Schizophrenia Spectrum & Other Psychotic Disorders for NCMHCE Study

Quick review of the essential points— DSM5 diagnosis criteria, assessments, treatments—of these disorders to better prepare for the National Clinical Mental Health Counseling Exam. This was informed by several exam prep programs, and can be used like flashcards or as a presentation.

1. Review of DSM5 Mental Disorders for NCMHCE Study

2. Key Features
Delusions
Hallucinations
Disorganized Thinking (speech)
Grossly Disorganized or Abnormal Motor Behavior (Including
Catatonia)
Negative Symptoms

3. 1.Brief Psychotic Disorder
2.Delusional Disorder
3.(Schizotypal Personality Disorder)
4.Schizophreniform Disorder
5.Schizoaffective Disorder
6.Schizophrenia
7.Catatonia
8.Substance/Medication-Induced Psychotic Disorder
9.Psychotic Disorder Due to Another Medical Condition
10.Other Specified Schizophrenia Spectrum and Other Psychotic
Disorder
11.Unspecified Schizophrenia Spectrum and Other Psychotic
Disorder

4. Brief Psychotic
1-30 days
No mood
disorder
No negative
symptoms
Schizophreniform
No negative
symptoms
1-6 months
Schizophrenia
Negative
symptoms,
unmotivated
1 month period of
psychosis
Persisting 6
months
Schizoaffective
Mood
disorder
All have positive psychotic symptoms

5. S4. Assess & Refer
Tests
PNSS Positive & Negative Syndrome Scales
Structured Interview for Psychotic Symptoms

6. S4. Treatment
Medications
Antipsychotics
Therapy
Behavior Therapies
Psychosocial Therapies

8. Diagnosis I
Key: Discomfort in close
relationships, distorted
thinking and perceptions,
and eccentric behavior
Requires at least 5:
1) Senses others are thinking of them
2) Belief in superstitions and magical thinking and
powers
3) Odd perceptions
4) Odd thinking and speech
5) Suspiciousness and paranoia
6) Constricted, inappropriate affect
7) Odd behavior
8) Lacks close friends
9) Social anxiety related to paranoia

9. Diagnosis II
Co-occurring:
Delusional disorder
Schizophreniform disorders
Schizophrenia
Rule out:
Autism Spectrum Disorder
Disturbance is only part of a
psychotic disorder
Bipolar or depressive disorder with
psychotic features
Result of medical problem

11. Diagnosis
1. Presence of one or more of the
following symptoms:
Delusions
Hallucinations
 Disorganized speech
Grossly disorganized or
catatonic behavior
2. Lasts at least one day but less
than one month
Full return to premorbid level of
functioning
Often in response to a very
stressful event, such as a death in
the family
Rule Out
Major depressive or bipolar
disorder with psychotic features
Other psychotic disorder

12. S1. Find Out
Medical history
Affective functioning
Cognitive functioning
Development of symptoms,
duration and frequency
Family history
Past trauma
Substance use history
S2. Refer or Assess
Medical evaluation (heart, thyroid)
Psychiatric evaluation
Tests
PNSS Positive & Negative
Symptom Scales
Structured Interview for Psychotic
Symptoms
Mental status exam

13. S4. Treatment
Medications
Anti-psychotic
Therapy
Psychoeducation
Hospitalization until positive
symptoms under control
NAMI for community support

14. S5. Monitoring
Completion of homework
assignments
Frequency and severity of
symptoms check list
Medication compliance
S6. Termination
Continued medication
Anxiety support group

16. Diagnosis
1. Presence of delusion only
Non bizarre, plausible
Internally consistent
2. Long lasting, held strongly
3. Specifiers
Erotomanic
Grandiose
Jealous
Persecutory
Somatic
Mixed
Unspecified
Rule Out
Major depressive or bipolar
disorder with psychotic features
Other psychotic disorder

17. S1. Find Out
Medical history
Affective functioning
Cognitive functioning
Development of symptoms,
duration and frequency
Family history
Past trauma
Substance use history
S2. Refer or Assess
Psychiatric evaluation
Tests
Structured Interview for Psychotic
Symptoms
Mental status exam

18. S4. Treatment
Very challenging since the patient
sees no problem
Non judgmental, empathetic
stance
Therapy
CBT
Medications
Anti-psychotics (for agitation)

20. Diagnosis
1. Two or more of the following during 1
month period:
Delusions
Hallucinations
Disorganized speech
Grossly disorganized/ catatonic
behavior
Negative symptoms
Symptoms similar to Schizophrenia
but duration is less
2. Episode lasts at least 1 month but less
than 6 months
Rule Out
Schizoaffective disorder
Depressive/Bipolar
disorders with psychotic
features
Not attributed to
substance use or medical
condition

21. S1. Find Out
Medical history
Affective functioning
Cognitive functioning
Development of symptoms,
duration and frequency
Family history
Past trauma
Substance use history
S2. Refer or Assess
Medical evaluation (heart, thyroid)
Psychiatric evaluation
Tests
PNSS Positive & Negative
Symptom Scales
Structured Interview for Psychotic
Symptoms
Mental status exam

22. S4. Treatment
Medications
Antipsychotics
Therapy
Psychoeducation
Behavior Therapy
Social Skills Training
Hospitalization until positive
symptoms under control
NAMI for community support

24. Diagnosis I
1. Requires 2 or more of the following for a significant time
during a 1 month period:
Delusions,
Hallucinations,
Disorganized speech (frequent derailment or incoherence),
Grossly disorganized or catatonic behavior,
Negative symptoms
2. Since onset of disturbance, level of functioning in work,
social relations, or self care is below what it was prior
Or failure to achieve expected level if onset is in
childhood/adolescence
3. Symptoms persist for at least 6 months
Psychotic features typically emerge between the late
teens and the mid-30s
Rule Out
Substance or
medically induced

25. Diagnosis II
Positive Symptoms are excesses in
behavior:
Hallucinations (critical voices)
Delusions: Unrealistic beliefs
Disorganized speech, inability to
maintain conversation
Disorganized or catatonic behavior can
be bizarre
Negative Symptoms are deficits in
behavior (reduced function):
Reduction of emotional expression
Lack of motivation or energy
Loss of enjoyment in activities (social
interaction)
Negative symptoms tend to be the
most persistent
Four A’s of Schizophrenia:
Inappropriate Affect
Loosening of Associations
Autistic Thoughts
Ambivalence
Common Delusions:
Grandeur
Persecution
Reference
Somatic
Control

26. S1. To Find Out S2. Assess & Refer
VeriPsych Blood Test (measures 51
biomarkers)
Tests
PNSS Positive & Negative
Syndrome Scales
Structured Interview for Psychotic
Symptoms
Mental status exam

27. S4. Treatment
Medications
Antipsychotics (Abilify, Clozaril,
Seroquel, Risperdal)
Therapy
Psychoeducation
Social Skills Training
Hospitalization until positive
symptoms under control
Stress Management
NAMI for community support

28. S5. Monitoring
Completion of homework
assignments
Frequency and severity of
symptoms check list
Medication compliance
S6. Termination
Continued medication
Anxiety support group

30. Diagnosis
Symptoms of both schizophrenia and a mood disorder
Uninterrupted period of illness where there is a major mood episode
(major depressive/manic) concurrent with Schizophrenic symptoms, or
alternating
▪Delusions or hallucinations for 2 or more weeks in the absence of
major mood episode (depressive or manic) during the lifetime
duration of illness
▪Major mood symptoms are mostly present
Specify type
Bipolar
Depressive

31. S4. Treatment
Medications
Mood stabilizers for bipolar type
(Lithium, Depakote)
Also anticonvulsants
Antidepressants for depression
(Prozac, Lexapro)
Antipsychotics
Therapy

33. Diagnosis
1. Presence of 1 or both of the following:
Delusions
Hallucinations
2. Symptoms developed during or soon after substance
intoxication or withdrawal or after exposure to a
medication
Involved substance is capable of producing the
psychotic symptoms
As shown from the history, physical examination or
laboratory findings
Rule Out
Independent
psychotic disorder
Delirium

35. Diagnosis
1. Prominent hallucinations or delusions
2. Direct pathophysiological consequence of another medical condition
Not better explained by another mental disorder
Not occurring exclusively during the course of a delirium
Specify with delusions or hallucinations

36. S4. Treatment
Resolve medical conditions

38. Catatonia Associated with Another Mental Disorder
Catatonia Disorder due to Another Medical Condition
Unspecified Catatonia