Non schizophrenic Psychosis الذهان الغير فصامي

Non
schizophrenic
Psychosis
Dr. Mohammad Hussein
1
Consultant Psychiatrist

schizophrenic Psychosis
Diagnosis of
Schizophrenia DSM5

Diagnosis of
Schizophrenia DSM5
A B C D E F
Symptoms
Severity
Duration
Ex
Other
Pych.
Ex
Substance
Autism

Two (or more) of the following, each present for a significant portion of
time during a one-month period (or less if successfully treated).
At least one of these must be (1), (2), or (3):
Diagnosis of
Schizophrenia DSM5
A
1) Delusions.
2) Hallucinations.
3) Disorganized speech
4) Grossly disorganized
or catatonic behavior.
5) Negative symptoms
Symptoms

For a significant portion of the time since the onset of the disturbance,
level of functioning in one or more major areas, such as
Diagnosis of
Schizophrenia DSM5
work
is markedly below the level achieved
prior to the onset
B
Severity
interpersonal relations self-care

Continuous signs of the disturbance persist for at least 6 months. This six-
month period must include at least 1 month of symptoms that meet
Criterion A (ie, active-phase symptoms) and may include periods of
prodromal or residual symptoms.
Diagnosis of
Schizophrenia DSM5
During these prodromal or residual periods, the signs of the disturbance
may be manifested by only negative symptoms or by two or more
symptoms listed in Criterion A present in an attenuated form (eg, odd
beliefs, unusual perceptual experiences).
C
Duration

Schizoaffective disorder and depressive or bipolar disorder with psychotic
features have been ruled out
Diagnosis of
Schizophrenia DSM5
D
Ex Other Pych.

Diagnosis of
Schizophrenia DSM5
E
Ex Substance
The disturbance is not attributable to the direct physiological effects of a
substance (eg, a drug of abuse, a medication) or another medical
condition.

Diagnosis of
Schizophrenia DSM5
If there is a history of autism spectrum disorder or a communication
disorder of childhood onset, the additional diagnosis of schizophrenia is
made only if prominent delusions or hallucinations, in addition to the
other required symptoms of schizophrenia, are also present for at least
one month
F
Autism

Non
schizophrenic
Psychosis
13

Non schizophrenic
Psychosis
Symptoms
Etiology
Duration
Brief Psychotic Disorder
Schizophreniform Disorder
Schizoaffective Disorder
Delusional Disorder
Shared Psychotic Disorder
Psychotic Disorder Due to a General Medical Condition
Substance-Induced Psychotic Disorder

one theme of
non-bizarre
delusions
persistent
of
beliefs may be ordinary things
that could occur
1 DSM = 1 month
ICD = 3month
Delusional Disorder

hyperalertness with
persecutory delusions persistent
of
thought process is unimpaired
1
hallucinations are not prominent
reflect delusional ideas
olfactory/tactile <
visual/auditory
insight & judgement are impaired
Delusional
Disorder
theme of
non-
bizarre
delusions

Epidemiology
Prevalence 0.025%
Hospital admissions
1%
40–49 yrs
Mean age
female
male =

Epidemiology
Prevalence 0.025%
Hospital admissions
1%
40–49 yrs
Mean age
female
male
80%
married

Othello
syndrome
morbid jealousy
22
jealoushusbandsyndrome

Othello syndrome
 central theme is a delusion of spouse’s infidelity and a pre-occupation
with this delusion
 Accusing partner of looking or giving attention to other people.
 Questioning of the partner's behavior.
 Interrogation of phone calls, including wrong numbers or
accidental phone calls, and all other forms of communication.
 Not allowing any social media accounts
 Always asking where the partner is and who they
are with.
 Isolating partner from their family and friends.
 Verbal and/or physical violence towards the partner

De Clérambault syndrome
Erotomanic Type

De Clérambault syndrome
Erotomanic Type
 Patient belief that some important person is secretly in love with him (or her)
 Clinical samples are often female
 forensic samples contain a preponderance of males.
 Patients may make efforts to contact this person, and some cases are associated with
dangerous or assaultive behaviour.

Persecutory type
 most common )35%( presentation of delusional disorder.
 Patients are convinced that others are attempting to do them harm.
 Often they attempt to obtain legal recourse
 may resort to violence

Grandiose type
 believe they fill some special role, have some special relationship,
or possess some special abilities
 They may be involved with social , potical or religious organizations.

Somatic Type
 Monosymptomatic hypochondriacal psychosis
 patients who are delusionally concerned with bodily infestation,
deformity or odour
 repeat contacts with physicians requesting various forms
of medical or surgical treatment
Delusional infestation
Delusional halitosis
Delusional dysmorphophobia

Management
of delusion disorder

source
or focus of
delusional
ideas

Pharmacotherapy
delusion
OCD
body dysmorphic
dis.
anxiety
symptoms
Post-psychotic
depression
Antidepressants
antipsychotics Antidepressants Antidepressants
severe
depression
with risk
of suicide
Comorbid Depression

Pharmacotherapy
antipsychotics
Pimozide
FGA used to be
the drugs of choice
Risperidone ,
olanzapine,
Quetiapine,
Paliperidone
The initial dosages in DD were
lower than
the dosage of schizophrenia
Due to SE,
SGAs more frequently
used

Pharmacotherapy
significantly lower
scores in PANSS
negative
symptoms
lower
scores in PANSS
positive symptoms
PANSS; Positive and Negative Syndrome Scale
Long acting
antipsychotics

Prognosis of delusional
Disorder
acute forms
chronic forms
 50 % of patient recover fully
 40% relapsing course
 10 % go on to chronic illness
 53% were well on follow up
 10 % were better
 31% remained unchanged
jealous type has a more favorable outcome.
Persecutory type has waxing and waning course

Shared Psychotic Disorder Induced delusional disorder
Folie à deux
psychosi
s
2
3
Folie à familie
The essential feature is a delusional system that develops in an individual who is involved
in a close relationship with other person who already has
a psychotic disorder with prominent delusion.

induced
inducer
primary
secondary

siblings
dementia
Without intervention the courseis chronic

Shared
Psychotic
Disorder
TYPES
FOLIE IMPOSE
(IMPOSED PSYCHOSIS)
 The delusions were transferred from
one individual to another with the
existence of an intimate relationship.
FOLIE SIMULTANEE
(SIMULTANEOUS PSYCHOSIS)
 Both partners shared the psychoses
simultaneously.
FOLIE COMMUNIQUÉE
(COMMUNICATED PSYCHOSIS)
 similar to type (1) but more
resistance is applied to the delusions
by the second partner.
FOLIE INDUITE
(INDUCED PSYCHOSIS)
 additional new delusions induced to
the second partner by the first
partner.
 These soon disappear once
the two were separated.
 There are reports of sharing
genetical risk factors among
siblings.
 Finally, the second partner will
adopt it even after separation.
 present among two mentally ill
individuals.

induced
inducer
intervention
Anti-psychotics Psychotherapy
40% of cases

‫نخلص‬ ‫قربنا‬

01
02
How to differentiate schizophrenia
from substance-induced
psychotic disorder?
Does substance-induced
psychotic disorders progress to
schizophrenia?

Substance- or medication-induced psychotic disorder is
characterized by hallucinations and/or delusions due to
the direct effects of a substance or withdrawal from a
substance in the absence of delirium

Substance-Induced Psychotic Disorder DSM5
A.
Prominent
hallucinations or
delusions.
B.
There is evidence
from the history,
physical
examination, or
laboratory findings
that either:
 the symptoms in Criterion A
developed during, or within
a month of, substance
intoxication or withdrawal
C.
The disturbance is
not better
accounted for by a
psychotic disorder
that is not
substance induced
 the symptoms precede the onset of the substance use
 the symptoms persist for a substantial period of
time(e.g., about a month) after the cessation of
acute withdrawal or severe intoxication
 there is other evidence that suggests the existence
of an independent nonsubstance-induced psychotic
disorder (e.g., a history of recurrent nonsubstance-
related episodes).
D.
The disturbance
does not occur
exclusively during
the course of
delirium
 medication used is
etiologically related to
the disturbance

A.
B.
C.
D.
In DSM-5,
the distinction between substance-induced
psychosis and schizophrenia is based on the
persistence of psychosis
beyond 1 month after last exposure
to the implicated substance
01
How to differentiate schizophrenia from substance-
induced
psychotic disorder?

B.
02
psychotic disorders progress to
schizophrenia?

02
psychotic disorders progress to schizophrenia?
*Rajiv Tandon M.D., Sonia Motin Shariff, M.D. 2019
Swedish national
registry-based study*
7,606 individuals who had an index registry
diagnosis of substance induced psychotic disorder
assessed their diagnostic evolution over an
average of 7 years,
as well as how that related to their work history
diagnostic data on first-, second-, and third-
degree relatives of these individuals
examined how individual diagnostic outcomes
related to familial risk of alcohol or drug
abuse and nonaffective psychosis.

02
11% progressed to schizophrenia

nature of the abused substance;
cannabis > stimulants > alcohol

severity of substance use
89% did not progressed to schizophrenia

higher familial risk scores
for nonaffective psychosis

early retirement

02
Swedish national registry-based study*
“Schizophrenia following substance-induced
psychotic disorder is better explained
as a drug-precipitated disorder in highly vulnerable
individuals rather than a syndrome
predominantly caused by drug exposure.”

Substance-Induced
Psychotic Disorder
Management

Of Substance-Induced Psychotic Disorder
Management
1 2
3 4
Independent,
disconnected
Sequential,
disconnected
Parallel,
connected
Integrated

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@nafsyclinic

Non schizophrenic Psychosis الذهان الغير فصامي

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