Part Three of Schizophrenia Spectrum and other Psychotic Disorders

Part Three of Schizophrenia Spectrum and Other Psychotic Disorders will cover Catatonia Associated With Another Mental Disorder (Catatonia Specifier), Catatonic Disorder Due to Another Medical Condition, and Delusional Disorder.

Click HERE to read the Introduction to Schizophrenia Spectrum and Other Psychotic Disorders, which gives definitions to important terms and an overview of the disorders within this class.

 What is Catatonia?

Catatonia or catatonic behavior is a noticeable decrease in the level and intensity of which an individual interacts with or responds to their environment.

 Symptoms of Catatonia

The following list contains brief descriptions of catatonia symptoms.

• Stupor: a daze; not actively responding to the surrounding environment
• Catalepsy: a trance; loss of sensation and consciousness; rigid body posture
• Waxy flexibility: decreased response to external stimuli; remaining immobile/resisting someone who tries to change their body position
• Mutism: little to no verbal response
• Negativism: “opposition to or no response to instructions or external stimuli” (DSM)
• Posturing: “spontaneous and active maintenance of a posture against gravity” (DSM). An example of this is an individual standing on one leg and with one or both arms extended over their head.
• Mannerism: repeating a ‘normal’ gesture, such as clearing the throat or twirling hair around a finger, in an exaggerated manner
• Stereotypy: “repetitive, abnormally frequent, non-goal-directed movements” (DSM). An example of this is arm flapping or rocking the body from side to side.
• Agitation: anxiety or disturbance that is not influenced by external stimuli
• Grimacing: a twisted or out of shape facial expression
• Echolalia: mimicking another’s speech
• Echopraxia: mirroring a person’s movements

(Diagnostic and Statistical Manual of Mental Disorders, 2013)

 What is a specifier?

Specifiers are used when an individual meets the criteria for a diagnosis, yet they also experience multiple symptoms of another mental health diagnosis.  Specifiers can be a description added to a diagnosis or, if the symptoms are severe, an added specifier diagnosis is given.  It is important to note that the individual would be given an additional mental health diagnosis if they met all criteria.

 Catatonia Associated With Another Mental Disorder (Catatonia Specifier)

Catatonia Associated With Another Mental Disorder, or Catatonia Specifier, is used when an individual experiences three or more of the previously mentioned symptoms of catatonia.  It is typically seen in conjunction with depressive, psychotic, bipolar, and/or neurodevelopmental disorders.  Due to the range of catatonic symptoms, the diagnosing professional must rule out medical conditions and medications that contribute to catatonia prior to diagnosis.

 Catatonic Disorder Due to Another Medical Condition

There are five criteria for diagnosis with Catatonic Disorder Due to Another Medical Condition:  One, the individual must experience three or more of the catatonia symptoms that were previously mentioned; Two, there is “evidence from the history, physical examination, or laboratory findings that the disturbance is the direct consequence of another medical condition”; Three, the symptoms are “not better explained by another medical disorder”; Four, the symptoms do not occur only during delirium; and Five, the presence of symptoms cause “distress or impairment in social, occupational, or other important areas of functioning” (Diagnostic and Statistical Manual of Mental Disorders, 2013).

 Delusional Disorder

The Diagnostic and Statistical Manual of Mental Disorders describes five types of delusions:  erotomanic, grandiose, jealous, persecutory, somatic, and nihilistic.  For detailed descriptions of these delusions, click HERE, where you will be redirected to the Introduction to Schizophrenia Spectrum and Other Psychotic Disorders blog post.

Delusions are beliefs that remain even when evidence that is contrary to the belief is presented.  Diagnosis with Delusional Disorder involves individuals experiencing one or more delusions for at least one month.  Delusions can be present in persons who have Schizophrenia and/or in persons who are experiencing a manic or major depressive episode.  Because the presence of delusions is one of the criteria for diagnosing Schizophrenia, diagnosis with Delusional Disorder requires that the individual has never met the criterion for Schizophrenia. (Click HERE to review the diagnostic criteria for Schizophrenia).  In addition, diagnosis with Delusional Disorder requires that the manic or major depressive disorder be briefer that the duration of the delusional period.

Aside from the “impact of the delusion(s) or its [consequences], functioning is not [noticeably] impaired, and behavior is not obviously bizarre or odd” (Diagnostic and Statistical Manual of Mental Disorders, 2013).  A delusion is classified as bizarre if it is highly improbable and if another individual from the same culture as the person experiencing the delusion does not understand it.  Finally, the symptoms and its accompanying disturbances are not better explained by another medical condition or the effects of a substance, such as drugs of abuse or prescribed medications.

 Up Next!

Introduction to Bipolar and other Related Disorders!

References

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013. Web. [access date: 2 March 2018]. dsm.psychiatryonline.org