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Schizophrenia Spectrum and
Other Psychotic Disorders -
DSM-5-TR
By: Letícia Gouveia, psychology student.
Essential Characteristics Defining Psychotic Disorders:
Delusions
Delusions are fixed beliefs that are not subject to change, even in the face of conflicting evidence.
Persecutory : belief that the individual will be harmed in some way by someone (most common). Referential : belief that gestures, comments, etc., are directed at oneself (most common). Grandiose : when the person believes they have exceptional abilities, wealth, or fame. Erotomanic : false belief that another person is in love with them. Nihilistic : conviction that a major catastrophe will occur. Somatic : preoccupation with health and organ function.
Delusions are considered bizarre if they are clearly implausible or incomprehensible to others from the same culture, and do not arise from common life experiences. For example: believing that an external force removed a personʼs internal organs and replaced them with another personʼs organs, without leaving any wounds or scars.
Hallucinations
Hallucinations are experiences similar to perception that occur without an external stimulus. They are vivid and clear, just like normal perceptions, and are not under voluntary control. They can occur in any sensory modality, although auditory
hallucinations are the most common. These are typically experienced as voices, either familiar or not, and are perceived as distinct from the individualʼs own thoughts.
Disorganized Thinking
Disorganized thinking is usually inferred from the individualʼs speech. The person may shift from one topic to another, with responses and questions that may be obliquely related or entirely unrelated. In rare cases, speech can become so disorganized that it is almost incomprehensible.
Grossly Disorganized or Abnormal Motor Behavior Including Catatonia)
This can range from “silly and puerileˮ behavior to unpredictable agitation. Catatonic behavior is a significant reduction in reactivity to the environment. It can range from resistance to instructions, to maintaining a rigid, inappropriate, or bizarre posture, to a complete lack of verbal and motor responses. It may also include purposeless and excessive motor activity without an obvious cause. Other features include repeated stereotyped movements, fixed gaze, grimacing, mutism, and echolalia.
Negative Symptoms
Diminished emotional expression : reduction in the expression of emotions through facial expressions, eye contact, speech intonation, and movements of the hands, head, and face. Avolition : reduction in motivated, self-initiated, and goal-directed activities. Alogia : decreased speech output. Anhedonia : reduced ability to experience pleasure. Affective flattening.
Psychotic Disorders:
Brief Psychotic Disorder
A sudden onset of at least one of the following symptoms: delusions, hallucinations, disorganized speech, or grossly disorganized or catatonic behavior. The duration of the episode is at least one day but less than one month, with eventual return to the previous level of functioning.
To distinguish schizoaffective disorder from major depressive disorder or bipolar disorder with psychotic features, delusions or hallucinations must be present for at least two weeks in the absence of a mood episode (depressive or manic).
Substance/Medication-Induced Psychotic Disorder
The name of the substance-induced psychotic disorder ends with the name of the specific substance (e.g., cocaine, dexamethasone). If more than one substance is involved, each must be listed separately. The disorder may occur in association with intoxication from the following classes of substances: alcohol, cannabis, hallucinogens, inhalants, sedatives, hypnotics, and stimulants (including cocaine). Some medications include anesthetics and analgesics, anticholinergics, antihypertensives, and cardiovascular drugs, among others. According to studies, approximately 32% of individuals with this disorder are later diagnosed with schizophrenia or bipolar disorder, with the highest rate being for cannabis-induced psychotic disorder 44%.
Psychotic Disorder Due to Another Medical Condition
Three factors guide determining whether the relationship between psychosis and the medical condition is etiological:
Biological plausibility : the presence of a medical condition that has the potential to cause such a disorder. Temporal association : if there is a temporal association between the onset, exacerbation, or remission of the medical condition and the psychotic symptoms. Typicality : if there are features that are unusual for a primary psychotic disorder.
Catatonia Associated with Another Mental Disorder (Catatonia
Specifier)
The clinical presentation is dominated by three (or more) of the following symptoms:
Stupor : absence of psychomotor activity; no active engagement with the environment.
Catalepsy : passive induction of a posture maintained against gravity.
Mutism.
Grimacing.
Negativism : opposition or absence of response to instructions or external stimuli.
Mannerisms : bizarre, exaggerated, or inappropriate caricature of normal actions.
Stereotypy : repetitive, abnormally frequent movements that do not have a goal.
Agitation , not influenced by external stimuli.
Echolalia : imitation of the speech of others.
Echopraxia : imitation of the movements of others.
