CMN 552
Module 4
Primary Study Guide
University of South Alabama
, CMN552 zx
Module 4 Primary Study Guide zx zx zx zx
DSM5 Section II: Schizophrenia Spectrum SW SW SW SW
Delusions Delusions are fixed beliefs that are not amenable to change in light of conflicting evidence.
zx SW SW SW SW SW SW SW SW SW SW SW SW SW SW SW
Their content may include a variety of themes (e.g., persecutory, referential, somatic, religious, grandiose).
z x zx zx zx zx zx zx zx zx zx zx zx zx
● Persecutory delusions (i.e., belief that one is going to be harmed, harassed, and so forth by an indi zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
vidual, organization, or other group) are most common. zx zx zx zx SW SW
● Referential delusions (i.e., belief that certain gestures, comments, environmental cues, and so forth are zx zx zx zx SW zx zx zx zx zx zx zx zx
directed at oneself) are also common. zx zx zx zx zx zx
● Grandiose delusions (i.e., when an individual believes that he or she has exceptional abilities, we zx zx zx zx zx zx zx zx zx zx zx zx zx zx
alth, or fame) zx zx
● Erotomanic delusions (i.e., when an individual believes falsely that another person is in love with him zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx z
or her) x zx
● Nihilistic delusions involve the conviction that a major catastrophe will occur zx zx zx zx zx zx zx zx zx zx
● Somatic delusions focus on preoccupations regarding health and organ function. zx zx zx zx zx zx zx zx zx
Delusions are deemed bizarre if they are clearly implausible and not understandable to same culture p eer
zx zx zx zx zx zx zx zx zx zx zx zx zx zx z x zx
s and do not derive from ordinary life experiences. An example of a bizarre delusion is the belief that an outsi
zx zx zx zx zx zx zx zx zx zx zx zx zx SW SW zx zx zx zx zx
de force has removed his or her internal organs and replaced them with someone else’s organs without
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
leaving any wounds or scars. Delusions that express a loss of control over mind or body are generally con
zx zx zx zx zx zx SW zx zx zx zx zx zx zx zx zx zx zx
sidered to be bizarre; these include the belief that one’s thoughts have been “removed” by some outside force (th
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
ought withdrawal), that alien thoughts have been put into one’s mind (thought insertion), or that on e’s body or a
zx zx zx zx zx zx zx zx zx zx zx zx zx zx z x zx zx zx zx
ctions are being acted on or manipulated by some outside force (delusions of control).
zx zx zx zx zx zx zx zx zx zx zx zx zx
An example of a nonbizarre delusion is the belief that one is under surveillance by the police, despite a lac k o
zx zx zx zx SW SW zx zx zx zx zx zx zx zx zx zx zx zx zx zx z x
f convincing evidence.
zx zx
The distinction between a delusion and a strongly held idea is sometimes difficult to determine and depends in part
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
on the degree of conviction with which the belief is held despite clear or reasonable contradictory evidenc e rega
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx z x
rding its veracity. Assessing delusions in individuals from a variety of cultural backgrounds can be d
zx zx zx zx zx zx zx zx zx zx zx zx zx zx z x
ifficult. Some religious and supernatural beliefs (e.g., evil eye, causing illness through curses, influence of s piri
zx zx zx zx zx zx zx zx zx zx zx zx zx zx z x zx
ts) may be viewed as bizarre and possibly delusional in some cultural contexts but be generally accepted
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
in others. However, elevated religiosity can be a feature of many presentations of psychosis. Individuals who h ave
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx z x zx z
experienced torture, political violence, or discrimination can report fears that may be misjudged as persec utory d
x zx zx zx zx zx zx zx zx zx zx zx zx zx z x zx zx
elusions; these may represent instead intense fears of recurrence or posttraumatic symptoms. A careful evaluatio
zx zx zx SW zx zx zx zx zx zx zx zx z x Sz x
n of whether the person’s fears are justified given the nature of the trauma can help to differentiate a ppropriate fe
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx z x zx zx zx
ars from persecutory delusions.
zx zx zx
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 m
SW SW SW SW SW SW SW SW zx zx z x zx zx zx zx zx zx zx zx
pact of normal perceptions, and not under voluntary control. They may occur in any sensory modality, but audi
zx zx zx zx zx SW zx zx zx zx z x zx zx zx zx zx zx
tory hallucinations are the most common in schizophrenia and related disorders. Auditory hallucinati ons ar
SW SW SW SW SW SW SW SW z x zx zx zx zx zx
e usually experienced as voices, whether familiar or unfamiliar, that are perceived as distinct from the individua
zx zx zx zx zx zx zx zx zx z x zx zx zx zx zx zx
l’s own thoughts. The hallucinations must occur in the context of a clear sensorium; those th at occur whil
zx zx zx zx zx zx zx zx z x zx zx zx zx zx zx zx SW zx
e falling asleep (hypnagogic) or waking up (hypnopompic) are considered to be within the ran ge of normal exp
zx zx zx zx zx zx z x zx zx zx zx zx zx zx zx zx zx zx
erience. Hallucinations may be a normal part of religious experience in certain cultural contex ts.
zx zx zx zx zx z x zx zx zx zx zx zx zx zx
, . The in zx zx
dividual may switch from one topic to another (derailment or loose associations). Answers to questions
zx zx zx zx zx zx zx zx zx zx zx SW zx zx
may be obliquely related or completely unrelated (tangentiality). Rarely, speech may be so severely dis org
zx zx zx zx zx zx zx zx zx zx zx zx zx z x zx
anized that it is nearly incomprehensible and resembles receptive aphasia in its linguistic disorganization ( incohe
zx SW zx zx zx zx zx zx zx zx zx zx zx z x zx
rence or “word salad”). Because mildly disorganized speech is common and nonspecific, the symptom must b
zx zx zx zx zx zx zx zx zx zx zx zx zx SW SW
e severe enough to substantially impair effective communication. The severity of the i mpairment may be dif
SW SW SW SW SW SW SW SW zx zx zx z x zx zx zx zx
ficult to evaluate if the person making the diagnosis comes from a different linguistic ba ckground than that of the p
zx zx zx zx zx zx zx zx zx zx zx zx zx z x zx zx zx zx zx zx
erson being examined. For example, some religious groups engage in glossolalia (“speaking in tongues”); othe
zx zx zx zx zx zx zx zx zx z x Sz x zx zx zx
rs describe experiences of possession trance (trance states in
zx zx zx zx zx zx zx zx
which personal identity is replaced by an external possessing identity). These phenomena are characterized by
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
disorganized speech. These instances do not represent signs of psychosis unless they are accompanied by oth zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
er clearly psychotic symptoms.
zx zx zx SW
e
Grossly Disorganized or Abnormal Motor Behavior (Including Catatonia)
SW SW SW SW SW SW SW
Grossly disorganized or abnormal motor behavior may manifest itself in a variety of ways, ranging from childli ke
zx zx zx zx zx zx zx SW zx zx zx zx zx zx zx z x zx zx
“silliness” to unpredictable agitation. Problems may be noted in any form of goal-
zx zx zx zx zx zx zx zx zx zx zx zx
directed behavior, leading to difficulties in performing activities of daily living.
z x zx zx zx zx zx zx zx zx zx
Catatonic behavior is a marked decrease in reactivity to the environment. This ranges from resistance to i
SW SW SW SW SW SW SW SW SW SW SW zx zx zx zx zx
nstructions (negativism); to maintaining a rigid, inappropriate or bizarre posture; to a complete lack of verba
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
l and motor responses (mutism and stupor). It can also include purposeless and excessive motor activity witho
z x zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
ut obvious cause (catatonic excitement). Other features are repeated stereotyped movements, stari ng, grim
zx zx zx zx zx zx zx zx zx zx z x zx zx
acing, and the echoing of speech. Although catatonia has historically been associated with schizo phrenia, cata
zx zx zx zx zx zx zx zx zx zx zx zx z x zx zx
tonic symptoms are nonspecific and may occur in other mental disorders (e.g., bipolar or dep ressive disorders
zx zx zx SW zx zx zx zx zx zx zx zx z x zx zx zx zx
with catatonia) and in medical conditions (catatonic disorder due to another medical conditi on).
zx zx zx zx zx zx zx zx zx zx zx z x zx
Negative Symptoms SW
Negative symptoms account for a substantial portion of the morbidity associated with schizophrenia but are l es
zx zx SW zx zx zx zx zx zx zx zx zx zx zx z x zx
s prominent in other psychotic disorders. Two negative symptoms are particularly prominent in schizo phre
zx zx zx zx zx zx zx zx zx zx zx zx z x zx
nia: diminished emotional expression and avolition.
zx SW SW SW SW
● Diminished emotional expression includes reductions in the expression of emotions in the face, ey zx zx zx zx zx zx zx zx zx zx zx zx zx
e contact, intonation of speech (prosody), and movements of the hand, head, and face that normall y gi
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx z x
ve an emotional emphasis to speech. zx zx zx zx zx
● Avolition is a decrease in motivated self initiated purposeful activities. The individual may sit for lon zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
g periods of time and show little interest in participating in work or social activities.
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
Other negative symptoms include alogia, anhedonia, and asociality.
SW SW SW SW SW SW SW
● Alogia is manifested by diminished speech output zx zx zx zx zx zx
● Anhedonia is the decreased ability to experience pleasure. Individuals with schizophrenia can still enj zx zx zx zx zx zx zx zx zx zx zx zx zx
oy a pleasurable activity in the moment and can recall it, but show a reduction in the frequency o
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
f engaging in pleasurable activity z x zx zx zx
● Asociality refers to the apparent lack of interest in social interactions and may be associated with avo zx zx zx zx zx zx zx SW zx zx zx zx zx zx zx zx
lition, but it can also be a manifestation of limited opportunities for social interactions. zx SW zx zx zx zx zx zx zx zx zx zx zx
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 cap
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
acity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of beha
zx zx zx zx zx zx zx zx zx zx zx zx zx zx z x
vior, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the f ollo
zx zx zx zx zx zx zx zx zx zx zx zx zx zx SW SW SW SW z x zx zx
wing:
1. Ideas of reference (excluding delusions of reference). zx zx zx zx zx zx
2. Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
g., superstitiousness, belief in clairvoyance, telepathy, or “sixth sense”; in children and adolescent s, bi
zx zx zx zx zx zx zx zx zx zx zx zx zx z x
zarre fantasies or preoccupations). zx zx zx
3. Unusual perceptual experiences, including bodily illusions. zx zx zx zx zx
4. Oddthinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped).
zx zx zx zx zx zx zx zx zx zx
5. Suspiciousness or paranoid ideation. zx zx zx
6. Inappropriate or constricted affect. zx zx zx
7. Behavior or appearance that is odd, eccentric, or peculiar. zx zx zx zx zx zx zx zx
8. Lack of close friends or confidants other than first-degree relatives. zx zx zx zx zx zx zx zx zx
9. Excessive social anxiety that does not diminish with familiarity and tends to be associated with par zx zx zx SW zx SW zx zx zx zx zx zx zx zx zx
anoid fears rather than negative judgments about self. zx zx zx zx zx zx zx
B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx z
psychotic features, another psychotic disorder, or autism spectrum disorder.
x SW zx zx zx zx zx zx zx
Note: If criteria are met prior to the onset of schizophrenia, add “premorbid”
zx zx zx zx SW zx zx zx SW zx zx zx
Schizotypal (Personality) Disorder: Differential Diagnosis SW SW SW SW
Other mental disorders with psychotic symptoms
zx zx zx zx zx
Schizotypal personality disorder can be distinguished from delusional disorder, schizophrenia, and a bipolar or dep
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
ressive disorder with psychotic features because these disorders are all characterized by a period of per
zx zx zx SW zx zx zx zx zx zx zx zx zx zx z x
sistent psychotic symptoms (e.g., delusions and hallucinations). To give an additional diagnosis of schizot yp
zx zx zx zx zx zx zx zx zx zx zx zx z x zx
al personality disorder, the personality disorder must have been present before the onset of psycho tic sy
zx zx zx zx zx zx zx zx zx zx zx zx zx z x zx zx
mptoms and persist when the psychotic symptoms are in remission. When an individual
zx zx zx zx zx zx zx zx zx zx zx zx
has a persistent psychotic disorder (e.g., schizophrenia) that was preceded by schizotypal personality disorder, schi
zx zx SW zx zx zx zx zx zx zx zx zx zx zx
zotypal personality disorder should also be recorded, followed by “premorbid”
zx zx zx zx zx zx zx zx zx
Neurodevelopmental disorders. zx
There may be great difficulty differentiating children with schizotypal personality disorder from the heterogene ous g
zx zx zx zx zx zx zx zx zx zx zx zx z x zx zx
roup of solitary, odd children whose behavior is characterized by marked social isolation, eccentricity, or peculiariti
zx zx zx zx zx zx zx zx zx zx zx zx z x zx zx
es of language and whose diagnoses would probably include milder forms of autism spectrum disor der or languag
zx zx zx zx zx zx zx zx zx zx zx zx z x zx zx zx zx
e communication disorders. Communication disorders may be differentiated by the primacy and severity of the
zx zx zx zx zx zx zx zx z x zx zx zx zx zx z
disorder in language and by the characteristic features of impaired
x zx zx zx zx zx zx zx zx zx
language found in a specialized language assessment. Milder forms of autism spectrum disorder are diff ere
zx zx zx zx zx zx zx zx zx zx zx zx zx z x zx
ntiated by the even greater lack of social awareness and emotional reciprocity and stereotyped behavior s and i
zx zx zx zx zx zx zx zx zx zx zx zx zx z x zx zx zx
nterests.
Personality change due to another medical condition zx zx zx zx zx zx
Schizotypal personality disorder must be distinguished from personality change due to another medical condit ion,
zx zx zx zx zx zx zx zx zx zx zx zx z x zx zx
in which the traits that emerge are a direct physiological consequence of another medical condition.
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
Substance use disorders zx zx
Schizotypal personality disorder must also be distinguished from symptoms that may develop in association w ith
zx zx zx zx zx zx zx zx zx zx zx zx zx z x zx zx
persistent substance use. zx zx
Other personality disorders and traits
zx zx zx zx
Module 4
Primary Study Guide
University of South Alabama
, CMN552 zx
Module 4 Primary Study Guide zx zx zx zx
DSM5 Section II: Schizophrenia Spectrum SW SW SW SW
Delusions Delusions are fixed beliefs that are not amenable to change in light of conflicting evidence.
zx SW SW SW SW SW SW SW SW SW SW SW SW SW SW SW
Their content may include a variety of themes (e.g., persecutory, referential, somatic, religious, grandiose).
z x zx zx zx zx zx zx zx zx zx zx zx zx
● Persecutory delusions (i.e., belief that one is going to be harmed, harassed, and so forth by an indi zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
vidual, organization, or other group) are most common. zx zx zx zx SW SW
● Referential delusions (i.e., belief that certain gestures, comments, environmental cues, and so forth are zx zx zx zx SW zx zx zx zx zx zx zx zx
directed at oneself) are also common. zx zx zx zx zx zx
● Grandiose delusions (i.e., when an individual believes that he or she has exceptional abilities, we zx zx zx zx zx zx zx zx zx zx zx zx zx zx
alth, or fame) zx zx
● Erotomanic delusions (i.e., when an individual believes falsely that another person is in love with him zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx z
or her) x zx
● Nihilistic delusions involve the conviction that a major catastrophe will occur zx zx zx zx zx zx zx zx zx zx
● Somatic delusions focus on preoccupations regarding health and organ function. zx zx zx zx zx zx zx zx zx
Delusions are deemed bizarre if they are clearly implausible and not understandable to same culture p eer
zx zx zx zx zx zx zx zx zx zx zx zx zx zx z x zx
s and do not derive from ordinary life experiences. An example of a bizarre delusion is the belief that an outsi
zx zx zx zx zx zx zx zx zx zx zx zx zx SW SW zx zx zx zx zx
de force has removed his or her internal organs and replaced them with someone else’s organs without
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
leaving any wounds or scars. Delusions that express a loss of control over mind or body are generally con
zx zx zx zx zx zx SW zx zx zx zx zx zx zx zx zx zx zx
sidered to be bizarre; these include the belief that one’s thoughts have been “removed” by some outside force (th
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
ought withdrawal), that alien thoughts have been put into one’s mind (thought insertion), or that on e’s body or a
zx zx zx zx zx zx zx zx zx zx zx zx zx zx z x zx zx zx zx
ctions are being acted on or manipulated by some outside force (delusions of control).
zx zx zx zx zx zx zx zx zx zx zx zx zx
An example of a nonbizarre delusion is the belief that one is under surveillance by the police, despite a lac k o
zx zx zx zx SW SW zx zx zx zx zx zx zx zx zx zx zx zx zx zx z x
f convincing evidence.
zx zx
The distinction between a delusion and a strongly held idea is sometimes difficult to determine and depends in part
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
on the degree of conviction with which the belief is held despite clear or reasonable contradictory evidenc e rega
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx z x
rding its veracity. Assessing delusions in individuals from a variety of cultural backgrounds can be d
zx zx zx zx zx zx zx zx zx zx zx zx zx zx z x
ifficult. Some religious and supernatural beliefs (e.g., evil eye, causing illness through curses, influence of s piri
zx zx zx zx zx zx zx zx zx zx zx zx zx zx z x zx
ts) may be viewed as bizarre and possibly delusional in some cultural contexts but be generally accepted
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
in others. However, elevated religiosity can be a feature of many presentations of psychosis. Individuals who h ave
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx z x zx z
experienced torture, political violence, or discrimination can report fears that may be misjudged as persec utory d
x zx zx zx zx zx zx zx zx zx zx zx zx zx z x zx zx
elusions; these may represent instead intense fears of recurrence or posttraumatic symptoms. A careful evaluatio
zx zx zx SW zx zx zx zx zx zx zx zx z x Sz x
n of whether the person’s fears are justified given the nature of the trauma can help to differentiate a ppropriate fe
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx z x zx zx zx
ars from persecutory delusions.
zx zx zx
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 m
SW SW SW SW SW SW SW SW zx zx z x zx zx zx zx zx zx zx zx
pact of normal perceptions, and not under voluntary control. They may occur in any sensory modality, but audi
zx zx zx zx zx SW zx zx zx zx z x zx zx zx zx zx zx
tory hallucinations are the most common in schizophrenia and related disorders. Auditory hallucinati ons ar
SW SW SW SW SW SW SW SW z x zx zx zx zx zx
e usually experienced as voices, whether familiar or unfamiliar, that are perceived as distinct from the individua
zx zx zx zx zx zx zx zx zx z x zx zx zx zx zx zx
l’s own thoughts. The hallucinations must occur in the context of a clear sensorium; those th at occur whil
zx zx zx zx zx zx zx zx z x zx zx zx zx zx zx zx SW zx
e falling asleep (hypnagogic) or waking up (hypnopompic) are considered to be within the ran ge of normal exp
zx zx zx zx zx zx z x zx zx zx zx zx zx zx zx zx zx zx
erience. Hallucinations may be a normal part of religious experience in certain cultural contex ts.
zx zx zx zx zx z x zx zx zx zx zx zx zx zx
, . The in zx zx
dividual may switch from one topic to another (derailment or loose associations). Answers to questions
zx zx zx zx zx zx zx zx zx zx zx SW zx zx
may be obliquely related or completely unrelated (tangentiality). Rarely, speech may be so severely dis org
zx zx zx zx zx zx zx zx zx zx zx zx zx z x zx
anized that it is nearly incomprehensible and resembles receptive aphasia in its linguistic disorganization ( incohe
zx SW zx zx zx zx zx zx zx zx zx zx zx z x zx
rence or “word salad”). Because mildly disorganized speech is common and nonspecific, the symptom must b
zx zx zx zx zx zx zx zx zx zx zx zx zx SW SW
e severe enough to substantially impair effective communication. The severity of the i mpairment may be dif
SW SW SW SW SW SW SW SW zx zx zx z x zx zx zx zx
ficult to evaluate if the person making the diagnosis comes from a different linguistic ba ckground than that of the p
zx zx zx zx zx zx zx zx zx zx zx zx zx z x zx zx zx zx zx zx
erson being examined. For example, some religious groups engage in glossolalia (“speaking in tongues”); othe
zx zx zx zx zx zx zx zx zx z x Sz x zx zx zx
rs describe experiences of possession trance (trance states in
zx zx zx zx zx zx zx zx
which personal identity is replaced by an external possessing identity). These phenomena are characterized by
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
disorganized speech. These instances do not represent signs of psychosis unless they are accompanied by oth zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
er clearly psychotic symptoms.
zx zx zx SW
e
Grossly Disorganized or Abnormal Motor Behavior (Including Catatonia)
SW SW SW SW SW SW SW
Grossly disorganized or abnormal motor behavior may manifest itself in a variety of ways, ranging from childli ke
zx zx zx zx zx zx zx SW zx zx zx zx zx zx zx z x zx zx
“silliness” to unpredictable agitation. Problems may be noted in any form of goal-
zx zx zx zx zx zx zx zx zx zx zx zx
directed behavior, leading to difficulties in performing activities of daily living.
z x zx zx zx zx zx zx zx zx zx
Catatonic behavior is a marked decrease in reactivity to the environment. This ranges from resistance to i
SW SW SW SW SW SW SW SW SW SW SW zx zx zx zx zx
nstructions (negativism); to maintaining a rigid, inappropriate or bizarre posture; to a complete lack of verba
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
l and motor responses (mutism and stupor). It can also include purposeless and excessive motor activity witho
z x zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
ut obvious cause (catatonic excitement). Other features are repeated stereotyped movements, stari ng, grim
zx zx zx zx zx zx zx zx zx zx z x zx zx
acing, and the echoing of speech. Although catatonia has historically been associated with schizo phrenia, cata
zx zx zx zx zx zx zx zx zx zx zx zx z x zx zx
tonic symptoms are nonspecific and may occur in other mental disorders (e.g., bipolar or dep ressive disorders
zx zx zx SW zx zx zx zx zx zx zx zx z x zx zx zx zx
with catatonia) and in medical conditions (catatonic disorder due to another medical conditi on).
zx zx zx zx zx zx zx zx zx zx zx z x zx
Negative Symptoms SW
Negative symptoms account for a substantial portion of the morbidity associated with schizophrenia but are l es
zx zx SW zx zx zx zx zx zx zx zx zx zx zx z x zx
s prominent in other psychotic disorders. Two negative symptoms are particularly prominent in schizo phre
zx zx zx zx zx zx zx zx zx zx zx zx z x zx
nia: diminished emotional expression and avolition.
zx SW SW SW SW
● Diminished emotional expression includes reductions in the expression of emotions in the face, ey zx zx zx zx zx zx zx zx zx zx zx zx zx
e contact, intonation of speech (prosody), and movements of the hand, head, and face that normall y gi
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx z x
ve an emotional emphasis to speech. zx zx zx zx zx
● Avolition is a decrease in motivated self initiated purposeful activities. The individual may sit for lon zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
g periods of time and show little interest in participating in work or social activities.
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
Other negative symptoms include alogia, anhedonia, and asociality.
SW SW SW SW SW SW SW
● Alogia is manifested by diminished speech output zx zx zx zx zx zx
● Anhedonia is the decreased ability to experience pleasure. Individuals with schizophrenia can still enj zx zx zx zx zx zx zx zx zx zx zx zx zx
oy a pleasurable activity in the moment and can recall it, but show a reduction in the frequency o
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
f engaging in pleasurable activity z x zx zx zx
● Asociality refers to the apparent lack of interest in social interactions and may be associated with avo zx zx zx zx zx zx zx SW zx zx zx zx zx zx zx zx
lition, but it can also be a manifestation of limited opportunities for social interactions. zx SW zx zx zx zx zx zx zx zx zx zx zx
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 cap
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx
acity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of beha
zx zx zx zx zx zx zx zx zx zx zx zx zx zx z x
vior, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the f ollo
zx zx zx zx zx zx zx zx zx zx zx zx zx zx SW SW SW SW z x zx zx
wing:
1. Ideas of reference (excluding delusions of reference). zx zx zx zx zx zx
2. Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
g., superstitiousness, belief in clairvoyance, telepathy, or “sixth sense”; in children and adolescent s, bi
zx zx zx zx zx zx zx zx zx zx zx zx zx z x
zarre fantasies or preoccupations). zx zx zx
3. Unusual perceptual experiences, including bodily illusions. zx zx zx zx zx
4. Oddthinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped).
zx zx zx zx zx zx zx zx zx zx
5. Suspiciousness or paranoid ideation. zx zx zx
6. Inappropriate or constricted affect. zx zx zx
7. Behavior or appearance that is odd, eccentric, or peculiar. zx zx zx zx zx zx zx zx
8. Lack of close friends or confidants other than first-degree relatives. zx zx zx zx zx zx zx zx zx
9. Excessive social anxiety that does not diminish with familiarity and tends to be associated with par zx zx zx SW zx SW zx zx zx zx zx zx zx zx zx
anoid fears rather than negative judgments about self. zx zx zx zx zx zx zx
B. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with
zx zx zx zx zx zx zx zx zx zx zx zx zx zx zx z
psychotic features, another psychotic disorder, or autism spectrum disorder.
x SW zx zx zx zx zx zx zx
Note: If criteria are met prior to the onset of schizophrenia, add “premorbid”
zx zx zx zx SW zx zx zx SW zx zx zx
Schizotypal (Personality) Disorder: Differential Diagnosis SW SW SW SW
Other mental disorders with psychotic symptoms
zx zx zx zx zx
Schizotypal personality disorder can be distinguished from delusional disorder, schizophrenia, and a bipolar or dep
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
ressive disorder with psychotic features because these disorders are all characterized by a period of per
zx zx zx SW zx zx zx zx zx zx zx zx zx zx z x
sistent psychotic symptoms (e.g., delusions and hallucinations). To give an additional diagnosis of schizot yp
zx zx zx zx zx zx zx zx zx zx zx zx z x zx
al personality disorder, the personality disorder must have been present before the onset of psycho tic sy
zx zx zx zx zx zx zx zx zx zx zx zx zx z x zx zx
mptoms and persist when the psychotic symptoms are in remission. When an individual
zx zx zx zx zx zx zx zx zx zx zx zx
has a persistent psychotic disorder (e.g., schizophrenia) that was preceded by schizotypal personality disorder, schi
zx zx SW zx zx zx zx zx zx zx zx zx zx zx
zotypal personality disorder should also be recorded, followed by “premorbid”
zx zx zx zx zx zx zx zx zx
Neurodevelopmental disorders. zx
There may be great difficulty differentiating children with schizotypal personality disorder from the heterogene ous g
zx zx zx zx zx zx zx zx zx zx zx zx z x zx zx
roup of solitary, odd children whose behavior is characterized by marked social isolation, eccentricity, or peculiariti
zx zx zx zx zx zx zx zx zx zx zx zx z x zx zx
es of language and whose diagnoses would probably include milder forms of autism spectrum disor der or languag
zx zx zx zx zx zx zx zx zx zx zx zx z x zx zx zx zx
e communication disorders. Communication disorders may be differentiated by the primacy and severity of the
zx zx zx zx zx zx zx zx z x zx zx zx zx zx z
disorder in language and by the characteristic features of impaired
x zx zx zx zx zx zx zx zx zx
language found in a specialized language assessment. Milder forms of autism spectrum disorder are diff ere
zx zx zx zx zx zx zx zx zx zx zx zx zx z x zx
ntiated by the even greater lack of social awareness and emotional reciprocity and stereotyped behavior s and i
zx zx zx zx zx zx zx zx zx zx zx zx zx z x zx zx zx
nterests.
Personality change due to another medical condition zx zx zx zx zx zx
Schizotypal personality disorder must be distinguished from personality change due to another medical condit ion,
zx zx zx zx zx zx zx zx zx zx zx zx z x zx zx
in which the traits that emerge are a direct physiological consequence of another medical condition.
zx zx zx zx zx zx zx zx zx zx zx zx zx zx
Substance use disorders zx zx
Schizotypal personality disorder must also be distinguished from symptoms that may develop in association w ith
zx zx zx zx zx zx zx zx zx zx zx zx zx z x zx zx
persistent substance use. zx zx
Other personality disorders and traits
zx zx zx zx
