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1. Other Schizophrenia Spectrum Disorders 1
Schizophrenia
Spectrum Disorders

2. Contents
•Schizoaffective disorder
•Schizophreniform disorder
•Brief psychotic disorder
•Delusional disorder
•Secondary psychotic disorders
-GMC
- Substances
•Schizotypal personality disorder
Other Schizophrenia Spectrum Disorders 2

3. Learning objectives
•After completion of this section, you need to be able to explain:
•Schizoaffective disorder
•Schizophrenifrom disorder
•Brief Psychotic disorder
•Delusional disorder &
•Schizotypal personality disorder
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4. Schizoaffective Disorder
DSM-5 Diagnostic Criteria
A. An uninterrupted period of illness during which there is a major
depressive or manic episode concurrent with Criterion A of schizophrenia
B. Delusions or hallucinations for 2 or more weeks in the absence of major
depressive or manic episode
C. Symptoms that meet criteria for a major depressive or manic episode are
present for the majority of the total duration of the active and residual
portions of the illness
D. A general medical condition or substance use is not the cause of
symptoms.
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5. Clinical Features of Schizoaffective Disorder
-Symptoms of schizophrenia are present, but the
symptoms are also associated with recurrent or chronic
mood disturbances
-Psychotic symptoms and mood symptoms may occur
independently or together
-If manic or mixed symptoms occur, they must be present
for one week, and major depressive symptoms must be
present for two weeks.
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6. Epidemiology of Schizoaffective Disorder
- The lifetime prevalence is under one percent.
- First-degree biological relatives of schizoaffective disorder
patients have an increased risk of schizophrenia as well as
mood disorders
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7. Classification of Schizoaffective Disorder
A. Bipolar Type. Diagnosed when a manic episode occurs, major
depression may also occur
B. Depressive type. Diagnosed if only major depressive episodes occur
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8. Specify as
•First episode, currently in acute
episode
•First episode, currently in partial
remission,
•First episode, currently in full
remission
•Multiple episode, currently in acute
episode
•Multiple episode, currently in partial
remission
•Multiple episode, currently in full
remission,
•Continuous
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9. Differential Diagnosis of Schizoaffective
Disorder
A. Schizophrenia
B. Major Depressive Disorder with psychotic features
C. Bipolar Disorder with psychotic features
D. Delusional Disorder
E. Substance-Induced Psychotic Disorder.
F. Psychotic disorder due to a general medical
condition, delirium
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10. Treatment of Schizoaffective Disorder
A. Psychotic symptoms are treated with antipsychotic
agents
B. The depressed phase of schizoaffective disorder is
treated with antidepressant medications
C. For bipolar type, mood stabilizers (e.g., lithium,
valproate or carbamazepine) are used
D. Electroconvulsive therapy may be necessary for
severe depression or mania
E. Hospitalization and supportive psychotherapy may
be required
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11. Schizophreniform Disorder
•Patients with schizophreniform disorder meet full
criteria for schizophrenia, but the duration of illness
is between one and six months.
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12. DSM-5 Diagnostic Criteria for
Schizophreniform Disorder
A.Criteria “A” of Schizophrenia
B.The duration of illness 1-6months
C.Other psychiatric illnesses are ruled out
D.It is not accounted to Substance use or medical
illness
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13. Specify as
1.With good prognostic features:
•2 or more good prognostic factors
1. Onset of psychosis occurs within four weeks of behavioral
change.
2. Confusion often present at peak of psychosis.
3. Good premorbid social and occupational functioning.
4. Lack of blunted or flat affect.
2.With poor prognostic features:
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14. Clinical Features of Schizophreniform
Disorder
- Symptomatology, including positive and negative psychotic features,
is the same as schizophrenia
- Total impairment of Social or occupational functioning may not occur
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15. Epidemiology of Schizophreniform Disorder
•Lifetime prevalence of schizophreniform disorder is approximately
0.2%.
•Prevalence is the same in males and females.
•Depressive symptoms commonly coexist and are associated with an
increased suicide risk.
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16. Differential Diagnosis of
Schizophreniform Disorder
A. Psychotic disorder due to a general medical condition,
delirium, or dementia
B. Substance abuse, medication or toxic substances may cause
symptoms
C. Concomitant use of drugs that can cause or exacerbate
psychosis, such as amphetamines, may complicate the
diagnostic process
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17. Treatment of Schizophreniform Disorder
Antipsychotic medication in conjunction with
supportive psychotherapy is the primary treatment
Hospitalization may be required if the patient is
unable to care for himself or if suicidal or homicidal
ideation is present
Depressive symptoms may require antidepressants
or mood stabilizers
Early and aggressive treatment is associated with a
better prognosis
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18. Brief Psychotic Disorder
•Brief psychotic disorder is characterized by hallucinations,
delusions, disorganized speech or behavior
•Symptom onset is often rapid, with marked functional
impairment.
•The duration of symptoms is between one day and one
month
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19. DSM-5 Diagnostic Criteria for Brief
Psychotic Disorder
A. At least one of the following sx must be 1, 2 or 3:
1. Delusions.
2. Hallucinations.
3. Disorganized speech.
4. Grossly disorganized or catatonic behavior.
B. Duration of symptoms is between one day and one month,
C. The disturbance is not caused by another form of mental illness,
substance abuse or other medical condition
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20. Clinical Features of Brief Psychotic Disorder
Emotional turmoil and confusion are often present.
Mood and affect may be labile.
Onset is usually sudden and may subside rapidly
Attentional deficits are common
Psychotic symptoms are usually of brief duration (several days
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21. Epidemiology of Brief Psychotic Disorder
A. The disorder is rare, and younger individuals have a
higher rate of illness, with the average age of onset in
the late twenties to early thirties.
B. The risk of suicide is increased in patients with this
disorder, especially in young patients.
C. Patients with personality disorders have a higher
risk for brief psychotic disorder.
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22. Specify Brief Psychotic Disorder as
A. Brief Psychotic Disorder with Marked Stressors is
present if symptoms occur in relation to severe
stressors (ie, death of a loved one).
B. Brief Psychotic Disorder without Marked Stressors
is present if symptoms occur without identifiable
stressors.
C. Brief Psychotic Disorder with Postpartum Onset
occurs within four weeks of giving birth.
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23. Differential Diagnosis of Brief Psychotic
Disorder
•Substance-Induced Psychotic Disorder
•Psychotic Disorder Caused a General Medical
Condition
•Depressive and bipolar disorders
•Other psychotic disorders
•Malingering
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24. Treatment of Brief Psychotic Disorder
A. Brief hospitalization may be necessary, especially if suicidal or
homicidal ideation is present. Patients can also be very confused and
impulsive.
B. A brief course of a neuroleptic, such as haloperidol 2-10 mg per day,
is usually indicated. Adjunctive benzodiazepines can speed the
resolution of symptoms. Short-acting benzodiazepines, such as
lorazepam 1-2 mg every 4 to 6 hours, can be used as needed for
associated agitation and anxiety.
C. Supportive psychotherapy is indicated if precipitating stressors are
present. Supportive psychotherapy is initiated after psychosis has
resolved.
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25. Delusional Disorder
DSM-5 Diagnostic Criteria for Delusional Disorder
A. The presence of one (or more) delusions with a duration of 1 month or
longer.
B.Criterion ‘A’ for schizophrenia has never been met
C.Behavior and functioning are not significantly bizarre or impaired.
D. If depressive or manic episodes have occurred, the total duration of mood
pathology is brief
E. The disturbance is not attributed to a substance use or medical condition
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26. Clinical Features of Delusional Disorder
The presence of a one or more delusion is the cardinal feature of this
disorder. The delusion must be plausible, such as believing that someone is
trying to harm them.
 Patient’s thought processes and thought content are normal except when
discussing the specific delusion.
Hallucinations are not prominent unless delusional disorder is of the
somatic type. Cognition and sensorium are intact.
There is generally no disturbance of thought processes, such as loosening
of associations or tangentiality
The insight of patients into their illness is generally poor, and this disorder
may cause significant impairment in social and occupational functioning.
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27. Epidemiology of Delusional Disorder
A. Delusional disorder is uncommon, with a prevalence of 0.03%.
B. Mean age of onset is generally between 35-45; however, age of
onset is highly variable. The incidence in males and females appears
equal.
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28. Classification of Delusional Disorder
 Persecutory type
Erotomanic type
Grandiose type
 Jealous type
Somatic type
Mixed type
Unspecified type: when the delusion is difficult to specify
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29. Differential Diagnosis of Delusional Disorder
A.Schizophrenia
B.Other schizophreniform disorders
C.Substance-Induced Psychotic Disorder
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30. Treatment of Delusional Disorder
A. Delusional disorders are often refractory to
antipsychotic medication.
B. ?Psychotherapy, including family or couples
therapy, may offer some benefit.
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31. Other Schizophrenia Spectrum Disorders 31
Psychotic disorder secondary to GMC & Psychotic disorder secondary to GMC &
substance induced substance induced
•Also known as secondary psychotic disorders.
•Diagnostic Criteria
•There are prominent hallucinations or delusions.

32. Other Schizophrenia Spectrum Disorders 32
Psychotic disorder caused by a general medical Psychotic disorder caused by a general medical
conditioncondition
•Clinical features includes:-
• Hallucinations tend to include visual, olfactory and tactile elements
•Delusions; Persecutory delusions are probably the most common.
•An example is Temporal Lobe Epilepsy, Olfactory hallucinations and
religious delusions are common.
•Some authors advocate routine brain imaging of all cases of new onset
psychosis.

33. Other Schizophrenia Spectrum Disorders 33
Treatment of psychotic disorder due to general Treatment of psychotic disorder due to general
medical conditionmedical condition
• The underlying medical conditions should be corrected.
• A trial of antipsychotic medication may be necessary to manage
disruptive symptoms while the patient's medical condition is being
treated.
• It should be noted that it can be less responsive to medication
compared to primary disorders such as schizophrenia

34. Other Schizophrenia Spectrum Disorders 34
Differential diagnosisDifferential diagnosis
• Primary Psychotic Disorders –
•The onset of illness in a primary psychotic disorder is usually earlier
(before age 35),
• symptoms begin prior to the onset of the medical illness.
• Absence of a personal or family history of psychotic disorder.
• Non-auditory hallucinations (e.g., tactile hallucinations) are more
commonly seen in general medical conditions.
•Substance-induced Psychotic Disorder

35. Other Schizophrenia Spectrum Disorders 35
Substance-induced Psychotic DisorderSubstance-induced Psychotic Disorder
•It occurs in the context of recent or prolonged substance use
•Substance-induced psychotic disorder can be part of an intoxication or withdrawal
syndrome.
• Blood or urine screens for suspected substances may be helpful in establishing this
diagnosis.
• Common substances that can cause psychosis include: anticholinergics, steroids,
amphetamines, cocaine, hallucinogens, L-dopa, and disulfiram.

36. Substance-induced Psychotic Disorder Substance-induced Psychotic Disorder
TreatmentTreatment
Directed towards the underlying substance
Immediate behavioral control
 Hospitalization may be necessary
 Antipsychotic medications
Benzodiazepins
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37. Schizotypal Personality Disorder
•It captures a pervasive pa
t­tern of social and interpersonal deficits,
•Reduced capacity for close relationships;
•cognitive or perceptual distortions;
•eccentricities of behavior,
•It usually begins by early adulthood, or in childhood and adolescence
•Abnormalities of beliefs, thinking, and perception are below the threshold
for the diagno
­sis of a psychotic disorder.
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38. Other specified schizophrenia spectrum
disorder
e. g.
-Persistent hallucination,
-Delusion with overlapping mood disorders
-Attenuated psychosis
-Shared delusion
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39. Unspecified schizophrenia spectrum disorder
•Significant impairment due to this spectrum disorder
•Do not meet any of the disorders in the spectrum
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40. Other Schizophrenia Spectrum Disorders 40