1- Schizophreniform disorder
The picture is similar to that of schizophrenia for first four
symptom (characteristic symptoms) without the fifth one to be
involved (negative symptoms). The duration is usually 1-6 month.
The patient with positive symptoms for 1-6 month has a good
prognosis because remission is usually expected before 6 months.
The social and occupational deterioration is not observed and
medical conditions which may cause schizophrenic like symptoms
for a limited period of time must be excluded.
2- Schizoaffective disorders
This disorder is characterized by a mixture of schizophrenic
symptoms and mood affective symptoms (manic symptoms,
depressive symptoms, ….. etc) which at least 4 wks to 2 yrs or
more.
That's to say 4wks( 1 month) of schizophrenic symptoms
(hallucination and/ or delusion …. etc) combined with affective
mood disorder symptoms (excitement "minia", depression, …etc)
must be present to be a "mixed" schizoaffective disorders and can
continue for 2yrs or more)
3- Brief psychotic disorder
The picture of the positive schizophrenic symptoms lasting for one
day to one month with no occupation and social dysfunction or
deterioration with exclusion of other condition. The patient returns
usually to normal state with very good prognosis.
Note: other psychotic and medical disorders must be excluded and
also drugs (hallucinogens) must also be excluded.
4- Shared or induced psychosis
Here , the patient becomes schizophrenic because he lives with
schizophrenic person or has a close contact with schizophrenic
friend
He gains the schizophrenic feature involuntarily by his close
relationship with original patient.
Ex. Between the mother and her daughter , the condition is treated
by separation of the two with specific Rx of both of them
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5- Medical condition induce psychosis
A certain medical disorder may induce the symptoms of psychotic
disorder for limited period of time after which a symptoms
disappear
6- Drug induce psychosis
The symptoms of psychotic disorder may appear due to either
misuse (abuse) of drug or withdrawal of drug. The symptoms that
are induced are not related to the drug directly, but occur due to
changes in the neurotransmitter at the synapses.
Note: certain drugs (with no misuse, abuse or withdrawal) may
cause psychotic symptoms (ex: bromocriptine "dopamine agonist")
7- Delusional disorder
As we know delusion is a flase belief of morbid origin and is not
consistent with his culture or society. There are types of delusions
(primary, secondary, …etc) but we want to demonstrate only the
following ones:
o Bizarre delusion : the delusion can not be believed like
patient thinks that his bowel inside his chest ( very strange
believes)
o Non bizarre delusions: the delusion can be believed by some
one who does not know that the patient has delusions . Ex:
someone has plan to kill me because I had … etc, someone
wants to poison me because I had hurted him previously, …
etc
We must know and understand the following fact … (delusion disorder
are psychotie disorder which are related to schizophrenia in which the
patient are not called schizophrenics but patients of delusional disorders
which are of types …) while (delusions only (without "disorder") is a
symptom which refers to the presence of thought disorder and may be
one of symptoms of psychotic disorder like schizophrenia and
depression and abnormal personality. However the followings are the
diagnostic criteria.
For delusion disorders :- according to (DSM-IV)
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a) Nonbizzare delusions(i.e. involving situations that occur in real life,
such as being followed , poisoned , infected, loved at distance,
deceived by spouse or lover or having a disease) of at least one
month's duration.
b) Criterion I for schizophrenia have ever been met.
Note/ Tactile and olfactory hallucination may be present in
"Delusional disorder" if they are related to the delusional theme.
c) Apart from the impact of the delusions, functioning is not markedly
and behavior is not obviously bizarre.
d) If mood episodes have occurred concurrently with delusions, their
total duration has been brief relative to the duration of the delusional
periods
e) The disturbance is not due to the direct physiological effects of a
substance (e.g. a drug of abuse, a medication) or general medical
condition
Note/ these criteria must be present to say that the patient has a
schizophrenic like disorder called "delusion disorder"
Note/ we said previously that two or more of the following symptoms of
criteria I of the diagnostic criteria of schizophrenia must be present to
diagnose schizophrenia (delusions, hallucinations, disorganized speech,
disorganized behavior, negative symptoms).
But only one symptoms is enough if delusions are bizarre or
hallucinations are either running commentary, 3rd person
The following types are the predominate ones of delusional disorders:
1) Persecutory type:
The patient thinks that people want to hurt him and the supposed
persecutors of the deluded patient may be definite people in the
environment like members of family, neighbours, or friends or ….etc
…. Others
2) Grandiose type
Here, the patient has delusions of inflated worth, power, knowledge,
identity or special relationship to a diety or famous person. In addition,
he feels that he is important, intelligent or a prophet.
3) Erotomatic type (delusions of love)
Erotomatic comes from erotic (sexual desire) and mania. Here , the
patient thinks that some person is in love with him. He may pester the
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victim with letters and other behavior . if there is no response to the
letters, then he thinks that are people (enemies) who have wicked
intention.
4) Somatic type
Here, the patient feels that he has some physical defect or general
medical condition . he may think that he has a tumor, tuberculosis,
syphilis and other diseases .
Example / the following type, here the patient feels the presence of a bad
smell coming from his body (mouth, rectum, vagina …), so he tries to
avoid other people so that they cannot detect this disorder.
Example/ The dysmorphie type here, the patient feels that his nose is
deviated, his mouth is wide , his ears outwards (bat ears) , …. Etc his
body is not well organized,… he tries to correct these abnormalities by
consulting doctors an asking them to do a plastic surgery on his body, but
the doctors tell him that he does not suffer from and abnormality and that
his body is normal. After that , the patient continues to consult doctors
seeking for help and intervention with his problem.
Example / Infestation type , here, the patient feels that he is infested by
parasites, worms, insects, …..etc. either in the skin (external) or in the
GIT and other internal organs (internal)
5) Nihilistic type
Here, the patient feels that or denies the existence of body, his mind,
his loved ones, and the world around him. he thinks that his body is
dead, the world has stopped.
He may think that the day is coming or that he is, so there is so need to
drink and eat because he will neverdie.
This type of delusions may be seen in severe agitated degree of
depression or schizophrenia or in delusional disorder
6) Jealous type
Here , the patient that his/her sexual partner is unfaithful …. But is
most common in males. This type of delusional disorder is more
common in eastern countries due to cultural factors that makes the
husband think that his wife is a part of him, his wife is not equal to
him or that his wife is his own and he can do whatever he wants with
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her. In addition, the husband thinks that and thing related to his wife is
related to him.
However, the patient with this type delusion thinks that his wife has a
sexual relationship with another person. So the patient to observe her
behavior and may follow her in the streets to detect her partner. He
may interrogate his wife by asking questions and may even search his
wife's underclothes for stain of seminal fluid. Sometimes , the wife is
beaten to make her confession and not uncommonly murder is
attempted or committed. It's better to the wife not to confess because
the patient may kill her after wards . It has been found that faithful
loyal with no any sexual relationship.
Treatment :The best treatment is separation of the couple before
unwanted consequences occur
Note/ pimozide may be helpful for the husband
( neuroleptic)
(confession)
7) Mixed type
Here , the patient has delusion of more than one of the previously
mentioned types, but no one theme predominates.
8) Unspecified type
In addition to the specific types of delusional disorders, we have the
following ones (rare):o Couvades syndrome delusion type
Here, the patient feels the same symptoms of his wife who is pregnant
in the first three months like nausea , anorexia, vomiting, fatiquability,
..etc
It's said to be a neurotic disorder
o
Paraphrenic delusional type:
Here, the patient has paranoid delusions and auditory hallucinations
but the social and occupational function is not deteriorated
o
Capgras delusion type
Here, the patient feels that the person in front is not the same person
but similar to him. It occurs usually abruptly and can be considered as
hysterical delusion in which the patient gains attention as hysterical
delusion in which the patient gains attention
Q/ what is the most dangerous type of delusional disorder?
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A/ Jealous type, because a high numbers of women (wives) had been
murdered by their husbands due to this type of delusions especially
eastern countries.
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