Brief psychotic, schizophreniform,schizoaffective & delusional disorders

1. Brief psychotic, Schizophreniform,
Schizoaffective & delusional
disorders

2. Outline
• Objective
• Brief psychotic d/o
• Schizophreniform d/o
• Schizoaffective d/o
• Delusional d/o

3. Objective
• Discuss on the definition
• Epidemiology
• Diagnosis
• Prognosis &
• Treatment of (brief psychotic,
schizophreniform, Schizoaffective &
delusional)

4. BRIEF PSYCHOTIC DISORDER
Definition:- A psychotic condition w/c occurs
suddenly & lasts at least one day but not
>1mo
With a full remission & return to a pre morbid
functioning

5. Epidemiology
 Not well studied
 Younger pts. (20s & 30s) > older pts.
 Female > Male
 Low socio-economic status
 Major psychosocial stressors (e.g.,
immigrants)

6. Etiology
• Unknown
• Pts. with personality d/o
• Family history of schizophrenia or mood
disorders
• Inadequate coping mechanism
• Secondary gain

7. DSM 5-TR
Diagnostic Criteria
A. Presence of one (or more) of the following symptoms. At least one
of these must be 1, 2 or 3:
1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
Note: Don’t include a symptom if it is culturally sanctioned response.
B. Duration- at least one day but less than one month, with eventual
full return to premorbid level of functioning.
C. not better explained by MDD or bipolar disorder with psychotic
features or another psychic disorder and is not attributable to the
physiological effects of a substance or another medical condition.

8. Specify if:
– With marked stressor(s)
– Without marked stressor(s)
– With postpartum onset
Specify if:
– With catatonia

9. Course & prognosis
• Total course of illness is < 1month
• 50-80% pts. will have no further major psychiatric
problem
• Around 50% of pts. will later show chronic psychiatric
disorders

10. Good Prognostic Features
• Good pre morbid adjustment
• Few pre morbid schizoid traits
• Sudden onset of symptoms
• Affective symptoms
• Little affective blunting
• Short duration of symptoms
• Absence of relatives with SCZ

11. Treatment
Hospitalization
• Brief hospitalization
– For both evaluation and protection
– Structured setting of a hospital may help patients
regain their sense of reality
– Physical restraints, or one-to-one monitoring of
the patient may be necessary

12. Pharmacotherapy.
• The two major classes of drugs are:
–Antipsychotics
–Benzodiazepines

13. Treatment
• Avoid long-term use of any medication
• If maintenance medication is necessary, reconsider the
diagnosis

14. Psychotherapy
• Provides an opportunity to discuss the
stressors & the psychotic episode
• Exploration & development of coping
strategies
• Helps pts. deal with the loss of self-esteem &
to regain self confidence

15. Schizophreniform
Disorder
Its signs & symptoms goes consistent with SCZ except
it stays b/n one month & six month
Occupational & social Functional impairment not
required
Have a better prognosis

16. EPIDEMIOLOGY
• Not well studied
• Common in adolescents & young adults
• < than half as common as SCZ
• M:F =5:1

17. DSM 5-TR diagnosis
A. 2 or more of the following, each present for a
significant portion of time during a 1- month period
(or less, if successfully treated). At least one of
these must be 1, 2 or 3:
A. Delusions
B. Hallucinations
C. Disorganized speech
D. Grossly disorganized or catatonic behavior
E. Negative symptoms
B. Duration - at least 1 month but < 6 months

18. Diagnosis…
C. Schizoaffective disorder and depressive or bipolar disorder
with psychotic features have been ruled out
D. The disorder is not attributable to the psychological effects of
a substance or another medical condition.

19. Diagnosis
Specify if:
– with good prognostic features
– without good prognostic features
Specify if:
– with catatonia
Specify current severity:

20. COURSE AND PROGNOSIS
Course
 60-80% Progress to SCZ
 20 to 40% -unknown
 Some will have a 2nd or 3rd episode during w/h
they will deteriorate into a more chronic condition
of SCZ
 A few may have only a single episode and then
continue on with their lives

21. TREATMENT
• Treatment modalities
•Antipsychotic drugs
•Psychotherapy
•ECT

22. Antipsychotic drugs
• usually for 3- 6months
• Response to treatment is much more rapid than pts. with
schizophrenia

23. Schizoaffective
Disorder
• Has features of both schizophrenia and mood d/o.
EPIDEMIOLOGY
The lifetime prevalence of schizoaffective disorder is <
1%(0.5 to 0.8%)-estimates

24. Gender Differences
bipolar subtype M=F
 depressed subtype F>M(>2x)
 The age of onset for women > men, as in SCZ.

25. Age Differences
 Bipolar subtype ( young)
 Depressed subtype ( older)

26. ETIOLOGY
• The cause is unknown
• The d/o may be a type of SCZ, a type of mood
d/o, or the simultaneous expression of each
• It may also be a distinct third type of
psychosis, one that is unrelated to either SCZ
or a mood d/o

27. A. An uninterrupted period of illness during which there is a major
mood episode concurrent with criteria A of SCZ
B. Delusions or Hallucinations >2wks in the absence of major mood
episode during the life time duration of the illness
C. MoodSymptoms episode are present for the majority of the total
duration of the active & residual portion of the illness
D . The disturbance is not attributable to the effects of a substance
or other medical conditions
DSM-5- TR diagnosis

28. Diagnosis…
Specify whether: Bipolar type OR Depressive
type
Specify if: With catatonia
Specify if: 1st episode(currently in acute episode,
in partial remission, in full remission)
: Multiple episodes(currently in acute episode,
in partial or remission)
: continuous

29. TREATMENT
Mood stabilizers
Antipsychotics
Antidepressants
Anxiolytics
Benzodiazepines

30. Psychosocial Treatment
• Patients benefit from a combination of:
• Family Therapy
• Social Skills Training
• Cognitive Rehabilitation

31. Delusional disorders
• Delusions are fixed beliefs that are not amenable to
change in light of conflicting evidence(DSM-5)
• False fixed beliefs not in keeping with the culture
(Synopsis)
3/9/2024 31

32. Delusional Disorder
• Psychotic illness with some superficial
resemblances to schizophrenia
• “Nonbizarre delusions”; delusions must be
about situations that can occur in real life,
such as being followed, infected, loved at a
distance, and so on(Synopsis of Psychiatry,
11th ed)
3/9/2024 32

33. DSM-5- TR diagnosis
A. The presence of >=1 delusions with a duration of
1 month or longer
B. Criterion A for schizophrenia has never been met
C. Apart from the impact of the delusion(s) or its
ramifications, functioning is not markedly
impaired, and behavior is not obviously bizarre or
odd
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34. Diagnosis
D. If manic or major depressive episodes have
occurred, these have been brief relative to the
duration of the delusional periods
E. Not attributable to the effects of a substance
or GMC and
Not better explained by another mental d/o,
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35. Specify whether:
• Erotomanic type
• Grandiose type
• Jealous type
• Persecutory type
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36. dx…
• Somatic type
• Mixed type
• Unspecified type
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37. COURSE & PROGNOSIS
• Identifiable psychosocial stressor often
accompanies the onset
– Recent immigration, social conflict with family
members or friends, and social isolation
• Commonly, sudden onset
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38. Good prognosis:
– High levels of occupational, social & functional
adjustments
– Female sex
– Onset before age 30
– Sudden onset
– Short duration of illness
– Presence of precipitating factors
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39. TREATMENT
• Goals of treatment;
– Establish the diagnosis
– Decide on appropriate interventions
– Manage complications
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40. Psychotherapy
• Individual therapy more effective
• Insight-oriented, supportive, cognitive, and
behavioral therapies are often effective
• Initially, a therapist should neither agree with
nor challenge a patient's delusions
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41. Pharmacotherapy
• In severely agitated pts. antipsychotic
• Physicians should not insist on medication
immediately after hospitalization
• Start with low doses and go slowly
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42. Treatment
• Noncompliance common cause of drug failure
– Concurrent psychotherapy
• Discontinue the drug if no benefit from
antipsychotic
• Respond to antipsychotics; maintenance doses
can be low
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43. REFERENCES
43
1. Kaplan & Sadock`s Synopsis of psychiatry,11th ed.
2. Kaplan & Sadock Comprehensive Textbook of
Psychiatry 9th ed.
3. Alem et al, clinical course and outcome of
schizophrenia in a predominantly treatment
naïve cohort in rural Ethiopia
4. The American psychiatric publishing Textbook of
schizophrenia
5. Handbook of psychiatric drugs- 2005
6. Introductory textbook of psychiatry

44. •Thank
You!