Differential Diagnosis Schizoaffective Disorder Schizophrenia Schizophreniform Disorder Major Depressive Disorder (single episode), with mood-incongruent psychotic features Dysthymic Disorder

Schizoaffective Disorder a psychotic disorder both the symptoms of schizophrenia and mood disorders are present Diagnosis: major depressive episode, manic episode, or both are present during the active phase of Schizophrenia The patient should also have delusions or hallucinations for at least 2 weeks without mood disorders Should also not be substance-induced or due to a general medical condition

Schizoaffective Disorder Rule inRule out -symptoms of depression (loss of interest or pleasure, weight loss/decrease in appetite, loss of energy, hypersomnia) -positive symptom of schizophrenia (hallucinations – 3 voices) -no symptoms of mania - can’t be ruled out: it is not clear whether the depressive episode occurred concurrently with hallucination

Schizophrenia characterized by delusions, hallucinations, disorganized speech, disorganized behavior, and negative symptoms such as alogia, anhedonia, and avolition. two or more of the said symptoms must be present for at least 6 months There is decline in the social and occupational functioning of the individual. the patient’s mood episodes should be shorter than the active and residual periods of schizophrenia OR the major depressive episodes are not concurrent with psychotic symptoms but the duration is more than 6 months

Schizophrenia Rule inRule out auditory hallucinations paucity of his speech negative symptoms (flat affect, avolition, alogia and anhedonia) being vigilant, paranoid and afraid which could be signs of delusion impaired occupational and social functioning cannot be ruled out it is not clear in the history whether the psychotic symptoms occur with depressive symptoms and whether they have been present since the depressive symptoms 4 years ago or just after he was admitted to the institution

Schizophreniform Disorder very similar set of manifestations as schizophrenia its duration must be at least one month but less than 6 months. at least two or more psychotic symptoms: hallucination, delusions, disorganized speech and behavior or negative symptoms. Epidemiologic studies: relatives of patients with schizophreniform disorder, in contrast to those with schizophrenia, have a more likely chance to develop mood disorders.

Schizophreniform Disorder Rule inRule out hallucinations (hearing voices), paranoid delusions, and negative symptoms family history: relatives diagnosed with mood disorders cannot be ruled out it is not clear in the history when the psychotic symptoms started and whether the psychotic symptoms occur with depressive symptoms

Major Depressive Disorder with mood-incongruent psychotic features Diagnosis of this disorder requires at least four of the following: – Difficulties in sleeping – Psychomotor agitation/retardation – Poor appetite and weight loss or increased appetite and weight gain – Loss of energy – Feelings of worthlessness – Difficulty concentrating, thinking, or making decisions – Recurrent thoughts of death/suicide

Major Depressive Disorder with mood-incongruent psychotic features symptoms be present almost everyday for at least 2 weeks and should not be due to normal bereavement functional impairment the active and residual periods of schizophrenia are longer than the mood episodes and the hallucinations free of mood episode last for less than 2 weeks

Major Depressive Disorder with mood-incongruent psychotic features Rule inRule out hypersomnia little appetite and profound weight loss (20 pounds in a few months) profound loss of energy decreased speech production inactivity no interest or pleasure in any activities symptoms have lasted more than two weeks cannot be ruled out as it is not clear in the history whether the psychotic symptoms occur with depressive symptoms and it was also not stated when the psychotic symptoms started

Dysthymic Disorder chronic long lasting form of depression Literally means 'bad state of mind' or 'ill humor' tends to run in families two to three times more common in women than in men

Dysthymic Disorder Shares many characteristic symptoms of major depressive disordersymptoms symptoms tend to be less severe but do fluctuate in intensity Diagnosis: must experience 2 or more of the following symptoms for most of the day, more days than not, for at least 2 year – Feelings of hopelessness – Insomnia or hypersomnia Insomniahypersomnia – Poor concentration or difficulty making decisions – Low energy or fatiguefatigue – Low self-esteem;self-esteem – Poor appetite or overeating

Dysthymic Disorder Rule inRule out Unable to pursue long-term goals after break-up 4 years PTA Hypersomnia only upon admission Poor appetite and weight loss only over last couple of months Profound loss of energy upon admission