The document discusses several mental disorders involving psychosis, including schizophrenia, delusional disorder, and brief psychotic disorder. Schizophrenia is characterized by breakdown of personality functioning and disturbances in thought and behavior. Delusional disorder involves nonbizarre fixed false beliefs. Brief psychotic disorder involves psychotic symptoms like delusions or hallucinations that last less than one month.

1. The Schizophrenias and
Delusional Disorder

2. Schizophrenias mental disorders characterized by
the breakdown of integrated persoanolity
functioning, withdrawal from reality, emotional
blunting and distortion, and disturbances in
thought and behavior.
Psychosis- a significant loss of contact with reality, as
when hallucinations or delusions are present.
Delusional Disorder a paranoid disorder in which a
person nurtures, gives voice to, and sometimes
takes action on beliefs that are considered
completely false and absurd by others.
Entrance into a delusional system.
Brief Psychotic Disorder

3. The Schizophrenias
Origins go back to Benedict Morel
Demence Precoce (mental deterioration at early age)
Adopted by Kraeplin
Term is misleading however, as there is no compelling
evidence of progressive brain degeneration in the natural
course of the disorder
In 1911 Eugen Bleuler termed these disorders
“schizophrenia” (split mind). A disorganization of
thought processes:
Split between the intellect and emotion
Split between the intellect and external reality

4. The Clinical Picture in
Schizophrenia
(see next slide)
Positive-syndrome
Negative-syndrome
Type I schizophrenia
Type II schizophrenia

5. Type I & II Association to Pos & Neg
Positive Syndrome
Hallucinations
Delusions
Derailment of Assoc.
Bizarre Behavior
Min. Cog Impairment
Sudden Onset
Variable Course
TYPE I.--------------------
The above plus
Good Med Response
Limbic System
Abnormality
Normal Brain Ventricles
Negative Syndrome
Emotional Flattening
Poverty of Speech
Asociality
Apathy
Sig. Cog Impairment
Insidious Onset
Chronic Course
Type II.-------------------
Plus
Uncertain Med Response
Frontal Lobe Abnormality
Enlarged Brain Ventricles

6. The Clinical Picture in Schizophrenia
Disturbances of associative thinking
Cognitive Slippage or Loosening of Associations
Disturbances of thought content
Delusions (false beliefs; thoughts controlled by others)
Disruption of perception
Hallucinations (auditory, olfactory, visual, etc.)
Unable to sort out and process sensory information
Emotional dysfunction
Anhedonia (inability to experience joy)
Blunting

7. The Clinical Picture in Schizophrenia
Confused sense of self
Disrupted volition
Disruption in goal directed behavior
Retreat to an inner world
Rejection of external world
Loosened ties to external world
Disturbed motor behavior
Psychomotor agitation and
retardation & other peculiarities
of movement

8. Schizophrenia Criteria
A. Characteristic Symptoms (2 or more during a 1
month period)
Delusions
Hallucinations
Disorganized Speech
Grossly disorganized or catatonic behavior
Negative symptoms
B. Social/Occupational Dysfunction
C. Duration
D. Schizoaffective and Mood Disorder Exclusions
E. Substance/General Medical Condition Exclusion
F. Relationship to a Pervasive Developmental Dis.

9. The Classic Subtypes
Undifferentiated (waste basket)
Catatonic (pronounced motor signs both
extreme stupor and excitement)
Disorganized (earlier more severe
disintegration of the personality)
Paranoid (person becomes centered on
themes of suspiciousness, persecution,
and/or grandeur)
Schizophrenia Residual (considerable
recovery with mild signs of past disorder)

10. Split Mind: Causal Factors I
Biological Factors
Genetic studies demonstrate heritablility
Adoption studies demonstrate moderate genetic effect
(heritability)
Biochemical factors appear to include dopamine
Neurophysiological factors
Cognitive dysmetria and smooth pursuit eye movement
Neuroanatomical factors
Brain mass anomalies include enlargement of ventricles and
sulci are noted

11. Treatments and Outcomes
Antipsychotic Medication
Psychosocial Approaches
Family Therapy (focus on expressed emotion)
Individual Psychotherapy (coping skills and
personal management)
Social-Skills Training
Outcome studies demonstrate around 40%
social recoveries with medication use in
conjunction with other treatment

12. Delusional Disorders

13. Definition
• Delusions are false fixed,unshakable
beliefs not in keeping with the culture.
• Based on incorrect inference about external reality
that is firmly sustained ;despite what almost
everyone else believes and despite obvious proof of
evidence to the contrary.
The diagnosis of delusional disorder is
made when a person exhibits non
bizarre delusions of at least 1 month
duration

14. Delusional Disorder I
Individual feels singled out and taken
advantage of, mistreated, plotted against,
stolen from, spied on, ignored or otherwise
mistreated
Hold a delusional system usually centered
on one theme
Aside from delusional system such
individuals may appear perfectly normal in
conversation, emotionality, and conduct

15. Delusional Disorder
A. Nonbizarre delusions (i.e., involving situations that occur in real
life, such as being followed, poisoned, loved at a distance, or deceived
by spouse or lover, or having a disease) of at least 1 month's
duration.
B. Criterion A for Schizophrenia has never been met.
Note: Tactile and olfactory hallucinations may be present if they are
related to the delusional theme.
C. Apart from the impact of the delusion(s) or its
ramifications, functioning is not markedly impaired and
behavior is not obviously odd or bizarre.
D. If mood episodes have occurred concurrently with
delusions, their total duration has been brief relative to the
duration of the delusional periods.
E. The disturbance is not due to the direct physiological
effects of a substance (drug abuse, medication or a medical
condition)

16. Delusional Disorder
Types (based on theme)
Persecutory (they are being subjected to spying, stalking,
rumors)** most common of the types.
Jealous (sexual partner is being unfaithful)
Erotomanic (a high status person wants to start a sexual
liaison with them)
Somatic (belief of having some physical illness or disorder
whose nature is delusionally absurd)
Grandiose (person has extrordinary status, power, ability,
talent, beauty, etc.)
Mixed (combinations of the above themes)

17. Persecutory Type
The delusion of persecution - classic
symptom of delusional disorder
Associated with anger, irritability
They are convinced that they are being
persecuted or harmed.
In contrast to persecutory delusions in
schizophrenia, there is clarity, logic, and
systematic elaboration of the
persecutory theme.

18. Jealous Type
Delusions of infidelity - spouse is unfaithful.
Othello syndrome - morbid jealousy that can
arise from multiple concerns.
Usually afflicts men
Difficult to treat and diminish only on
separation, divorce, or death of the spouse.
Physical and verbal abuse occur more
frequently

19. Grandiose Type
A delusion of inflated worth, power,
knowledge , identity or special relationship to
a famous person.

20. Erotomanic Type
Another person, usually of higher
status, is in love with him or her.
Solitary, withdrawn, dependence
Poor levels of social or occupational
functioning.

21. Somatic Type
monosymptomatic hypochondriacal
psychosis.
the delusion is fixed, unarguable, and
presented intensely, because the
patient is totally convinced of the
physical nature of the disorder.
hypochondriacs often admit that their
fear of illness is largely groundless..

22. The illness is unremitting, although the
delusion severity may fluctuate.
Hyperalertness and high anxiety also
characterize patients with this subtype.
Patients generally present to a specific
medical specialist for evaluation.

23. Types
(1) delusions of infestation (including
parasitosis)
(2) delusions of dysmorphophobia-
misshapenness, personal ugliness, or
exaggerated size of body parts
(common type)
(3) delusions of foul body odours or
halitosis; olfactory reference syndrome

24. Brief Psychotic Disorder
1) Presence of one (or more) of the following symptoms:
delusions
hallucinations
disorganized speech (e.g., frequent derailment or incoherence)
grossly disorganized or catatonic behavior
Note: Do not include a symptom if it is a culturally sanctioned response pattern.
2) 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 fx.
3) 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.
Specify if: with Marked Stressor, without Marked Stressor, or
Postpartum onset.