Day # 2: Psychotic Timelines

Welcome back! Today we are going to cover the basic criteria for diagnosing psychotic spectrum disorders. As a reminder from yesterday, here are the core clinical features.


-Today's Content Level: Beginner

-Remember that all readers are encouraged to read through each post as it's helpful to return to the basics sometimes.


-Beginner = medical student and equivalents in other fields

-Intermediate = junior psychiatry resident and equivalents

-Advanced = senior psychiatry resident, practicing psychiatrists, and equivalents



Clinical Features


The core features of psychotic disorders include: (must have at least one of 1, 2, or 3)

1. Delusions

2. Hallucinations

3. Disorganized speech

4. Disorganized or catatonic behavior

5. “Negative symptoms”


Diagnosis


Now that we know the core features of psychotic spectrum disorders let’s discuss an overview of the potential diagnoses. These are mostly very similar and lie along the same spectrum of symptoms we discussed. You’ll notice that the timeline is really the only/main difference between brief psychotic disorder, schizophreniform disorder, and schizophrenia.


Brief Psychotic Disorder

•Duration: ≥ 1 day, < 1 month

•Criteria: Must have ≥ 1 of delusions, hallucinations, or disorganized speech. Can also have disorganized behavior.


Schizophreniform Disorder

•Duration: ≥ 1 month, < 6 months

•Criteria: Must have ≥ 2 of delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms


Schizophrenia

•Same criteria for schizophreniform but duration ≥ 6 months


Schizoaffective disorder

•Period of illness during which there is a major mood episode (depression or mania) along with criteria for schizophrenia.

•This can trip up new learners as it can be confused with a mood disorder with psychotic features which we will cover later.

•The key difference is here there must be delusions or hallucinations for ≥ 2 weeks in the absence of a major mood episode at some time in their life


Delusional disorder

•Duration: > 1 month

•Criteria: Presence of ≥1 or more delusions and has NOT met criteria for other psychotic disorder. Aside from delusion, functioning is NOT impaired. See tomorrow for more info, but types of delusions can include grandiose, jealous, erotomania, persecutory, somatic, mixed, or unspecified if with bizarre content.


Substance or Medication-induced psychotic disorder

•Presence of one or both: delusions, hallucinations

•Thought to develop during or soon after substance intoxication or withdrawal or after exposure to medication

•Examples to consider: Alcohol (delirium tremens or alcoholic hallucinosis), cannabis (especially synthetic), PCP, hallucinogens, inhalants, sedatives, hypnotics, anxiolytics, amphetamines, cocaine


Psychotic disorder due to another medical condition

•Psychosis can occur as a direct cause from another medical condition. All psychiatric diagnoses should be considered AFTER ruling out or at least considering other medical causes. There should be evidence from history, physical exam, or labs that it is a direct consequence of the medical condition. This is a huge topic in and of itself but just to wet your appetite some examples include epilepsy, multiple sclerosis, deafness, migraine, thyroid abnormalities, organ failure, autoimmune disease, and electrolyte abnormalities. This topic will be covered separately.


Conclusion


Great work. Now you have an overview of the clinical features and diagnostic criteria of psychotic spectrum disorders. This is essentially the DSMV definition of these disorders. Tomorrow we will get a grasp of how common these disorders are and why they might develop in the first place. We will also offer an alternative explanation than the DSM.

Resources used for this lesson include pocket psychiatry and DSM-V.












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