CMN 552 Module 4 Primary Study Guide University of South Alabama

CMN 552
Module 4
Primary Study Guide
University of South Alabama

, CMN 552 SW




Module 4 Primary Study Guide SW SW SW SW




DSM5 Section II: Schizophrenia Spectrum
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Delusions
Delusions are fixed beliefs that are not amenable to change in light of conflicting evidence. Their
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content may include a variety of themes (e.g., persecutory, referential, somatic, religious, grandiose).
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● Persecutory delusions (i.e., belief that one is going to be harmed, harassed, and so forth by an SW SW SW SW SW SW SW SW SW SW SW SW SW SW SW SW




individual, organization, or other group) are most common.
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● Referential delusions (i.e., belief that certain gestures, comments, environmental cues, and so forth
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are directed at oneself) are also common.
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● Grandiose delusions (i.e., when an individual believes that he or she has exceptional abilities,SW SW SW SW SW SW SW SW SW SW SW SW SW




wealth, or fame) S W SW SW




● Erotomanic delusions (i.e., when an individual believes falsely that another person is in love with SW SW SW SW SW SW SW SW SW SW SW SW SW SW




him or her) S W SW SW




● Nihilistic delusions involve the conviction that a major catastrophe will occur SW SW SW SW SW SW SW SW SW SW




● Somatic delusions focus on preoccupations regarding health and organ function. SW SW SW SW SW SW SW SW SW




Delusions are deemed bizarre if they are clearly implausible and not understandable to same culture p
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eers and do not derive from ordinary life experiences. An example of a bizarre delusion is the belief that
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an outside force has removed his or her internal organs and replaced them with someone else’s organs without
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S leaving any wounds or scars. Delusions that express a loss of control over mind or body are generally
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considered to be bizarre; these include the belief that one’s thoughts have been “removed” by some outside
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force (thought withdrawal), that alien thoughts have been put into one’s mind (thought insertion), or that on
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e’s body or actions are being acted on or manipulated by some outside force (delusions of control).
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An example of a nonbizarre delusion is the belief that one is under surveillance by the police, despite a lac
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k of convincing evidence.
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The distinction between a delusion and a strongly held idea is sometimes difficult to determine and depends in
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Wpart on the degree of conviction with which the belief is held despite clear or reasonable contradictory evidenc
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e regarding its veracity. Assessing delusions in individuals from a variety of cultural backgrounds can be d
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ifficult. Some religious and supernatural beliefs (e.g., evil eye, causing illness through curses, influence of s
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pirits) may be viewed as bizarre and possibly delusional in some cultural contexts but be generally accepted
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in others. However, elevated religiosity can be a feature of many presentations of psychosis. Individuals who h
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ave experienced torture, political violence, or discrimination can report fears that may be misjudged as persec
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utory delusions; these may represent instead intense fears of recurrence or posttraumatic symptoms. A careful
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Wevaluation of whether the person’s fears are justified given the nature of the trauma can help to differentiate a
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ppropriate fears from persecutory delusions. SW SW SW SW




Hallucinations
Hallucinations are perception- SW SW




like experiences that occur without an external stimulus. They are vivid and clear, with the full force and i
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mpact of normal perceptions, and not under voluntary control. They may occur in any sensory modality, but
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auditory hallucinations are the most common in schizophrenia and related disorders. Auditory hallucinati
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ons are usually experienced as voices, whether familiar or unfamiliar, that are perceived as distinct from the
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individual’s own thoughts. The hallucinations must occur in the context of a clear sensorium; those th
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at occur while falling asleep (hypnagogic) or waking up (hypnopompic) are considered to be within the ran
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ge of normal experience. Hallucinations may be a normal part of religious experience in certain cultural contex
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ts.

,Disorganized Thinking (Speech) SW SW




Disorganized thinking (formal thought disorder) is typically inferred from the individual’s speech. The
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individual may switch from one topic to another (derailment or loose associations). Answers to questions
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may be obliquely related or completely unrelated (tangentiality). Rarely, speech may be so severely dis
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organized that it is nearly incomprehensible and resembles receptive aphasia in its linguistic disorganization (
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incoherence or “word salad”). Because mildly disorganized speech is common and nonspecific, the
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symptom must be severe enough to substantially impair effective communication. The severity of the i
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mpairment may be difficult to evaluate if the person making the diagnosis comes from a different linguistic ba
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ckground than that of the person being examined. For example, some religious groups engage in glossolalia
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W(“speaking in tongues”); others describe experiences of possession trance (trance states in
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which personal identity is replaced by an external possessing identity). These phenomena are characterized
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W by disorganized speech. These instances do not represent signs of psychosis unless they are accompanied
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S Wby other clearly psychotic symptoms. Less severe disorganized thinking or speech may occur during th
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e prodromal and residual periods of schizophrenia.
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Grossly Disorganized or Abnormal Motor Behavior (Including Catatonia)
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Grossly disorganized or abnormal motor behavior may manifest itself in a variety of ways, ranging from childli
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ke “silliness” to unpredictable agitation. Problems may be noted in any form of goal-
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directed behavior, leading to difficulties in performing activities of daily living.
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Catatonic behavior is a marked decrease in reactivity to the environment. This ranges from resistance to
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instructions (negativism); to maintaining a rigid, inappropriate or bizarre posture; to a complete lack of verba
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l and motor responses (mutism and stupor). It can also include purposeless and excessive motor activity
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without obvious cause (catatonic excitement). Other features are repeated stereotyped movements, stari
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ng, grimacing, and the echoing of speech. Although catatonia has historically been associated with schizo
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phrenia, catatonic symptoms are nonspecific and may occur in other mental disorders (e.g., bipolar or dep
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ressive disorders with catatonia) and in medical conditions (catatonic disorder due to another medical conditi
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on).

Negative Symptoms SW




Negative symptoms account for a substantial portion of the morbidity associated with schizophrenia but are l
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ess prominent in other psychotic disorders. Two negative symptoms are particularly prominent in schizo
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phrenia: diminished emotional expression and avolition.
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● Diminished emotional expression includes reductions in the expression of emotions in the face, SW SW SW SW SW SW SW SW SW SW SW SW S




eye contact, intonation of speech (prosody), and movements of the hand, head, and face that normall
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y give an emotional emphasis to speech.
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● Avolition is a decrease in motivated self initiated purposeful activities. The individual may sit for
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long periods of time and show little interest in participating in work or social activities.
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Other negative symptoms include alogia, anhedonia, and asociality.
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● Alogia is manifested by diminished speech output SW SW SW SW SW SW




● Anhedonia is the decreased ability to experience pleasure. Individuals with schizophrenia can still
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enjoy a pleasurable activity in the moment and can recall it, but show a reduction in the frequency o
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f engaging in pleasurable activity
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● Asociality refers to the apparent lack of interest in social interactions and may be associated with
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avolition, but it can also be a manifestation of limited opportunities for social interactions.
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Schizotypal (Personality) Disorder: Diagnostic Criteria SW SW SW SW

, A. A pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced
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capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of beha
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vior, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the f
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ollowing:
1. Ideas of reference (excluding delusions of reference). SW SW SW SW SW SW




2. Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms
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(e.g., superstitiousness, belief in clairvoyance, telepathy, or “sixth sense”; in children and adolescent
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s, bizarre fantasies or preoccupations).
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3. Unusual perceptual experiences, including bodily illusions. SW SW SW SW SW




4. Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped).
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5. Suspiciousness or paranoid ideation. SW SW SW




6. Inappropriate or constricted affect. SW SW SW




7. Behavior or appearance that is odd, eccentric, or peculiar. SW SW SW SW SW SW SW SW




8. Lack of close friends or confidants other than first-degree relatives.
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9. Excessive social anxiety that does not diminish with familiarity and tends to be associated with SW SW SW SW SW SW SW SW SW SW SW SW SW SW




paranoid fears rather than negative judgments about self.
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B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder
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S with psychotic features, another psychotic disorder, or autism spectrum disorder.
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Note: If criteria are met prior to the onset of schizophrenia, add “premorbid”
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Schizotypal (Personality) Disorder: Differential Diagnosis SW SW SW SW




Other mental disorders with psychotic symptoms
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Schizotypal personality disorder can be distinguished from delusional disorder, schizophrenia, and a bipolar or
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S depressive disorder with psychotic features because these disorders are all characterized by a period of per
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sistent psychotic symptoms (e.g., delusions and hallucinations). To give an additional diagnosis of schizot
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ypal personality disorder, the personality disorder must have been present before the onset of psycho
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tic symptoms and persist when the psychotic symptoms are in remission. When an individual
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has a persistent psychotic disorder (e.g., schizophrenia) that was preceded by schizotypal personality disorder,
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S schizotypal personality disorder should also be recorded, followed by “premorbid”
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Neurodevelopmental disorders. SW




There may be great difficulty differentiating children with schizotypal personality disorder from the heterogene
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ous group of solitary, odd children whose behavior is characterized by marked social isolation, eccentricity, or
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peculiarities of language and whose diagnoses would probably include milder forms of autism spectrum disor
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der or language communication disorders. Communication disorders may be differentiated by the primacy
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and severity of the disorder in language and by the characteristic features of impaired
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language found in a specialized language assessment. Milder forms of autism spectrum disorder are diff
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erentiated by the even greater lack of social awareness and emotional reciprocity and stereotyped behavior
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s and interests.
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Personality change due to another medical condition SW SW SW SW SW SW




Schizotypal personality disorder must be distinguished from personality change due to another medical condit
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ion, in which the traits that emerge are a direct physiological consequence of another medical condition.
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Substance use disorders SW SW




Schizotypal personality disorder must also be distinguished from symptoms that may develop in association w
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ith persistent substance use.
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Other personality disorders and traits
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