DOCSLIB.ORG

The Evolution of DSM-5 Schizophrenia Spectrum Disorders

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Evolution of DSM-5 Schizophrenia Spectrum Disorders Curr Psychiatry Rep (2013) 15:409 DOI 10.1007/s11920-013-0409-9 SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS (SJ SIEGEL, SECTION EDITOR) Defining Psychosis: The Evolution of DSM-5 Schizophrenia Spectrum Disorders Mahendra T. Bhati Published online: 22 September 2013 # Springer Science+Business Media New York 2013 Abstract Descriptions of mental illness exist throughout Introduction recorded history. However, until the mid-twentieth cen- tury, there was no standard nosology or diagnostic stan- Descriptions of mental illness exist throughout recorded his- dard for mental disorders. This limited understanding of tory and across cultures and civilizations. Written records of these disorders and development of better treatments. As mental illnesses such as depression and dementia are found in conditions such as dementia praecox and schizophrenia ancient texts including the ancient Egyptian Eber Papyrus (c. were being described, collaborative efforts were made in 1550 BC) [1] and Hindu scriptures such as the Mahabharata the twentieth century to develop the first Diagnostic and (c. 400 BC) [2]. Psychiatric disorders, including schizophre- Statistical Manual of Mental Disorders (DSM). This nia, are widely recognized throughout recorded history and review provides an overview of the history of psychiat- long recognized as a significant public health concern. How- ric diagnosis with a focus on the history of schizophre- ever, through most of history the lack of both systematic, nia as a diagnosis in the DSM. DSM-5 updates to evidence-based diagnoses and nosology for mental disorders diagnostic criteria for schizophrenia and related disor- posed significant limitations for understanding and develop- ders are provided. Limitations to diagnostic validity and ing better treatments for mental illnesses. Physicians such as reliability are discussed in addition to changes in diag- Emil Kraepelin began characterizing mental illnesses such as nostic approaches to schizophrenia spectrum and other schizophrenia in the early twentieth century, and the Diagnos- psychotic disorders in an effort to improve diagnostic tic and Statistical Manual of Mental Disorders (DSM) pub- validity and reliability. The DSM-5 reflects the culmi- lished in 1952 represented the first coordinated effort to create nation of an ongoing collaborative effort to improve the a diagnostic manual solely dedicated for use in psychiatric diagnosis of mental disorders, and future research in disorders and integrated with the International Classification Research Domain Criteria (RDoC) will help provide of Diseases (ICD) published by the World Health Organiza- convergent validity when understanding and treating tion (WHO). The DSM has since undergone five major revi- mental illnesses. sions over its 60 year history, and the DSM-5 published in 2013 now serves as the main clinical and research reference for diagnosing mental illnesses. This article provides a review Keywords Schizophrenia . Schizophrenia spectrum of the history of psychiatric diagnosis and development of the disorders . Psychotic disorders . Psychiatric diagnosis . DSM [3] with a focus on the evolution of diagnostic criteria Psychiatric nosology . ICD . DSM . DSM-5 . RDoC . for schizophrenia spectrum and other psychotic disorders as Psychiatry published in the DSM-5 [4••]. Limitations to using the DSM-5 will be discussed in addition to future research to improve the understanding and nosology of mental illnesses. This article is part of the Topical Collection on Schizophrenia and Other Psychotic Disorders History of Psychiatric Diagnosis M. T. Bhati (*) Department of Psychiatry, Perelman School of Medicine, University Prior to the twentieth century there was no standard definition of Pennsylvania, 3535 Market Street, 2nd floor, Philadelphia, PA 19104, USA or classification of mental disorders. This posed a challenge to e-mail: [email protected] clinicians who had difficulty accurately diagnosing and 409, Page 2 of 7 Curr Psychiatry Rep (2013) 15:409 treating mental illnesses and researchers who recognized the standard for clinicians and researchers. The central and ongo- significance of mental illnesses, specifically schizophrenia, on ing goal of the DSM is to aid diagnosis and assessment of public health but could not accurately characterize and study psychiatric disorders, and it does not make recommendations such conditions. For the majority or history, psychiatric ill- regarding treatments. nesses were poorly characterized, treatments were insuffi- There was little difference in the DSM-I compared to the cient, and prognosis poor. DSM-II published in 1968 [6]. Both versions largely reflected The first attempt to systematically study mental illness was a psychodynamic approach to psychiatric diagnosis. The in the 1840 U.S. Census when an effort was made to collect DSM-II included 182 disorders and attempted to achieve information on the frequency of “idiocy” and “insanity.” greater uniformity of diagnostic classification at an interna- These efforts were intended to account for the number of tional level with nomenclature based on the ICD-8. The individuals in the U.S. who lived in mental institutions and validity of psychiatric diagnoses has been based on expert provided invaluable data for epidemiologists. By the 1880 clinical consensus since the 1970s drawn from a wide-range census, seven categories of mental health were identified of clinical experience and available basic, clinical, and epide- including 1) mania, 2) melancholia, 3) monomania, 4) paresis, miological research [7]. Robert Spitzer was chair of the task 5) dementia, 6) dipsomania, and 7) epilepsy. In 1917 the force leading to the publication of the DSM-III in 1980. The American Medico-Psychological Association (now known initial aim of the DSM-III was to better align DSM nomen- as the American Psychiatric Association), together with the clature with the ICD, but Spitzer and colleagues lead a broader National Commission on Mental Hygiene, formulated a plan effort to improve the uniformity and validity of psychiatric adopted by the U.S. Bureau of the Census for gathering diagnoses. Criteria adopted for many DSM-III disorders were uniform statistics across mental hospitals. Together both taken from Feighner [8] and Research Diagnostic Criteria groups developed the first psychiatric diagnostic manual in- (RDC) [9], both used in psychiatric research to provide more cluding 22 diagnoses and titled the Statistical Manual for the reliable diagnosis of mental disorders. Significant changes in Use of Institutions for the Insane. Post-World War II, a much the DSM-III included 265 diagnostic categories with intro- broader psychiatric nomenclature and classification scheme duction of explicit diagnostic criteria, a multi-axial system, was developed by the U.S. Army and led by psychiatrist, and a descriptive approach that attempted to be neutral with Brigadier General William C. Menniger. This nomenclature respect to theories of etiology (e.g., neurobiological, cogni- was called the Medical 203 and adopted and later modified by tive, psychodynamic, etc.). These changes were the result of the Veterans Administration (VA) to better incorporate outpa- extensive empirical work on the construction and validation of tient psychiatric presentations of World War II servicemen and explicit diagnostic criteria and the development of semi- veterans with illnesses including psychophysiological, per- structured interviews. Field trials sponsored by the NIMH sonality, and acute disorders. The World Health Organization were first performed for the DSM-III in an effort to establish (WHO) published the 6th edition of the International Classi- clinical reliability of DSM-defined psychiatric diagnoses [10]. fication of Diseases (ICD-6) in 1949, and it included for the Areas of inconsistency and further clarification of diagnostic first time a section on mental disorders. The ICD-6 was criteria led to a revision in 1987, the DSM-III-R, with 292 heavily influenced by the Medical 203 and included ten diagnoses. The DSM-IV, published in 1994, was the culmina- categories for psychoses and psychoneuroses in addition to tion of a 6-year effort involving constructing a comprehensive seven categories for disorders of character, behavior, and review of the literature to establish an empirical basis for intelligence. modifications. It contained 297 disorders, and numerous The American Psychiatric Association (APA) formed a changes were made in the DSM-IV including the addition, Committee on Nomenclature and Statistics who developed a reorganization, and elimination of psychiatric disorders in variant of the ICD-6 published in 1952 as the first DSM [5]. addition to updated diagnostic criteria and descriptive text. A The DSM-I was largely derived from the section on mental largely unchanged text revision, the DSM-IV-TR, was pub- disorders in the Standard Classified Nomenclature of Disease lished in 2000. developed at the National Conference on Nomenclature of The development of the recently published DSM-5 (2013) Disease in 1933 and included 106 mental disorders. The was the culmination of more than a decade of work by DSM-I contained a glossary of descriptions of mental illnesses thousands of clinicians and patients. Development of the arranged in diagnostic categories and emerged as the first DSM-5 began in 1999 among leaders of the NIMH and the official clinical manual of mental disorders. It attempted to APA who worked together to expand the scientific basis for use epidemiological
Load more

Recommended publications
  • First Episode Psychosis an Information Guide Revised Edition
    First episode psychosis An information guide revised edition Sarah Bromley, OT Reg (Ont) Monica Choi, MD, FRCPC Sabiha Faruqui, MSc (OT) i First episode psychosis An information guide Sarah Bromley, OT Reg (Ont) Monica Choi, MD, FRCPC Sabiha Faruqui, MSc (OT) A Pan American Health Organization / World Health Organization Collaborating Centre ii Library and Archives Canada Cataloguing in Publication Bromley, Sarah, 1969-, author First episode psychosis : an information guide : a guide for people with psychosis and their families / Sarah Bromley, OT Reg (Ont), Monica Choi, MD, Sabiha Faruqui, MSc (OT). -- Revised edition. Revised edition of: First episode psychosis / Donna Czuchta, Kathryn Ryan. 1999. Includes bibliographical references. Issued in print and electronic formats. ISBN 978-1-77052-595-5 (PRINT).--ISBN 978-1-77052-596-2 (PDF).-- ISBN 978-1-77052-597-9 (HTML).--ISBN 978-1-77052-598-6 (ePUB).-- ISBN 978-1-77114-224-3 (Kindle) 1. Psychoses--Popular works. I. Choi, Monica Arrina, 1978-, author II. Faruqui, Sabiha, 1983-, author III. Centre for Addiction and Mental Health, issuing body IV. Title. RC512.B76 2015 616.89 C2015-901241-4 C2015-901242-2 Printed in Canada Copyright © 1999, 2007, 2015 Centre for Addiction and Mental Health No part of this work may be reproduced or transmitted in any form or by any means electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system without written permission from the publisher—except for a brief quotation (not to exceed 200 words) in a review or professional work. This publication may be available in other formats. For information about alterna- tive formats or other CAMH publications, or to place an order, please contact Sales and Distribution: Toll-free: 1 800 661-1111 Toronto: 416 595-6059 E-mail: [email protected] Online store: http://store.camh.ca Website: www.camh.ca Disponible en français sous le titre : Le premier épisode psychotique : Guide pour les personnes atteintes de psychose et leur famille This guide was produced by CAMH Publications.
    [Show full text]
  • Autism Practice Parameters
    American Academy of Child and Adolescent Psychiatry AACAP is pleased to offer Practice Parameters as soon as they are approved by the AACAP Council, but prior to their publication in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP). This article may be revised during the JAACAP copyediting, author query, and proof reading processes. Any final changes in the document will be made at the time of print publication and will be reflected in the final electronic version of the Practice Parameter. AACAP and JAACAP, and its respective employees, are not responsible or liable for the use of any such inaccurate or misleading data, opinion, or information contained in this iteration of this Practice Parameter. PRACTICE PARAMETER FOR THE ASSESSMENT AND TREATMENT OF CHILDREN AND ADOLESCENTS WITH AUTISM SPECTRUM DISORDER ABSTRACT Autism spectrum disorder (ASD) is characterized by patterns of delay and deviance in the development of social, communicative, and cognitive skills which arise in the first years of life. Although frequently associated with intellectual disability, this condition is distinctive in terms of its course, impact, and treatment. ASD has a wide range of syndrome expression and its management presents particular challenges for clinicians. Individuals with an ASD can present for clinical care at any point in development. The multiple developmental and behavioral problems associated with this condition necessitate multidisciplinary care, coordination of services, and advocacy for individuals and their families. Early, sustained intervention and the use of multiple treatment modalities are indicated. Key Words: autism, practice parameters, guidelines, developmental disorders, pervasive developmental disorders. ATTRIBUTION This parameter was developed by Fred Volkmar, M.D., Matthew Siegel, M.D., Marc Woodbury-Smith, M.D., Bryan King, M.D., James McCracken, M.D., Matthew State, M.D., Ph.D.
    [Show full text]
  • Autism Spectrum Disorder: an Overview and Update
    Autism Spectrum Disorder: An Overview and Update Brandon Rennie, PhD Autism and Other Developmental Disabilities Division Center for Development and Disability University of New Mexico Department of Pediatrics DATE, 2016 Acknowledgements: Courtney Burnette, PHD, Sylvia Acosta, PhD, Maryann Trott, MA, BCBA Introduction to Autism Spectrum Disorder (ASD) • What is ASD? • A complex neurodevelopmental condition • Neurologically based- underlying genetic and neurobiological origins • Developmental- evident early in life and impacts social development • Lifelong- no known cure • Core characteristics • Impairments in social interaction and social communication • Presence of restricted behavior, interests and activities • Wide variations in presentation DSM-5 Diagnostic Criteria • Deficits in social communication and social interaction (3) • Social approach/interaction • Nonverbal communication • Relationships • Presence of restricted, repetitive patterns of behavior, interests, or activities (2) • Stereotyped or repetitive motor movements, objects, speech • Routines • Restricted interests • Sensory* From Rain Man To Sheldon Cooper- Autism in the Media 1910 Bleuler • First use of the word autistic • From “autos”, Greek word meaning “self” 1943 Leo Kanner 1944 Hans Asperger 1975 1:5000 1985 1:2500 1995 1:500 “When my brother trained at Children's Hospital at Harvard in the 1970s, they admitted a child with autism, and the head of the hospital brought all of the residents through to see. He said, 'You've got to see this case; you'll never see it
    [Show full text]
  • History of Psychiatry
    History of Psychiatry http://hpy.sagepub.com/ Psychiatric 'diseases' in history David Healy History of Psychiatry 2014 25: 450 DOI: 10.1177/0957154X14543980 The online version of this article can be found at: http://hpy.sagepub.com/content/25/4/450 Published by: http://www.sagepublications.com Additional services and information for History of Psychiatry can be found at: Email Alerts: http://hpy.sagepub.com/cgi/alerts Subscriptions: http://hpy.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav Citations: http://hpy.sagepub.com/content/25/4/450.refs.html >> Version of Record - Nov 13, 2014 What is This? Downloaded from hpy.sagepub.com by guest on November 13, 2014 HPY0010.1177/0957154X14543980History of PsychiatryHealy 543980research-article2014 Article History of Psychiatry 2014, Vol. 25(4) 450 –458 Psychiatric ‘diseases’ in history © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0957154X14543980 hpy.sagepub.com David Healy Bangor University Abstract A history of psychiatry cannot step back from the question of psychiatric diseases, but the field has in general viewed psychiatric entities as manifestations of the human state rather than medical diseases. There is little acknowledgement that a true disease is likely to rise and fall in incidence. In outlining the North Wales History of Mental Illness project, this paper seeks to provide some evidence that psychiatric diseases do rise and fall in incidence, along with evidence as to how such ideas are received by other historians of psychiatry and by biological psychiatrists. Keywords Disease, historical epidemiology, medical progress, post-partum psychoses, schizophrenia The twenty-fifth anniversary of the History of Psychiatry provides a wonderful opportunity to celebrate its editor who has had a huge influence on all aspects of the history outlined below.
    [Show full text]
  • Brief Psychotic Disorder Diagnostic Criteria 298.8 (F23)
    Brief Psychotic Disorder Diagnostic Criteria 298.8 (F23) A. Presence of one (or more) of the following symptoms. At least one of these must be (1), (2), or (3): 1. Delusions. 2. Hallucinations. 3. Disorganized speech (e.g., frequent derailment or incoherence). 4. Grossly disorganized or catatonic behavior. Note: Do not include a symptom if it is a culturally sanctioned response. B. Duration of an episode of the disturbance is at least 1 day but less than 1 month, with eventual full return to premorbid level of functioning. C. The disturbance is not better explained by major depressive or bipolar disorder with psychotic features or another psychotic disorder such as schizophrenia or catatonia, and is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition. Specify if: With marked stressor(s) (brief reactive psychosis): If symptoms occur in response to events that, singly or together, would be markedly stressful to almost anyone in similar circumstances in the individual’s culture. Without marited stressor(s): If symptoms do not occur in response to events that, singly or together, would be markedly stressful to almost anyone in similar circumstances in the individual’s culture. With postpartum onset: If onset is during pregnancy or within 4 weeks postpartum. Specify if: With catatonia (refer to the criteria for catatonia associated with another mental disorder, pp. 119-120, for definition) Coding note: Use additional code 293.89 (F06.1) catatonia associated with brief psychotic disorder to indicate the presence of the comorbid catatonia. Specify current severity: Severity is rated by a quantitative assessment of the primary symptoms of psychosis, including delusions, hallucinations, disorganized speech, abnormal psychomotor behavior, and negative symptoms.
    [Show full text]
  • The Clinical Presentation of Psychotic Disorders Bob Boland MD Slide 1
    The Clinical Presentation of Psychotic Disorders Bob Boland MD Slide 1 Psychotic Disorders Slide 2 As with all the disorders, it is preferable to pick Archetype one “archetypal” disorder for the category of • Schizophrenia disorder, understand it well, and then know the others as they compare. For the psychotic disorders, the diagnosis we will concentrate on will be Schizophrenia. Slide 3 A good way to organize discussions of Phenomenology phenomenology is by using the same structure • The mental status exam as the mental status examination. – Appearance –Mood – Thought – Cognition – Judgment and Insight Clinical Presentation of Psychotic Disorders. Slide 4 Motor disturbances include disorders of Appearance mobility, activity and volition. Catatonic – Motor disturbances • Catatonia stupor is a state in which patients are •Stereotypy • Mannerisms immobile, mute, yet conscious. They exhibit – Behavioral problems •Hygiene waxy flexibility, or assumption of bizarre • Social functioning – “Soft signs” postures as most dramatic example. Catatonic excitement is uncontrolled and aimless motor activity. It is important to differentiate from substance-induced movement disorders, such as extrapyramidal symptoms and tardive dyskinesia. Slide 5 Disorders of behavior may involve Appearance deterioration of social functioning-- social • Behavioral Problems • Social functioning withdrawal, self neglect, neglect of • Other – Ex. Neuro soft signs environment (deterioration of housing, etc.), or socially inappropriate behaviors (talking to themselves in
    [Show full text]
  • 1 SUPPLEMENTARY MATERIAL Burden of Illness Among
    SUPPLEMENTARY MATERIAL Burden of illness among patients with dementia-related psychosis Monica Frazer, PhD; Victor Abler, DO; Rachel Halpern, PhD; Ben Skoog, PharmD; and Nazia Rashid, PharmD Supplementary Table 1. Diagnosis and Medication Code List 1 Supplementary Table 1. Diagnosis and Medication Code List Code Code Type Description Psychosis Inclusion 290.12 ICD-9 Dx Presenile dementia with delusional features 290.20 ICD-9 Dx Senile dementia with delusional features 290.42 ICD-9 Dx Vascular dementia with delusions 290.8 ICD-9 Dx Other specified senile psychotic conditions 290.9 ICD-9 Dx Unspecified senile psychotic condition 293.81 ICD-9 Dx Psychotic disorder with delusions in conditions classified elsewhere Psychotic disorder with hallucinations in conditions classified 293.82 ICD-9 Dx elsewhere 297.1 ICD-9 Dx Delusional disorder 298.0 ICD-9 Dx Depressive type psychosis 298.1 ICD-9 Dx Excitative type psychosis 298.4 ICD-9 Dx Psychogenic paranoid psychosis 298.8 ICD-9 Dx Other and unspecified reactive psychosis 298.9 ICD-9 Dx Unspecified psychosis 368.16 ICD-9 Dx Psychophysical visual disturbances 780.1 ICD-9 Dx Hallucinations Psychotic disorder with hallucinations due to known physiological F060 ICD-10 Dx condition Psychotic disorder with delusions due to known physiological F062 ICD-10 Dx condition F22 ICD-10 Dx Delusional disorders F23 ICD-10 Dx Brief psychotic disorder Other psychotic disorder not due to a substance or known F28 ICD-10 Dx physiological condition Unspecified psychosis not due to a substance or known physiological
    [Show full text]
  • Dsm-5 Diagnostic Criteria for Eating Disorders Anorexia Nervosa
    DSM-5 DIAGNOSTIC CRITERIA FOR EATING DISORDERS ANOREXIA NERVOSA DIAGNOSTIC CRITERIA To be diagnosed with anorexia nervosa according to the DSM-5, the following criteria must be met: 1. Restriction of energy intaKe relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. 2. Intense fear of gaining weight or becoming fat, even though underweight. 3. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight. Even if all the DSM-5 criteria for anorexia are not met, a serious eating disorder can still be present. Atypical anorexia includes those individuals who meet the criteria for anorexia but who are not underweight despite significant weight loss. Research studies have not found a difference in the medical and psychological impacts of anorexia and atypical anorexia. BULIMIA NERVOSA DIAGNOSTIC CRITERIA According to the DSM-5, the official diagnostic criteria for bulimia nervosa are: • Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: o Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances. o A sense of lacK of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating).
    [Show full text]
  • Accurate Diagnosis of Primary Psychotic Disorders the Care Transitions Network
    Accurate Diagnosis of Primary Psychotic Disorders The Care Transitions Network National Council for Behavioral Health Montefiore Medical Center Northwell Health New York State Office of Mental Health Netsmart Technologies Objectives • By the completion of this webinar, participants should understand that the diagnoses of primary psychotic disorders will change early in the course of illness. • Participants will understand that when mood and psychotic symptoms overlap, diagnosis can further change over the patient’s lifetime. • Participants will be be able to use DSM-5 criteria to diagnose primary psychotic disorders and schizoaffective disorder. What diagnoses are on your differential? Think broadly. Differential should Include… • Schizophrenia • Schizophreniform Disorder • Brief Psychotic Disorder • Delusional Disorder • Other Specified Psychotic Disorder • Unspecified Psychotic Disorder Differential should exclude… Symptoms due to a medical condition or the effects of a medication or substance abuse Mood disorders with psychosis The timeline of psychotic symptoms is crucial for distinguishing between schizophrenia-spectrum disorders For psychotic disorders, the most accurate diagnosis can change as symptoms change over time Delusional Disorder Unspecified Psychotic Schizophreniform Schizophrenia Disorder Disorder Brief Psychotic Disorder JANUARY FEBRUARY MARCH APRIL MAY JUNE Symptoms resolve Brief Psychotic Disorder Symptoms Delusional Disorder resolve Schizophreniform Disorder Schizophrenia 6 month mark 1 month mark Also important for distinguishing schizophrenia-spectrum disorders are …..the psychotic symptom domains ….the frequency & severity of symptoms Schizophrenia Schizophrenia Negative Signs & Disorganized Signs 5 Symptoms Grossly Disorganized or Catatonic Behavior 4 Disorganized Speech 3 ≥ 2/5 key symptom domains Each present for a significant portion of time during a 1 month Positive Symptoms period. (Or less if successfully treated).
    [Show full text]
  • Is Pervasive Developmental Disorder Not Otherwise Specified Less
    J Autism Dev Disord DOI 10.1007/s10803-010-1155-z ORIGINAL PAPER Is Pervasive Developmental Disorder Not Otherwise Specified Less Stable Than Autistic Disorder? A Meta-Analysis Eme´lie Rondeau • Leslie S. Klein • Andre´ Masse • Nicolas Bodeau • David Cohen • Jean-Marc Guile´ Ó Springer Science+Business Media, LLC 2010 Abstract We reviewed the stability of the diagnosis of Keywords Validity Á Diagnosis Á Autistic disorder Á pervasive developmental disorder not otherwise specified Pervasive developmental disorder Á Autism Á Meta-analysis (PDD-NOS). A Medline search found eight studies reiter- ating a diagnostic assessment for PDD-NOS. The pooled group included 322 autistic disorder (AD) and 122 PDD- Introduction NOS cases. We used percentage of individuals with same diagnose at Times 1 and 2 as response criterion. The Over the past 15 years, there has been increasing interest in pooled Relative Risk was 1.95 (p \ 0.001) showing that the early identification of autism spectrum disorders AD diagnostic stability was higher than PDD-NOS. When (ASD). In that respect, several studies have examined the diagnosed before 36 months PDD-NOS bore a 3-year sta- stability of early diagnosis (Lord 1995; Cox et al. 1999; bility rate of 35%. Examining the developmental trajecto- Moore and Goodson 2003; Charman et al. 2005). In ries showed that PDD-NOS corresponded to a group of keeping with those studies, we conducted a meta-analysis heterogeneous pathological conditions including prodromic focussing on the stability of the diagnosis of pervasive forms of later AD, remitted or less severe forms of AD, and developmental disorder not otherwise specified (PDD- developmental delays in interaction and communication.
    [Show full text]
  • Schizophrenia Spectrum and Other Psychotic Disorders
    1 SCHIZOPHRENIA SPECTRUM AND OTHER PSYCHOTIC DISORDERS 2 OBJECTIVES Know and understand: • How to evaluate a person with psychotic symptoms • The epidemiology and clinical characteristics of late- onset schizophrenia • Evaluation of psychotic symptoms associated with disorders other than schizophrenia • Management of older adult patients with psychotic symptoms 3 TOPICS COVERED • Schizophrenia and Schizophrenia Spectrum Syndromes • Psychotic Symptoms in Delirium and Delusional Disorder • Psychotic Symptoms in Mood Disorder • Psychotic Symptoms in Dementia • Isolated Suspiciousness • Syndromes of Isolated Hallucinations: Charles Bonnet Syndrome • Other Psychotic Disorders Ø Psychotic Disorder Due to Another Medical Condition Ø Substance/Medication-Induced Psychotic Disorder 4 PSYCHOTIC SYMPTOMS • Hallucinations are perceptions without stimuli that can affect any of the 5 sensory modalities (auditory, visual, tactile, olfactory, gustatory) • Delusions are fixed, false, idiosyncratic beliefs that can be: Ø Suspicious (paranoid) Ø Grandiose Ø Somatic Ø Self-blaming Ø Hopeless 5 EVALUATION OF A PERSON WITH PSYCHOTIC SYMPTOMS • First evaluate for underlying causes such as delirium, dementia, stroke, or Parkinson disease Ø Acute onset of altered level of consciousness or inability to sustain attention suggests delirium Ø Delirium, most often superimposed on an underlying dementia, is the most common cause of new-onset psychosis in late life • Next, consider a primary mood disorder • Only after other causes are excluded should the diagnosis of
    [Show full text]
  • Towards Specifying Pervasive Developmental Disorder – Not
    Toward specifying pervasive developmental disorder-not otherwise specified. Mandy W, Charman T, Gilmour J, Skuse D. Autism Res. 2011 Feb 4. doi: 10.1002/aur.178. [Epub ahead of print] PMID: 21298812 Towards specifying Pervasive Developmental Disorder – Not Otherwise Specified. William Mandy DClinPsy Tony Charman PhD Jane Gilmour PhD David Skuse MD Running title: PDD-NOS Drs Mandy and Gilmour are at the Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, UK, WC1N 6BT. Professor Charman is at the Centre for Research in Autism Education, Institute of Education, 15 Woburn Square, London, UK, WC1H 0AL. Professor Skuse is at the Behavioural and Brain Science Unit, UCL Institute of Child Health, 30 Guilford Street, London, UK, WC1E 1EH. Correspondence to Dr William Mandy, Research Department of Clinical, Educational and Health Psychology, University College London, UK, WC1N 6BT. Email [email protected] Telephone: 00 44 (0)207 679 1675 Fax: 00 44 (0)207 916 1989 1 Towards Specifying Pervasive Developmental Disorder – Not Otherwise Specified LAY ABSTRACT Pervasive developmental disorder – not otherwise specified (PDD-NOS) is the most common and least satisfactory of the PDD diagnoses. It is not clearly defined in the diagnostic manuals, limiting the consistency with which it is used by researchers and clinicians. This in turn limits the amount that we have learnt about people with PDD-NOS. In a sample of 256 young people (mean age = 9.1 years) we aimed to implement a clear, transparent definition of PDD-NOS, and then to describe those receiving this diagnosis (n=66), investigating whether they differed from people with autistic disorder (n=97) and Asperger’s disorder (n=93).
    [Show full text]