Part One of the Schizophrenia Spectrum and Other Psychotic Disorders covers the disorders on the Schizophrenia Spectrum. Schizoaffective Disorder, Schizophrenia, Schizophreniform Disorder, and Schizotypal Disorder (which is technically a personality disorder) are described below.
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What do these disorders have in common?
Schizoaffective Disorder, Schizophrenia, and Schizophreniform Disorder have similar characteristics. We will cover what they have in common, and then we will discuss their differences.
The first common criterion for diagnosis on the Schizophrenia Spectrum is that the symptoms of each disorder must not be better explained by another medical condition or the effects of substance, such as drugs of abuse or prescribed medications. It is always important to rule out other diagnoses because treatments for mental disorders are based on the disorder’s symptoms and typical patterns of progression.
Both Schizophrenia and Schizophreniform have identical initial criteria, or Criterion A. This initial criterion lists the five domains that characterize Schizophrenia Spectrum: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms. The individual has to experience two or more of the five characteristics and at least one of these characteristics must be delusions, hallucinations, or disorganized speech (Diagnostic and Statistical Manual of Mental Disorders, 2013). A person cannot be diagnosed with Schizophrenia or Schizophreniform if they are only experiencing catatonia and/or negative symptoms.
An individual that has been diagnosed with Schizoaffective Disorder must meet the same initial criteria mentioned above in addition to experiencing a major mood episode. These major mood episodes can be manic; which is characterized by high energy, or they can be a major depressive episode; which is characterized by loss of energy and pleasure, as well as feelings of hopelessness.
Schizotypal Disorder is both a Schizophrenia Spectrum Disorder and a Personality Disorder. We will mention it here and again, but in further detail, when we cover disorders of personality.
Symptoms of Schizophrenia typically develop in early adolescence. Individuals begin to experience emotional, cognitive, and behavioral disruptions that significantly affect their daily lives. An individual must meet all six of the criterion set forth by the Diagnostic and Statistical Manuel 5 (DSM-5) for diagnosis of Schizophrenia:
One, a person must experience two or more of the five characteristics of the schizophrenia spectrum. Two, the symptoms must significantly affect functioning within their interpersonal relationships, with their ability to care for themselves, and with their occupational duties. Three, the symptoms must persist for at least six months. Four, Schizoaffective Disorder, which is described below, and Bipolar Disorders that have psychotic features have been ruled out. Five, the individual is not experiencing the effects of another medical condition and/or the affects of substance abuse. Finally, the sixth criterion is in regards to adding the diagnosis of Schizophrenia to an individual who is also diagnosed with “autism spectrum disorder or a communication disorder of childhood onset” (Diagnostic and Statistical Manual of Mental Disorders, 2013). In this situation, Schizophrenia can only be added if all over criterion have been met and “if prominent delusions or hallucinations are also present for at least one month” (Diagnostic and Statistical Manual of Mental Disorders, 2013).
The symptoms of Schizophreniform Disorder are the same as the symptoms of Schizophrenia Disorder. The two disorders differ in the duration of the presence of their symptoms. Where Schizophrenia’s symptoms must persist for at least six months, symptomatic episodes in Schizophreniform last at least one month but less that six months. This means that an individual has the opportunity to “recover” from the episode, and it also means that more episodes can occur.
Just like the other disorders, it is necessary to not only rule out the other Schizophrenia Spectrum disorders, but to also rule out “the physiological effects of a substance, a drug of abuse, a [prescribed] medication, or another medical condition (Diagnostic and Statistical Manual of Mental Disorders, 2013).
A diagnosis with Schizoaffective Disorder requires that the individual experience: a major mood episode; delusions, hallucinations, or disorganized speech; and, grossly disorganized behavior, catatonic behavior, or negative symptoms (as defined previously, are symptoms that take away from an individuals functioning). These mood episodes are what distinguish Schizoaffective Disorder from the other Schizophrenia Spectrum Disorders.
Mania, which is commonly associated with the bipolar disorders, is characterized by persistent elevated mood, irritability, and increased activity for the majority of the day, almost every day, for at least a week (Diagnostic and Statistical Manual of Mental Disorders, 2013). Symptoms of a depressed mood include feelings of worthlessness, difficulties thinking and/or concentrating, and even thoughts of suicide.
These combined symptoms of mania, depression, delusions, and hallucinations can be present in depressive disorders. Because of this, a diagnosis with Schizoaffective Disorder requires that the helping professional consider the individual’s entire course of symptom development. At some point during the lifetime of the illness, the diagnosed individual must experience at least two weeks of both delusions and hallucinations, without also experiencing symptoms of depression.
However, maintaining the Schizoaffective Diagnosis requires that the “episodes of depression or mania be present for the majority of the total duration of the illness” (Diagnostic and Statistical Manual of Mental Disorders, 2013). These required time constraints help prevent misdiagnosis.
Schizotypal (Personality) Disorder
Schizotypal Personality Disorder is mentioned in this series due to characteristics such as delusions and perceptual alterations. The schizotypal pattern of behavior and its symptoms become present in early adulthood.
Schizotypal Personality Disorder is characterized by deficits in close social and interpersonal relationships and “cognitive or perceptual distortions and eccentricities of behavior” (Diagnostic and Statistical Manual of Mental Disorders, 2013). The DSM-5 lists nine characteristics for Schizotypal Disorder; and a diagnosis requires an individual experience at least five:
One, “ideas of reference” or incorrectly interpreting events using meaning that is only specific to themselves. Two, “odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms”, which includes thinking they have special powers or that they can control people and objects with their thoughts (Diagnostic and Statistical Manual of Mental Disorders, 2013). The third characteristic is perceptual experiences. These are brief visual or auditory perceptions such as feeling watched or hearing someone whisper their name.
Four, speaking or thinking in vague, overelaborate, or metaphorical terms. The DSM-5 (2013) gives an example of this manner of speaking as the individual stating they were “not ‘talkable’ at work”. The fifth characteristic, “suspiciousness or paranoid ideation” is most similar to symptoms of Schizophrenia Spectrum Disorders. This paranoia can manifest as believing friends, family, and/or associates are ‘out to get them’.
The sixth and seventh characteristics are “inappropriate or constricted affect” and “behavior or appearance that is odd, eccentric, or peculiar” (Diagnostic and Statistical Manual of Mental Disorders, 2013). These are typically present while the individual is interacting with peers. They have facial expressions and body movements that are inappropriate for the setting or the conversation, and/or their style of dress may be described as unkempt.
Eight, the individual does not have close friends outside of their parents and siblings. The ninth characteristic involves the individual experiencing extreme and disproportionate social anxiety. This anxiety does not lessen, but it increases and fosters paranoia as they continue to stay within the setting.
Finally, symptoms associated with Schizotypal Personality Disorder must not occur “during the course of Schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or Autism Spectrum Disorder” (Diagnostic and Statistical Manual of Mental Disorders, 2013).
Part Two of Schizophrenia Spectrum and Other Psychotic Disorders!
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013. Web. [access date: 20 January 2018]. dsm.psychiatryonline.org