Psychosis
 First differential: Diagnostic Nosology “Dementia Praecox” vs. “Manic-Depression”
(Kraepelin, 1896) – Purely descriptive – no inference – in the European tradition.
 Dementia Praecox later termed “Schizophrenia” (Bleuler ,1911) – not purely
descriptive – inference-laden
Neurodevelopmental – starting very early in life – permanent
Neurodegenerative – start any time – worsening over time – fatal
“Social Drift”
 May not have mattered back then --- no effective treatments available yet.
 Effective treatments are hard to develop w/o accurate diagnosis
 Later: Thorazine found effective for schizophrenia, Lithium for Bipolar Disorder
 Sometimes effective treatment aids diagnosis (!)
Diagnostic Specifics
 In the Diagnostic & Statistical Manual (3rd edition on), diagnoses are based on
different patterns of signs & symptoms.
 Common signs of psychosis include
 Delusions
 Grandeur
 Reference
 Thought Control
 Thought Insertion/Withdrawal
 Hallucinations (Typically Auditory, occasionally Visual, othes likely neuropsych)
 There are no cardinal psychotic sx’s/signs of a single DSM-IV diagnosis. These
may be found in
 Schizophrenia
 Major Depressive Disorder (“Severe with Psychotic Features”)
 Bipolar I Disorder (Manic)
 Delusional Disorder (“Pure Paranoia”)
 Schizoid & Borderline Personality Disorders (typically transient)
 Note: Neither delusions nor hallucinations is necessary for the dx of
schizophrenia – (sound familiar?)
2 different classes of signs/sx’s
Positive(excesses)
Delusions
Hallucinations
Catatonia
Disorganized Speech
Negative(absence)
Avolitional syndrome
Poverty of speech (alogia)
Apathy
Schizophrenia DSM-5:
Two changes were made to DSM-IV Criterion A for schizophrenia:
1. the elimination of the special attribution of bizarre delusions and …..auditory
hallucinations (e.g., two or more voices conversing).
2. the addition of a requirement …. that the individual must have at least one of
these three symptoms:
1. delusions
2. hallucinations
3. disorganized speech.
At least one of 3 core “positive symptoms” is necessary for a reliable diagnosis of
schizophrenia.
Phases:
Premorbid -- Prodromal --------Active--------------Residual
no signs
early signs
florid –
aftermath - highest suicide risk
most intense
(compare to Major Dep)
DSM dx – duration – 6 months minimum (Active Phase) unless successfully tx’d
Prognosis –not based upon dx alone.
Characteristics
Age of Onset
Premorbid Functioning
Onset
Dominant Sxs
Stressors
Good Prognosis
Later
Good
Acute
Positive
Present
Poor Prognosis
Earlier
Bad
Insidious
Negative
Absent