TRASTORNOS PSICÓTICOS Y ESPECTRO DE LA ESQUIZOFRENIA RESUMIDOS. DSM V | DIAGNÓSTICO Y TRATAMIENTO

Introduction to Psychotic Disorders

Overview of Psychotic Disorders

• The session introduces psychotic disorders and schizophrenia spectrum, defining a disorder as a syndrome with significant cognitive, emotional, or behavioral alterations that impact social, occupational, or academic functioning. These changes can stem from psychosocial factors, experiences, neurological issues, genetics, or combinations thereof.

Delusional Disorder

• A delusion is described as a false belief characterized by persistent absurd thoughts accepted with conviction despite contrary evidence. Common types include:

• Erotomanic: Belief that someone is in love with the individual.

• Grandiose: Conviction of possessing exceptional talent or knowledge.

• Persecutory: Belief of being conspired against or harmed.

• Somatic: Involves bodily sensations or health concerns.

• Delusions may also be mixed and can vary in their degree of implausibility; for instance, believing in alien abduction is considered extravagant. Diagnostic criteria require at least one month of delusions without fulfilling schizophrenia criteria (e.g., disorganized speech).

Brief Psychotic Disorder

• Brief psychotic disorder features symptoms like delusions and hallucinations lasting from one day to less than a month. Key points include:

• Symptoms must return to normal functioning post-episode.

• Differentiation from other disorders like schizophrenia relies on symptom duration (less than one month).

• Cultural context plays a role; symptoms triggered by significant stressors may not qualify as pathological if they are culturally acceptable responses. Examples include crises such as economic downturns or wars. If the stressor is manageable for most individuals, it should be specified in the diagnosis.

Puerperal Psychosis

• Puerperal psychosis occurs in about one in a thousand women during pregnancy or shortly after childbirth due to hormonal changes and sleep cycle disruptions. It predominantly affects first-time mothers and shares similarities with brief psychotic disorder symptoms but requires specific diagnostic considerations based on timing relative to childbirth.

Understanding Schizophreniform Disorder and Schizophrenia

Overview of Schizophreniform Disorder

• The clinician-administered scale for the severity dimensions of psychosis is referenced, particularly focusing on the DSM-5 criteria for assessing severity over the past seven days.

• Schizophreniform disorder is characterized by two or more symptoms such as delusions, hallucinations, disorganized speech, and negative symptoms like diminished emotional expression.

• It differs from schizophrenia and brief psychotic disorder in terms of symptom quantity (minimum two required) and duration (1 month to less than 6 months).

• Continuous signs must last at least one month but less than six months; schizophrenia requires a minimum of six months.

• Clinicians must rule out schizoaffective disorder, major depressive episodes, or bipolar disorder during diagnosis.

Diagnostic Criteria for Schizophreniform Disorder

• Symptoms should not be better explained by another mental health condition or substance use; good prognosis is linked to prior social and occupational functioning.

• If psychotic symptoms reappear within four weeks after an episode with confusion or perplexity, it indicates a significant aspect of the disorder.

Understanding Schizophrenia

Diagnostic Criteria for Schizophrenia

• Six diagnostic criteria exist: presence of two or more core symptoms (delusions, hallucinations, disorganized speech), with at least one being a primary symptom.

• Significant deterioration in social, occupational, or personal care functioning compared to pre-pathology levels is necessary for diagnosis.

• Signs must persist for a minimum of six months with at least one month of active symptoms alongside residual symptoms post-treatment.

Exclusion Criteria

• Clinicians must exclude schizoaffective disorders and ensure that any related symptoms do not exceed those from primary diagnoses like delusions or hallucinations.

Prevalence and Treatment Insights

Prevalence Rates

• Schizophrenia affects approximately 45 million people globally; it is more common in men than women and often manifests in late adolescence to early adulthood.

Treatment Approaches

• The condition ranks among the top ten causes of disability worldwide. Its prevalence ranges from 0.7% to 1%.

• Causes are multifactorial involving genetic and environmental factors such as poverty and prenatal health issues.

• Antipsychotic medications are primarily used for treatment; advancements have led to atypical antipsychotics that reduce side effects while maintaining efficacy.

Understanding Schizoaffective Disorder

Overview of Schizoaffective Disorder

• Schizoaffective disorder combines symptoms of schizophrenia (e.g., hallucinations, delusions) with mood disorder symptoms (e.g., depression, mania).

Diagnostic Criteria

• The first diagnostic criterion is the presence of a major mood episode (depressive or manic). A depressive episode requires at least five specific symptoms lasting two weeks.

Symptoms of Depressive Episode

• Symptoms include:

• Depressed mood most of the day.

• Loss of interest or pleasure in almost all activities.

• Significant weight change not due to diet/exercise.

• Sleep disturbances (insomnia/hypersomnia).

• Additional symptoms may involve:

• Fatigue or loss of energy.

• Feelings of worthlessness or excessive guilt.

• Cognitive impairments affecting concentration and decision-making.

Symptoms of Manic Episode

• A manic episode must last at least one week and include an abnormally elevated mood along with increased energy. Three or more additional symptoms are required:

• Inflated self-esteem or grandiosity.

• Decreased need for sleep and increased talkativeness.

• Other signs include distractibility, goal-directed activity, and engaging in risky behaviors.

Combination with Schizophrenia Criteria

• The disorder also requires at least two schizophrenia symptoms such as delusions, hallucinations, disorganized speech, or catatonia.

Duration and Exclusion Criteria

• Delusions/hallucinations must persist for two weeks without major mood episode symptoms. This means episodes can occur simultaneously but must be distinguishable over time.

• Major mood symptoms should be present most days during the illness course.

Prevalence and Treatment Options

• Schizoaffective disorder affects about 1% of the population; it has similar prevalence rates to schizophrenia among those diagnosed with psychosis.

• Treatment typically involves a combination of medications (antipsychotics, mood stabilizers, antidepressants) tailored to the type of major mood episode experienced by the patient.

Substance-Induced Psychotic Disorder

Diagnostic Criteria for Substance-Induced Psychotic Disorder

• This disorder is characterized by five diagnostic criteria including:

• Presence of delusions and hallucinations related to substance use.

Substance Influence on Symptoms

• Symptoms arise from intoxication, withdrawal, consumption, or exposure to substances that affect the central nervous system. Alcohol is commonly linked but should not be confused with alcohol withdrawal syndrome.

Exclusion Conditions

• The diagnosis cannot be better explained by a medical condition or non-substance-induced psychotic disorders. Clinicians can rule out this diagnosis if patients had prior psychotic experiences before substance use.

Confusion Syndrome Consideration

• Symptoms should not occur solely during a confusional state; they must manifest independently from other cognitive impairments caused by substances.

Catatonia: Understanding Symptoms and Types

Overview of Catatonia

• Catatonia can manifest without loss of memory, consciousness, or attention during symptom episodes, impacting personal, work, and functional areas of an individual.

Types of Catatonia

• There are two primary types of catatonia:

• Mental Illness-Related: Often associated with schizophrenia; some experts consider it merely a symptom of this condition.

• Medical Condition-Related: Prevalence increases when linked to medical illnesses.

Associated Medical Conditions

• Medical conditions that may lead to catatonia include:

• Viral encephalitis

• Subarachnoid hemorrhage

• Subdural hematomas

• Arteriovenous malformations

• Temporal lobe tumors

Symptoms Criteria for Diagnosis

• For both types of catatonia, at least three symptoms must be present:

• Agitation or excessive motor activity without external cause.

• Stupor or lack of motor activity.

• Catalepsy (maintaining uncomfortable positions).

• Echolalia (verbal imitation).

• Echopraxia (imitation of movements).

Additional Diagnostic Criteria for Medical-Related Catatonia

• Four additional criteria must be met for medical-related catatonia:

• Evidence from clinical history or lab tests indicating a medical cause.

• The disorder should not be better explained by another mental illness like psychosis or delirium.

• The person remains alert and oriented during the episode.

• Significant distress or impairment in social, occupational, or personal functioning is observed.

Conclusion and Engagement Invitation

• The section on schizophrenia and other psychotic disorders concludes here. Viewers are encouraged to test their knowledge through interactive content. Comments are welcomed for any questions.