Psychotic Disorders &
Depression
Related Etiology, Epidemiology, and
Symptomology
Schizophrenia
 Disturbance that lasts for at least 6 months and
includes at least 1 month of active-phase symptoms.
Other Related Disorders
 Shizophreniform Disorder
 Delusional Disorder
 Brief Psychotic Disorder
 Shared Psychotic Disorder
 Psychotic Disorder due to a General Medical Condition
 Substance-Induced Psychotic Disorder
* From the Diagnostic and Statistical Manual, 4th edition (DSM-IV)
Diagnostic Criteria (Symptoms)
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Two or more must be present for a significant portion of 1 month
Delusions
Hallucinations
Disorganized Speech (e.g., frequent derailment or incoherence)
Grossly disorganized or catatonic behavior
Negative symptoms, i.e., affective flattening, alogia, or avolition
Social/Occupational Dysfunction
 For a significant portion of the time since the onset of
the disturbance, one or more major areas of functioning
such as work, interpersonal relations, or self-care are
markedly below the level achieved prior to the onset (or
when the onset is in childhood or adolescence, failure
to achieve expected level of interpersonal, academic, or
occupational achievement.
Duration
 Continuous signs of the disturbance persist for at least
6 months. This 6-month period must include at least 1
month of symptoms (or less if successfully treated) that
meet Criterion A (symptoms) and may include periods
of prodromal or residual symptoms. During these
prodromal or residual periods, the signs of the
disturbance may be manifested by only negative
symptoms or two or more symptoms listed in Criterion
A (symptoms) in an attenuated form (e.g., odd beliefs,
unusual perceptual experiences).
Subtypes
 Paranoid type - primary aspect is the presence of recurring
delusions or auditory hallucinations. Cognitive/affective
functioning remain relatively intact.
 Disorganized type - disorganized speech and behavior, and flat or
inappropriate affect (silliness, inappropriate laughter).
 Catatonic type - psychomotor immobility or excessiveness, extreme
negativism, mutism, echolalia.
 Undifferentiated type - criteria met for Criterion A but are not met
for the Paranoid, Disorganized, or Catatonic types.
 Residual type - absence of prominent delusions, hallucinations,
disorganized speech, and grossly disorganized or catatonic
behavior. Continuing evidence of the disorder such as flat affect,
odd beliefs, unusual perceptual experiences.
Associated Features
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Thought fragmentation
Euphoric Mood
Dysphoric Mood
Somatic/sexual dysfunction
Psychomotor retardation/excitation
Guilt obsession
Suicidal ideology
Changes in appetite and sleep patterns
Difficulty concentrating due to preoccupation with internal stimuli
Lack of insight
Odd mannerisms - (smiling, facial expressions, body postures)
Inability to experience pleasure
Causes
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Very complex
Stress does not cause schizophrenia but can exacerbate symptoms
Combination of neural (genetic) and environmental factors
No evidence of neuronal death or deterioration such as in
Alzheimer’s
 Neurotransmission abnormalities
 Prenatal features of molecular biological abnormalities
 Is not a “split” personality
Prevalence and Incidence
Prevalence estimates range from .5 % to
1 %.
Incidence rates are estimated to be
approximately 1 per 10,000 people per
year.
Onset generally occurs between late
adolescence and late 20’s/early 30’s.
Depression
Criteria for Major Depressive Episode
 Five or more of the following symptoms have been present during
the same 2-week period and represent a change from pervious
functioning; at least one of the symptoms is either (1) depressed
mood or (2) loss of interest or pleasure.
 Depressed mood most of the day, nearly every day, as indicated by
either subjective report (e.g., feels sad or empty) or observation
made by others (e.g., appears tearful).
 Markedly diminished interest or pleasure in all, or almost all,
activities most of the day, nearly every day (as indicated by either
subjective account or observation made by others).
 Significant weight loss when not dieting or weight gain (e.g., a
change of more than 5% of body weight in a month), or decrease
or increase in appetite nearly every day.
Criteria for MDE cont’d
 Insomnia or hypersomnia nearly every day
 Feelings of worthlessness or excessive or inappropriate guilt
(which may be delusional) nearly every day (not merely selfreproach or guilt about being sick)
 Diminished ability to think or concentrate, or indecisiveness,
nearly every day (either by subjective account or as observed by
others)
 Recurrent thoughts of death (not just fear of dying), recurrent
suicidal ideation without a specific plan, or a suicide attempt or a
specific plan for committing suicide.
Major Depressive Disorder
Single Episode
Recurrent
 Presence of a single MDE
 The MDE is not better
accounted for by
Schizoaffective disorder and
is not superimposed on other
psychotic disorders
 There has never been a manic
episode, a Mixed Episode, or
a Hypomanic Episode.
 Presence of two or more
MDE’s
 To be considered separate
episodes, there must be an
interval of at least 2
consecutive months in which
criteria are not met for a
MDE.
 Bullets 2 and 3 from Single
Episode apply here as well.
Associated Features
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Tearfulness
Irritability
Brooding
Obsessive rumination
Anxiety
Phobias
Excessive worry over physical health
Complaints of pain (headaches, joint, abdominal, etc.)
Feelings of hopelessness and helplessness
Suicidality - 15% die by suicide (increases four-fold over age 55)
Prevalence
10% - 25% for women
5% - 12% for men
Appear to be unrelated to ethnicity,
education, income, or marital status.
Onset can occur at any time but generally
occurs in mid-20’s.
Causes
Signs of biochemistry abnormalities
(neurotransmission interruptions)
Can have a genetic predisposition of the
illness but may not develop unless
environmental factors are present.
Dysthymia
Diagnostic Criteria for Dysthymic disorder
 Depressed mood for most of the day, for more days than not, as indicated
either by subjective account or observation by others, for at least 2 years.
 Presence, while depressed, of two or more of the following:
 Poor appetite or overeating
 Insomnia or hypersomnia
 Low energy or fatigue
 Low self-esteem
 Poor concentration or difficulty making decisions
 Feelings of hopelessness
 No MDE
 Irritability
 Loss of ability to experience pleasure