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beneficii
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16 Feb 2014, 11:19 pm

OddDuckNash99 wrote:
Another as-of-yet-unknown thing that fascinates me (and I'd love to study it someday) is the innate differences in affective psychosis and schizophrenia-type psychosis. You don't see first-rank Schneiderian symptoms in a purely affective psychosis, which usually takes on a mood-congruent pattern. Anyway, this is one of my biggest special interests, so there's a short ramble, and I'm more than happy to answer any other questions the OP has.


Actually, it looks like first rank symptoms will be de-emphasized in future diagnostic manuals, as recommended by reviewers such as this:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2632385/

They were in fact taken out of the DSM-5, which no longer permits you to be diagnosed with schizophrenia, schizophreniform disorder, or schizoaffective disorder with just one system. I hear they are likely to be taken out of the ICD-11, as well.

Now, if you look more closely at the source, you find there is still some validity to the concept of first rank symptoms as specific to schizophrenia, but only when a "a radical qualitative change in the thought processes" (quoted at the link) has occurred, in that context. Unfortunately, clinicians usually did not interview patients long enough to get whether indeed such "a radical qualitative change" had occurred, so lots of misdiagnoses and inconsistency in research occurred.


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OddDuckNash99
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17 Feb 2014, 5:48 am

beneficii wrote:
Actually, people with bipolar II can still have psychotic depression.

Yes, I realize that, but I focused on mania, due to that being the defining aspect of bipolar disorder. Plus, the poster specifically was asking about the "psychotic features" label being redundant for a "bipolar-I" diagnosis. And bipolar-I is mania.


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17 Feb 2014, 10:09 am

Ettina wrote:
The dividing line between schizoaffective and bipolar is said to be 'mood-incongruent' hallucinations/delusions.

Someone who's just bipolar, they may hallucinate/have delusions when they're in the middle of a severe mood episode, but the hallucinations/delusions match their mood. So if they're manic, they'll be grandiose or paranoid or both (paranoia often involves grandiosity - you'd have to be important for so many people to be out to get you, right?). If they're depressed, they'll have insulting voices or think they're dead or blame themselves to a delusional level ('I caused the Holocaust' sort of thing).

A schizoaffective person has clear manic/hypomanic and depressive episodes, but also has hallucinations/delusions that don't fit this pattern. Either they have some hallucinations/delusions when they aren't manic or depressed, or have hallucinations/delusions that don't match their mood (eg grandiose delusions when depressed). One guy I heard of had three distinct types of episodes - manic, depressed, and paranoid. The paranoid episodes were what got him the schizoaffective diagnosis.


Where I live you get one or the other diagnosis. You don't get both. Actually, the shrinks are just calling it a subtype of Schizophrenia, which I believe the DSM V was trying to do.


Bipolar can have hallucinations and delusions especially during a mania. The difference between the two diagnosis, is a bipolar who is not actively depressed or manic do not have the hallucinations/delusions. Schizoaffective people do. If you pull the antipsychotics, those problems start coming back.

So with Schizoaffective Disorder you get the mood swings which can go away, but the hallucinations/delusions still hang around even when the mood swings leave.