotic symptoms. The
symptoms often come on suddenly, but last for less
than one month, after which the person usually
recovers completely.
 There are three basic forms of brief psychotic disorder:
◦ Brief psychotic disorder with obvious stressor (also called
brief reactive psychosis): This type, also called brief reactive
psychosis, occurs shortly after and often in response to a
trauma or major stress, such as the death of a loved one, an
accident or assault, or a natural disaster. Most cases of brief
psychotic disorder occur as a reaction to a very disturbing
event.
◦ Brief psychotic disorder without obvious stressor: With this
type, there is no apparent trauma or stress that triggers the
illness.
◦ Brief psychotic disorder with postpartum onset: This type
occurs in women, usually within 4 weeks of having a baby.
59
 The most obvious symptoms include:
◦ Hallucinations: Hallucinations are sensory perceptions of
things that aren't actually present, such as hearing voices,
seeing things that aren't there or feeling sensations on your
skin even though nothing is touching your body.
◦ Delusions: These are false beliefs that the person refuses to
give up, even in the face of contradictory facts.
 Other symptoms of brief psychotic disorder include:
◦ Disorganized thinking
◦ Speech or language that doesn't make sense
◦ Unusual behavior and dress
◦ Problems with memory
◦ Disorientation or confusion
◦ Changes in eating or sleeping habits, energy level or weight
◦ Inability to make decisions

60
 Brief Psychotic Disorder is a psychosis that
has a rapid onset, generally following a major
stressor. Its hallmark is emotional turmoil,
mood lability, and confusion.
 A brief psychotic episode is time limited,

lasting at least a day, but less than a month.

 As a rule, the quicker the onset, the faster the

recovery.

61
 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 a culturally sanctioned response
pattern.
 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., a drug of abuse, a medication) or a general
medical condition.

62
 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 person's 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 person's
culture
With Postpartum Onset: if onset within 4 weeks
postpartum

63
 Schizophreniform disorder is characterized by the
presence of the criterion A symptoms of
schizophrenia, including delusions, hallucinations,
disorganized speech, disorganized or catatonic
behavior, and negative symptoms.
 The disorder, including its prodromal, active, and
residual phases, lasts longer than 1 month but less
than 6 months.
◦ Essentially, this is schizophrenia that fails to last for 6
months and does not involve social withdrawal.
◦ If schizophrenic symptoms last less than one month but
more than one day, diagnose Brief Psychotic Disorder
 No decline in functioning is required for this
diagnosis

64
 Symptoms of Schizophreniform disorder
◦ delusions
◦ disorganized speech which is strange, peculiar, difficult to
comprehend
◦ disorganized (bizarre or child-like) behavior
◦ catatonic behavior
◦ hallucinations
◦ negative symptoms (affective flattening, alogia, avolition)
 The symptoms of the disorder cannot:
◦ occur as part of a mood disorder
◦ occur as part of schizoaffective disorder or schizophrenia
◦ be due to intoxication with drugs or alcohol
◦ be an adverse reaction to a medication
◦ be caused by a physical injury or medical illness

65
 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.
(When the diagnosis must be made without waiting for recovery,
it should be qualified as "Provisional.“)
 Specify if:
Without Good Prognostic Features
With Good Prognostic Features: as evidenced by two (or more) of
the following:
 (1) onset of prominent psychotic symptoms within 4 weeks of the
first noticeable change in usual behavior or functioning
(2) confusion or perplexity at the height of the psychotic episode
(3) good premorbid social and occupational functioning
(4) absence of blunted or flat affect

66
Brief
Brief
Psychotic
Psychotic Schizophreniform Schizo-
Disorder
Disorder Disorder phrenia

1 2 3 4 5 6 >6
Months duration of symptoms

 Schizophrenia (>6 mo, 1 mo active sxs)

 Schizophreniform disorder (scz but 1-6 mo)
 Brief psychotic disorder (<1 mo)
 Schizoaffective disorder (mood + scz)

Sisay Y. Psyc 325 67