Psychosis Diagnosis Needs to Be Revisited over Time
Sherman, Carl, Clinical Psychiatry News
NEW YORK -- The diagnosis of psychosis cannot be made on the basis of a single clinical encounter. "You have to look at the whole course" to distinguish among the various psychotic disorders and bipolar disorder, Ronald Rieder, M.D., said at a conference on schizophrenia sponsored by Columbia University.
In many cases, the diagnosis, which is essential for an appropriate treatment plan and an accurate prognosis, must be regarded as a work in progress that is subject to revision as more information becomes available, said Dr. Rieder of the university.
Although all psychotic disorders share many symptoms, they may be distinguished from one another on the basis of specific manifestations, associated psychiatric symptoms, and the course of the illness.
Duration is a critical factor in making the formal distinction among disorders that otherwise might appear to be identical. The diagnosis of schizophrenia, for example, requires symptoms to be present for at least 6 months.
If a patient is seen before then, schizophreniform disorder would be an appropriate diagnosis--subject to change if symptoms persist and are accompanied by a decline in function.
Psychotic symptoms lasting less than a month, unrelated to drugs or a medical condition and without apparent deterioration, are accurately termed brief psychotic disorder, Dr. Rieder said at the meeting, which was cosponsored by the New York State Psychiatric Institute.
Delusional disorder, an infrequent diagnosis, is marked by delusions of at least a month's duration unaccompanied by other psychotic symptoms. The delusions are "nonbizarre"--false beliefs that do not fall outside the realm of possibility, such as delusions of jealousy or erotomania.
The mixture of psychosis and affective symptoms can particularly complicate diagnosis. Psychotic symptoms are present in one-half to two-thirds of patients with bipolar disorder but only during mood episodes (depressive or manic). …