AP II - SEMINAR ON SCHIZOPHRENIA DISORDER

UNIT 2
SCHIZOPHRENIA &
OTHER PSYCHOTIC
DISORDERS
Brinda, Janavika L,
R K Namitha, Pavithra P S,
Srilekha Iyengar

01
Pavithra P S
02
Brinda
03
R K Namitha
04
Janavika L & Srilekha
Iyengar
TABLE OF CONTENTS
MEANING &
CLINICAL FEATURES
CAUSES
TREATMENT SUBTYPES

“This is a quote, words full of
wisdom that someone
important said and can make
the reader get inspired.”
MEANING & CLINICAL
FEATURES
01
-Pavithra

Introduction to Schizophrenia
Schizophrenia is a chronic and severe mental disorder
that affects how a person thinks, feels, and behaves.
Terminology:
● “Démence précoce” - Belgian psychiatrist
Benedict Morel (1852 ) to refer to mental
deterioration at an early age.
● “Dementia Praecox” - German psychiatrist Emil
Kraepelin (1896) used the Latin version of Morel’s
Term.
● “Schizophrenia” - Swiss psychiatrist Eugen
Bleuler coined the term in 1911.
Greek word “sxizo” - to split or crack; “phren” -

Introduction to Schizophrenia
Characterized by: Episodes of Psychosis - hallucinations,
delusions, and disorganized thinking.
Long-term impairments in emotional and social
functioning.
Age of Onset: typically manifests in Late Adolescence or
Early Adulthood.
Males: Late teens to early 20s.
Females: Mid-20s to early 30s.

SYMPTOMS OF SCHIZOPHRENIA
DELUSIONS
Erroneous beliefs that are fixed
firmly despite clear contradictory
evidence (e.g., paranoia,
grandiosity).
Disturbance in the content of the
thought.
HALLUCINATIONS
Perceptual experiences without
external stimuli (auditory, visual,
olfactory, tactile, or gustatory).
Auditory - most common
followed by visual.
DISORGANIZED THINKING
& SPEECH
Incoherent or illogical thoughts,
leading to difficulties in
communication.
Disorder of the form of
thought/ideas being expressed.
POSITIVE
SYMPTOMS
(Excess or distortion of
normal functions)
BEHAVIOUR
Disorganized Behaviour:
Disruption of executive functions -
Inappropriate or bizarre behavior,
motor disturbances.
Catatonic Behavior: complete lack
of movement/responsiveness.

SYMPTOMS OF SCHIZOPHRENIA
AFFECTIVE FLATTENING
(BLUNTED AFFECT)
Lack of emotional response to
situations - Reduced emotional
expression, monotone speech, or
diminished facial expressions.
ANHEDONIA
Inability to feel pleasure or
interest in previously enjoyed
activities.
ALOGIA
Reduced speech output or poverty of
speech (very little speech).
NEGATIVE
SYMPTOMS
(Reduction or loss of
normal functions)
AVOLITION
Lack of motivation to initiate or
sustain goal-directed activities.
Eg; Sitting in front of tv or staring
into space with little interest in any
outside work or social activity.

DSM Criteria
CORE SYMPTOMS
(At least two of the
following, each present
for a significant portion
of time during a 1-month
period)
1. Delusions
2. Hallucinations
3. Disorganized
Speech
4. Grossly
Disorganized or
Catatonic Behavior
5. Negative
Symptoms
A B
FUNCTIONAL IMPAIRMENT
If Onset in:
● Adulthood - one or more
major areas of functioning
(e.g., work, interpersonal
relations, or self-care) are
markedly below the level
achieved prior to the onset in
adulthood.
● Childhood or Adolescence -
Failure to achieve expected
level of interpersonal,
academic, or occupational
functioning).
DURATION
Continuous signs of disturbance persist for at
least 6 months.
1. Active-phase symptoms (meeting
criterion A) - must be present for at least
1 month.
2. May include periods Prodromal
symptoms or Residual symptoms
Prodromal symptoms - early warning signs
that can occur before the onset of a condition
(before Active Phase).
Residual symptoms - symptoms that remain
after a patient's treatment for a condition
C

D
DSM Criteria
EXCLUSION OF
SCHIZOAFFECTIVE & MOOD
DISORDERS
The disturbance is not attributable
to schizoaffective disorder,
depressive, or bipolar disorder
with psychotic features.
E
EXCLUSION OF
SUBSTANCE/MEDICAL CONDITION
The symptoms are not due to the
physiological effects of a substance
(e.g., drug abuse or medication) or
another medical condition.
F
RELATION TO ASD OR
COMMUNICATION DISORDER
If there is a history of autism or
communication disorder of childhood
onset, the diagnosis of schizophrenia is
made only if prominent delusions or
hallucinations are also present for at least
1 month.
Differential Diagnosis:
● Major depressive or bipolar
disorder with psychotic or catatonic
features
● Schizoaffective disorder.
● Schizophreniform disorder and
brief psychotic disorder.
● Delusional disorder.
● Schizotypal personality disorder
● ASD
● PTSD
● communication disorders.
● body dysmorphic disorder
● Substance/medication-induced
psychotic disorder
● Other mental disorders associated
with a psychotic episode
Comorbidity:
● Substance-Related Disorders - Tobacco Use
Disorder, Alcohol/Drug Use Disorders
● Anxiety Disorders - OCD, Panic Disorder
● Personality Disorders - Schizotypal
Personality Disorder, Paranoid Personality
Disorder
● Medical Conditions - Weight Gain, Diabetes,
Cardiovascular Diseases, Pulmonary

CAUSES OF
SCHIZOPHRENIA
02 brinda

BIOLOGICAL CAUSES OF SCHIZOPHRENIA
Genetic Factors:
A strong genetic component, with higher risks observed in individuals with a family
history of schizophrenia.
Brain Structure and Function Abnormalities:
Studies indicate smaller temporal and frontal lobes, and abnormalities in the
hippocampus, amygdala, and thalamus.
Neurotransmitter Imbalances:
Dysregulation of dopamine and glutamate pathways plays a critical role in symptom
development.
Paternal Age:
Children born to fathers over 50 have a higher likelihood of developing schizophrenia,
possibly due to genetic mutations or other biological factors.

PSYCHOLOGICAL CAUSES OF SCHIZOPHRENIA
Psychodynamic Theory (Freud):
○ Regression to a pre-ego stage due to trauma or harsh parenting, leading to
self-centered behaviors (e.g., delusions, hallucinations).
○ Struggles to reestablish ego control manifest as psychotic symptoms.
○ Although lacking empirical support, some evidence points to early trauma as a
contributing factor.
Behavioral Theory:
○ Schizophrenia may result from improper reinforcement of behaviors, leading
individuals to focus on irrelevant cues (e.g., sounds, lights) rather than social
norms.
○ Bizarre behaviors become reinforced over time, perpetuating psychotic
symptoms.

COGNITIVE CAUSES OF SCHIZOPHRENIA
Misinterpretation of Sensory Experiences:
○ Biological abnormalities trigger
hallucinations and perceptual
difficulties.
○ Individuals misinterpret these
experiences, concluding that others are
hiding the truth, fostering paranoia and
delusions.
○ Cognitive biases, such as jumping to
conclusions, exacerbate these
misinterpretations.

ENVIRONMENTAL & SOCIAL CAUSES OF SCHIZOPHRENIA
Stressful Life Events:
High-stress environments or significant life
events may act as triggers in genetically
predisposed individuals.
Early Childhood Trauma:
Abuse, neglect, or unstable family
environments can increase vulnerability to
the disorder.
Socioeconomic Status:
Lower socioeconomic conditions and urban
living have been linked to higher rates of
schizophrenia.

TREATMENT FOR
SCHIZOPHRENIA 03
RK
Namitha

History of Treatments for Schizophrenia
Early Perception:
● Schizophrenia was misunderstood,
leading to stigma and fear.
● Symptoms were attributed to
supernatural causes (e.g., demonic
possession, curses).
● Individuals were often ostracized and
isolated from their communities.
● Recovery was considered impossible,
leading to neglect and hopelessness.
Early Treatments:
● Focused on controlling behavior rather than
addressing the condition.
● Patients were confined to asylums under harsh
and punitive conditions.
● Common practices included:
○ Physical restraints (chains,
straightjackets).
○ Extreme measures like bloodletting,
purging, and trephination.
● Neglect and minimal support were widespread,
with patients left in squalid conditions.

Milieu Therapy
Token Economy
Milieu therapy, a Humanistic Approach, pioneered by Maxwell Jones,
emphasized creating a therapeutic environment where patients
were treated as capable individuals. They could participate in
decision-making and engage in meaningful activities, improving
self-image and care.
Token economy, a Behavioral Approach, used operant conditioning
to reinforce desirable behaviors. Patients earned tokens for
acceptable behaviors, which could be exchanged for privileges like
food or cigarettes. This created a system of incentives to encourage
positive actions.
Introduction of Hopeful Approaches (1950s)

Discovery of Antipsychotic Drugs
The discovery of antipsychotic drugs in the 1950s
revolutionized the treatment of schizophrenia,
offering the first effective pharmacological
intervention for managing its symptoms. Initially
developed as antihistamines for allergies, certain
compounds, particularly phenothiazines,
demonstrated calming effects that caught the
attention of researchers. Among these,
chlorpromazine emerged as a groundbreaking
treatment for psychotic disorders.
Chlorpromazine (Thorazine): The Pioneer Drug
● Initially used to reduce preoperative anxiety,
chlorpromazine’s ability to alleviate psychotic
symptoms was soon recognized.
● Approved as Thorazine in 1954, it became the
first widely used antipsychotic.
● Effects on Patients:
○ Significantly reduced hallucinations,
delusions, and disordered thinking
(positive symptoms).
○ Calmed agitated behavior, enabling
many long-term institutionalized
patients to reintegrate into society.

Conventional Antipsychotics
(Neuroleptics)
Second-Generation Antipsychotics
(Atypical Antipsychotics)
Examples: Haloperidol (Haldol),
Thioridazine (Mellaril).
Mechanism:
● Block dopamine D-2 receptors.
● Effective for positive symptoms
like hallucinations and delusions.
Examples: Clozapine (Clozaril),
Risperidone (Risperdal).
Mechanism:
● Target both dopamine and
serotonin receptors.
● Treat both positive and negative
symptoms.
Types of Antipsychotic Drugs

Symptom Reduction
● Approximately 65% of schizophrenia patients respond favorably to antipsychotics.
● Timeline of Improvement:
○ Initial symptom relief observed within a few weeks.
○ Significant recovery often achieved within months of consistent use.
Relapse Risk
● Continuous medication use significantly lowers the risk of relapse.
● Discontinuing medication increases relapse rates, underscoring the importance of adherence
to treatment plans.
Effectiveness of Antipsychotic Drugs

Extrapyramidal Symptoms (EPS)
● Common with conventional antipsychotics due to strong dopamine blockade.
● Include:
○ Parkinsonian-like symptoms: Tremors, muscle rigidity, bradykinesia.
○ Neuroleptic Malignant Syndrome (NMS): Rare but life-threatening; includes severe
muscle rigidity, high fever, and autonomic instability.
○ Tardive Dyskinesia (TD): Involuntary, repetitive movements often appearing after long-
term use.
Second-Generation Drugs
● Have a lower risk of EPS and tardive dyskinesia.
● However, they can cause metabolic side effects like weight gain, diabetes, and cardiovascular
issues.
Side Effects of Antipsychotic Drugs

THERAPY TECHNIQUES
Cognitive -
Behavioral
Therapy (CBT)
Avatar
Therapy
Psychotherapy
Family
Therapy

The Community Approach to Treating Schizophrenia
Community Mental
Health Act (1963)
A landmark law aimed at deinstitutionalizing care,
ensuring patients with severe mental disorders are
treated in community settings instead of large
psychiatric hospitals.
Mental Health on
the Streets
Involves special initiatives like trained police units to
assist homeless individuals with mental disorders,
directing them to appropriate treatment facilities.
Deinstitutionalization
The shift from institutional care to community-based
services, reducing the number of psychiatric hospital
residents from 600,000 in 1955 to fewer than 40,000
today, with both successes and challenges in
implementation.

Coordination of Services:
Integrated care systems ensure patients receive
comprehensive support across therapy, medication,
social services, and vocational training, guided by
case managers for continuity and improved
outcomes.
Short-Term Hospitalization:
A focused approach to stabilize acute symptoms,
transitioning patients to outpatient care promptly to
minimize long-term disruption.
Occupational Training and Support:
Programs like sheltered workshops and supported
employment empower individuals with severe mental
disorders to develop work skills and maintain
meaningful employment.
Effective Features of Community Care for Schizophrenia
Partial Hospitalization:
Day treatment programs offer therapy and
activities, allowing patients to remain in the
community while receiving structured support;
semi hospitals provide 24-hour care for short-
term intensive needs.
Supervised Residences (Halfway Houses):
Transitional living environments staffed by
paraprofessionals that help residents build
independence, life skills, and social connections
in a supportive setting.

Innovative Approaches to Schizophrenia
Management
Transcranial Magnetic
Stimulation (TMS)
Electroconvulsive
Therapy (ECT)
Cognitive Remediation
with Brain Stimulation
Cannabidiol (CBD)
Anti-Inflammatory
Treatments (e.g.,
Minocycline)
Gut-Brain Axis
Therapies

FEATURES
PARANOID SCHIZOPHRENIA
DELUSIONS
AUDITORY
HALLUCINATIONS
COGNITIVE
FUNCTIONING
Persecutory
Grandiose
Systematic
Comment on Action
Criticise / insult them
Give Commands
Less disorganised
Appear logical and coherent
- Janavika L

BEHAVIOUR
PARANOID SCHIZOPHRENIA
SUSPICION &
HOSTILITY
PREOCCUPATION
WITH DELUSIONS
EMOTIONAL
INTENSITY
Distrust others
Fear of Manipulation
Concentration & Focus Fear, anger or agitation

FEATURES
DISORGANISED SCHIZOPHRENIA
THINKING &
SPEECH
DISORGANISED
BEHAVIOUR
INAPPROPRIATE
OR FLAT AFFECT
Loose Associations
Word Salad
Clang Associations
Daily tasks
Bizzare / purposeless
Lack of goal directed activity
Emotional response & situation
Flat affect
- Janavika L

● Catatonic schizophrenia is a subtype of schizophrenia that was previously recognized as a
diagnosis, but is no longer considered an official diagnosis. However, catatonia is still considered
an important syndrome to treat, especially when it occurs with schizophrenia.
Symptoms of catatonic schizophrenia include:
● Immobility:
● Unresponsiveness:
● Catatonic excitement:
● Posturing:
● Waxy flexibility:
● Stereotypy:
● Treatment for catatonic schizophrenia typically includes medications, psychotherapy, and
sometimes electroconvulsive therapy (ECT). Early intervention and personalized treatment plans
can help manage symptoms.
CATATONIC SCHIZOPHRENIA
- Srilekha Iyengar

● Undifferentiated schizophrenia was a subtype of schizophrenia previously recognized as a
diagnosis, but it is no longer considered an official diagnosis under the DSM-5. However,
understanding this subtype provides valuable insights into the diverse presentations of
schizophrenia. Individuals with undifferentiated schizophrenia exhibited symptoms that did not
clearly fit into other subtypes, such as paranoid, disorganized, or catatonic schizophrenia.
Symptoms of undifferentiated schizophrenia include:
● Hallucinations:
● Delusions:
● Disorganized speech:
● Negative symptoms:
● Behavioral disturbances:
● Treatment for undifferentiated schizophrenia typically includes a combination of antipsychotic
medications, psychotherapy, and psychosocial support. Early diagnosis and tailored treatment
plans are crucial for managing symptoms and improving quality of life. Rehabilitation programs
and community resources also play a significant role in helping individuals achieve functional
recovery
UNDIFFERENTIATED SCHIZOPHRENIA

SCHIZOAFFECTIVE DISORDER
MEANING
A mental illness with a combination of symptoms from schizophrenia (psychotic
features) and mood disorders (manic or depressive episodes).
Exists between schizophrenia and mood disorders on the psychiatric spectrum.
Two subtypes:
1. Bipolar type: Features manic or mixed episodes (may include depression).
2. Depressive type: Features only depressive episodes.
- Janavika L

DIAGNOSTIC CRITERIA
A. Concurrent Major Mood Episode and Schizophrenia Symptoms
● There is an uninterrupted period of illness where a major mood episode (major depressive or manic) occurs
concurrently with Criterion A of schizophrenia.
● Note: The major depressive episode must include Criterion A1: Depressed mood.
B. Psychotic Symptoms in the Absence of Mood Episode
● Delusions or hallucinations must be present for 2 or more weeks in the absence of a major mood episode
(depressive or manic) during the lifetime of the illness.
C. Dominance of Mood Symptoms
● Symptoms that meet the criteria for a major mood episode are present for the majority of the illness duration,
including the active and residual phases.
D. Exclusion of Substance or Medical Condition
● The disturbance must not be attributable to the physiological effects of:
1. A substance (e.g., drug abuse, medication).
2. Another medical condition.

CAUSES
Biological Factors:
● Genetics: Higher risk if there’s a family history of schizophrenia or bipolar disorder.
● Neurochemical Imbalances: Dysregulation of dopamine, serotonin, and glutamate.
● Brain Abnormalities: Structural issues in the prefrontal cortex, hippocampus, or
thalamus.
Environmental Factors:
● Stress and Trauma: Significant life changes or traumatic events.
● Prenatal Factors: Infections, malnutrition, or complications during pregnancy.
Psychosocial Factors:
● High Expressed Emotion (EE): Family environments with hostility, criticism, or over-
involvement.

TREATMENT
Pharmacological Treatment:
● Antipsychotics: Manage psychotic symptoms (e.g., Risperidone, Olanzapine).
● Mood Stabilizers: For bipolar type (e.g., Lithium, Valproate).
● Antidepressants: For depressive type (e.g., SSRIs like Sertraline).
Psychotherapy:
● Cognitive Behavioral Therapy (CBT): Helps in coping with delusions, hallucinations, and mood
symptoms.
● Interpersonal Therapy: Improves relationships and coping skills.
Family Therapy and Psychoeducation:
● Educates families and reduces stigma, promoting adherence to treatment.
Social Skills Training:
● Enhances communication, social, and vocational skills.

SCHIZOPHRENIFORM DISORDER
MEANING
Schizophreniform Disorder is a mental health condition classified as a psychotic
disorder, characterized by symptoms similar to schizophrenia but lasting for a
shorter duration. It is considered a provisional diagnosis often leading to either
recovery or progression to a more chronic condition like schizophrenia or
schizoaffective disorder.
- Janavika L

DIAGNOSTIC CRITERIA
A. Core Symptoms
Two (or more) of the following must be present for a significant portion of time during a 1-month period. At
least one must be (1), (2), or (3):
1. Delusions
2. Hallucinations
3. Disorganized speech (e.g., frequent derailment or incoherence).
4. Grossly disorganized or catatonic behavior.
5. Negative symptoms (i.e., diminished emotional expression or avolition).
B. Duration of Disorder
● The episode must last at least 1 month but less than 6 months.
● If recovery is not yet observed, the diagnosis should be qualified as “provisional.”

DIAGNOSTIC CRITERIA
C. Exclusion of Mood Disorders
Schizoaffective disorder or depressive/bipolar disorders with psychotic features must be ruled out by
confirming:
1. No major depressive or manic episodes have occurred concurrently with the active-phase
symptoms, OR
2. Mood episodes, if present, have occurred only for a minority of the illness duration.
D. Substance or Medical Condition Exclusion
● The disturbance must not be attributable to:
○ The physiological effects of a substance (e.g., drugs, medication).
○ Another medical condition.

CAUSES
Biological Factors:
● Genetics: Increased risk if there is a family history of schizophrenia or related
disorders.
● Neurochemical Imbalances: Abnormal dopamine functioning in the brain.
● Brain Structure: Changes in the prefrontal cortex and hippocampus.
Environmental Factors:
● Stress and Trauma: Stressful life events can trigger symptoms.
● Prenatal Risks: Exposure to infections, malnutrition, or complications during
pregnancy.

TREATMENT
● Antipsychotic Medications: Used to reduce psychotic symptoms (e.g., Risperidone, Haloperidol).
Psychotherapy:
● CBT (Cognitive Behavioral Therapy): Helps individuals manage delusions, hallucinations, and
disorganized thinking.
● Family Therapy: Educates families to create a supportive environment and reduce stress.
Hospitalization:
● May be necessary for individuals with severe symptoms or risk of harm to themselves/others.
.

DELUSIONAL DISORDER
MEANING:
Delusional disorder is a psychiatric condition characterized by persistent, non-bizarre delusions
lasting at least one month. These delusions are often plausible but lack sufficient evidence and
do not stem from a medical condition, substance use, or other psychotic disorders such as
schizophrenia.
Key Features:
● Delusions- Fixed, false beliefs that are not aligned with reality or cultural norms.
Examples include:
Erotomanic delusions: Belief that someone is in love with the individual.
Persecutory delusions: Belief of being harmed, harassed, or conspired against.
Grandiose delusions: Exaggerated sense of self-worth, knowledge, or power.
● Absence of Hallucinations
Hallucinations, if present, are not prominent or directly related to the delusional theme.
● Preserved Functioning
Unlike schizophrenia, overall functioning and behavior outside the delusional context are
relatively intact.
- Srilekha Iyengar

DIAGNOSTIC CRITERIA
A. Presence of One or More Delusions
The primary feature of delusional disorder is the
presence of one or more delusions that persist
for at least one month. Delusions are fixed, false
beliefs that are not based on evidence and are
resistant to contradictory information or
reasoning.
B. Exclusion of Other Psychotic Symptoms
The individual does not exhibit prominent
hallucinations, disorganized speech, grossly
disorganized or catatonic behavior, or negative
symptoms typical of schizophrenia. This exclusion
criterion ensures that the condition is distinct
from schizophrenia or schizoaffective disorder.
C. Minimal Functional Impairment
Outside of the delusional context, the individual's
behavior and functioning are relatively
unaffected. Unlike schizophrenia, there is no
marked decline in cognitive, occupational, or
social functioning.
D. Exclusion of Medical/Substance Causes
Symptoms cannot be attributed to the
physiological effects of a medical condition (e.g.,
brain injury, neurodegenerative disorders) or
substance use (e.g., drug-induced psychosis).

CAUSES
● Neurobiological Factors
Dysfunction in brain regions such as the prefrontal cortex and limbic system.
● Psychosocial Factor
Early trauma, stress, and social isolation may contribute to the disorder.
● Genetic Vulnerability
Family history of psychotic or mood disorders increases risk.

TREATMENT
Psychotherapy
● Cognitive-behavioral therapy (CBT): Helps
patients recognize and challenge delusional
beliefs.
● Supportive therapy: Builds coping strategies
and improves functioning.
Medications
● Antipsychotics: Examples include risperidone
and olanzapine to reduce delusional intensity.
● Antidepressants: May be used if mood
disturbances are present.
Prognosis
● Chronic Condition- Symptoms often
persist, but early intervention and
adherence to treatment can improve
outcomes.
● Functionality Maintained- Many
individuals maintain relatively normal
functioning in social and occupational
areas outside delusional content.

BRIEF PSYCHOTIC DISORDER
MEANING:
Brief psychotic disorder is a short-term mental health condition characterized by sudden onset
psychotic symptoms, such as delusions, hallucinations, or disorganized speech. Symptoms last at
least one day but resolve within one month, after which the individual returns to their premorbid
level of functioning.
Key Features:
● Acute Onset
Rapid development of psychotic symptoms, often in response to a significant stressor.
● Core Symptoms
- Delusions: Fixed, false beliefs not supported by evidence.
- Hallucinations: Perception of sounds, images, or sensations without external stimuli.
- Disorganized Speech: Incoherent or nonsensical communication.
- Disorganized Behavior: Erratic, unpredictable actions that impair daily functioning.
● Duration
Symptoms last for a minimum of one day but less than one month.

DIAGNOSTIC CRITERIA
A. Presence of One or More Psychotic
Symptoms
Psychosis is characterized by a disconnect from
reality, manifesting in symptoms such as
delusions, hallucinations, disorganized speech,
and grossly disorganized or catatonic behavior
(ranging from agitation to a lack of
responsiveness).
B. Short Duration
The episode must last at least one day but less
than one month, with symptoms resolving fully
within this time frame. Following the psychotic
episode, the individual returns to their premorbid
level of functioning, meaning they resume
normal daily life and behaviors without lasting
impairment.
C. Exclusion of Other Conditions
the symptoms must not be attributable to other
conditions, such as mood disorders with
psychotic features (like bipolar disorder or major
depression), substance-induced psychosis
(caused by drugs or alcohol withdrawal), or
medical conditions (like epilepsy or brain tumors)
that can cause similar symptoms.

CAUSES
● Stressful Life Events
Triggers such as trauma, grief, or acute stress may precipitate an episode.
● Neurochemical Dysregulation
Imbalance in neurotransmitters like dopamine may contribute to symptom
onset.
● Genetic and Environmental Factors
A family history of psychotic disorders increases vulnerability.

TREATMENT
● Short-Term Interventions
Hospitalization may be required during acute
episodes for safety and symptom stabilization.
● Medications
- Antipsychotics: Used to manage delusions or
hallucinations (e.g., haloperidol, risperidone).
- Benzodiazepines: Administered short-term
for agitation or severe anxiety.
● Psychotherapy
Supportive therapy: Aims to address the
psychological impact of the episode and
reduce stress.
● Prognosis
-Good Recovery
Most individuals recover completely
within a month and resume normal
functioning.
-Risk of Recurrence
Recurrence or progression to other
psychotic disorders, such as
schizophrenia, is possible in a subset of
cases.

SUBSTANCE/MEDICATION INDUCED
PSYCHOTIC DISORDER
MEANING
A type of psychotic disorder characterized by hallucinations or delusions caused by
substance intoxication, withdrawal, or medication use.
Key Features:
● Symptoms occur during or shortly after substance use or withdrawal.
● Hallucinations are excluded if the individual recognizes them as substance-
induced.
- Brinda

DIAGNOSTIC CRITERIA
A. Presence of one or both of the following symptoms:
● Delusions
● Hallucinations
B. Evidence that symptoms are substance-related:
1. Symptoms developed during or within one month of substance use, intoxication, or withdrawal.
2. The substance or medication is etiologically related to the disturbance.
C. Not better explained by another psychotic disorder:
● Symptoms precede substance use or persist beyond withdrawal/intoxication.
● Symptoms are disproportionate to the expected effects of the substance.
D. Not occurring exclusively during delirium.
E. Causes significant distress or impairment in functioning.

CAUSES
Substance Use:
● Intoxication or withdrawal from substances like alcohol, cannabis, amphetamines,
hallucinogens, or opioids.
Medication Side Effects:
● Psychotropic drugs, corticosteroids, or other medications with psychosis-inducing
properties.
Underlying Vulnerabilities:
● Genetic predisposition or a history of mental illness may increase susceptibility.
Duration and Amount of Use:
● Chronic or excessive substance use increases the likelihood of psychotic symptoms.

TREATMENT
Immediate Interventions:
● Discontinuation of the substance causing the psychosis.
● Medical detoxification in severe cases of intoxication or withdrawal.
● Antipsychotics (e.g., risperidone, olanzapine) to manage symptoms.
● Benzodiazepines for severe agitation or anxiety.
Psychotherapy:
● Cognitive Behavioral Therapy (CBT): Helps patients understand triggers and develop coping
strategies.
● Psychoeducation: Increases awareness about substance use and its risks.
Long-Term Management:
● Substance Use Treatment Programs to prevent relapse.
● Support groups like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA).
● Regular follow-ups to monitor recovery progress.

PSYCHOTIC DISORDER
DUE TO ANOTHER MEDICAL CONDITION
MEANING:
Psychotic Disorder Due to Another Medical Condition involves psychotic symptoms caused by an
illness or condition affecting brain function.
Key Features:
● Symptoms include hallucinations, delusions, and disorganized speech or thought
patterns.
● Occurs alongside temporary or chronic medical conditions such as stroke, traumatic brain
injury, or dementia.
● Excludes psychosis caused by drug use or delirium.
- RK Namitha

DIAGNOSTIC CRITERIA
A. Prominent Psychotic Symptoms
The individual experiences prominent delusions
or hallucinations.
B. Evidence of Another Medical Condition
There is evidence from the history, physical
examination, or laboratory findings that the
disturbance is the direct pathophysiological
consequence of another medical condition.
C. No Other Mental Disorder
The disturbance is not better explained by
another mental disorder, such as delirium or a
primary psychotic disorder (e.g., schizophrenia).
D. Not Exclusively During Delirium
The disturbance does not occur exclusively
during the course of a delirium (a state of acute
confusion).
E. Significant Impairment
The psychotic symptoms cause clinically
significant distress or impairment in social,
occupational, or other important areas of
functioning.

CAUSES
Medical Conditions Causing Psychosis:
● Neurological: Brain tumors, epilepsy, stroke, multiple sclerosis.
● Autoimmune: Lupus, HIV/AIDS.
● Others: Thyroid disease, Huntington’s disease, migraines.
Underlying Mechanisms:
● Changes in brain function due to the primary condition.
● Possible genetic predisposition or inflammatory/autoimmune disorders.
● Age as a contributing factor in some cases.

TREATMENT
Primary Focus: Treat the underlying medical condition.
● Successful treatment often leads to remission of psychosis.
Medications:
● Antipsychotics: Manage delusions and hallucinations.
● Benzodiazepines: Calm severe symptoms.
● Antidepressants: Address associated mood symptoms.
Prognosis:
● Temporary or lifelong psychosis depends on the nature of the medical condition.
● Recurrent conditions may require ongoing management.

OTHER SPECIFIED SCHIZOPHRENIA SPECTRUM
AND OTHER PSYCHOTIC DISORDER
- Pavithra
● An individual's shows symptoms characteristic of schizophrenia spectrum and other
psychotic disorders, but they do not meet the full diagnostic criteria for any
specific disorders in the schizophrenia spectrum and other psychotic disorders
diagnostic class.
● It causes significant impairment of their functioning in important areas of life.
● The clinician chooses to specify the reasons why the presentation of symptoms
does not meet full criteria of a diagnosis..

- Pavithra
Examples of Symptoms:
1. Persistent auditory hallucinations without other features of psychosis.
2. Delusions with overlapping mood episodes that do not fulfill criteria for
delusional disorder.
3. Attenuated psychosis syndrome - psychotic-like symptoms that are below a
threshold for full psychosis (e.g., the symptoms are less severe and more transient,
and insight is relatively maintained).
4. Delusional symptoms in the context of a relationship - delusional material from
the individual with a psychotic disorder provides content for the same delusions
held by the other person who may not otherwise have symptoms that meet criteria
for a psychotic disorder.

- Pavithra
Causes
● Genetic predisposition.
● Neurobiological factors, such as
imbalances in dopamine pathways.
● Environmental triggers, including
stress, trauma, or substance use.
● Interaction of biopsychosocial
factors, where biological
vulnerabilities and external stressors
combine.
Treatment
● Pharmacotherapy: Low-dose
antipsychotics to manage specific
symptoms (e.g., hallucinations or
delusions).
● Psychotherapy: CBT to enhance
insight and coping strategies.
● Monitoring: Prevent progression to
more severe disorders.

UNSPECIFIED SCHIZOPHRENIA SPECTRUM AND
OTHER PSYCHOTIC DISORDER
- Pavithra
● An individual's shows symptoms characteristic of schizophrenia spectrum and other
psychotic disorders, but they do not meet the full diagnostic criteria for any specific
disorders in the schizophrenia spectrum and other psychotic disorders diagnostic
class.
● Similar to other psychotic disorders but with insufficient data for specific
diagnosis.
● The clinician chooses to not specify the reasons why the presentation of symptoms
does not meet full criteria of a diagnosis.
● Commonly used in emergency or early assessment situations.

UNSPECIFIED SCHIZOPHRENIA SPECTRUM AND
OTHER PSYCHOTIC DISORDER
- Pavithra
Causes
● Insufficient data to determine
specific causes (e.g., emergency
settings or early stages of
assessment).
● Could include any causes of
psychotic symptoms - biological,
genetic, environmental, or
unknown factors.
Treatment
● Immediate care: Stabilize often with
antipsychotic medications, in acute or
emergency scenarios.
● Further evaluation: Gather more
information for a clearer diagnosis.
● Supportive therapy: Address immediate
distress and impairment.
● Follow-up care: Continued monitoring to
reassess the diagnosis and refine treatment
plans.

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AP II - SEMINAR ON SCHIZOPHRENIA DISORDER

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