What is Psychosis?

It can include a complete disconnect from reality. Here is an example of waxy flexibility. If you moved a catatonic person into this position they would be able to stay there without moving for hours. A catatonic state should not be confused with cataplexy which is a type of narcolepsy where people have motor immobility while remaining completely aware of their surroundings.  There we briefly discussed Mania with psychosis and depression with psychosis. The key difference between schizophrenia and a mood disorder with psychosis is that the psychosis in mood disorders is “Mood Congruent.” This means that the psychosis is only present during the mood. Schizophrenia is a chronic progressive psychiatric condition characterized by psychosis and an abnormal interpretation of reality. This is the disease schizophrenia, from which Sushant Singh Rajput was suffered.
They have a difficult time functioning in society due to progressive loss of function. Symptoms are categorized into 2 groups, Negative and Positive Symptoms. Positive symptoms are behaviors or sensations that are not normally present. The absence of normal behavior. but the difference between those types was low yield and in the most recent version of the DSM, those subtypes have been removed. To make a diagnosis of schizophrenia you need to rule out other potential causes of psychosis. Street drugs like cocaine or hallucinogens as well as prescription medications like corticosteroids or antiparkinsonian drugs can cause psychosis. General medical conditions such as stroke, delirium, and dementia also need to be ruled out from the differential diagnosis. Thankfully these intricacies are a bit beyond the scope of the USMLE Step 1 exam. 

Schizophrenia

If the question stem has a clear picture of psychosis you can safely choose Schizophrenia unless there is a big hint like a recent use of cocaine. We will cover treatment for psychosis-like antipsychotics in a later blog in the section. Now, this only depends upon you, that you go for further knowledge or not. The same group of symptoms is associated with different diagnoses based on their duration. According to the DSM, Schizophrenia must have symptoms that persist for more than 6 months. If the same symptoms are present for less than a month you have a different diagnosis. Symptoms of schizophrenia for less than 1month is referred to as brief psychotic disorder and symptoms for 1 to 6 months is schizophreniform disorder Schizoaffective Disorder is a mood disorder in the presence of a psychotic disorder. It can be thought of as Schizophrenia plus MajorDepressive Disorder or Bipolar Disorder. 


Differentiating between schizoaffective disorder and a mood disorder that has psychotic features can be challenging. Thankfully this is a bit beyond the scope of the exam, but the key is what symptoms are predominant. These individuals will not be depressed or manic in the absence of psychosis. Alternatively, They will not have psychotic symptoms when they are in a euthymic state (or neutral mood). Delusional Disorder is characterized by delusion and the lack of other psychotic symptoms (no hallucinations or thought disorder). These individuals do not have a loss of function and may appear normal most of the time. Unlike the delusions in Schizophrenia, the delusion in Delusional Disorder is usually fixed and-bizarre. So while the delusion is not based on reality it is at least plausible. 

Bizarre

A bizarre delusion would be something like “aliens abducted me” while a non-bizarre delusion would be something like “my neighbor is trying to kill me” which could potentially occur in real life. The prefix Schizo means “split”. This has, unfortunately, led to a lot of confusion in the media and the general public. Many believe schizophrenia is a type of split personality disorder (AKA Dissociative Identity Disorder)when the two disorders are not related. The split prefix actually refers to the gap between schizophrenic person and reality. This prefix applies to many of the disorders within the“Schizophrenia Spectrum and Other Psychotic Disorders” category, which is a new title added to the latest version of the DSM. Schizoid Personality Disorder, Schizotypal personality disorder, Schizophrenia, and Schizoaffective Disorder all have a detachment from reality and/or others. These disorders also share features like blunted affect. Individuals with a family history of schizophrenia are more likely to be schizoid, schizotypal, or schizoaffective. 


The way I remember this is that as the number of letters increases so do the number of symptoms. Schizoid Personality Disorder is when a person is very introverted and voluntarily withdraws from social interactions. Schizotypal can be thought of as Schizoid symptoms plus magical thinking & odd behavior. Schizophrenia can be thought of a Schizotypal symptoms pluspsychosis and as we have already discussed Schizoaffective disorder is basically Schizophreniaplus a Mood Disorder. Schizophreniform, unfortunately, does not fit into this mnemonic. We will covert schizoid and Schizotypal in much more detail in a later blog about Personality Disorders That brings us to the end of the blog. If you liked it and would like to make it easier to find other blogs from Stomp On Step 1you can click on this orange box here. Our next blog in the series will cover Anxiety disorders like OCD, PTSD & Generalized Anxiety Disorder.