Highlights:
- introduces Schizophrenia Spectrum
- order reflects severity
- Catatonia as separate disorder or specifier
- Schizoaffective Disorder simplified
- Schozphrenia - drop subtypes, revised active phase
- Attenuated Psychosis Syndrome not approved
Key Features
A. Delusions
- fixed beliefs not amenable to change in light of conflicting evidence
a. Persecutory Delusions
- belief that one is going to be harmed or harassed by others
b. Referential Delusions
- beliefs that gestures, comments or other cues are directed at oneself
c. Grandiose Delusions
- an individual believes that he/she has exceptional abilities, wealth or fame
d. Erotomanic Delusions
- an individual believes falsely that another person is in love with him or her
e. Nihilistic Delusions
- conviction that a major catastrophe will occur
d. Somatic Delusions
- preoccupations regarding health and organ function
B. Bizarre Delusions
- clearly implausible and not understandable to same culture peers, not from ordinary life
- loss of control over mind and body
a. Thought Withdrawal
- belief that one's thought have been removed by outside force
b. Thought Insertion
- belief that aliens thoughts have been put into one's mind
c. Delusions of Control
- belief that one's body or actions are manipulated by some outside force
C. Hallucinations
- perception-like experiences that occur without external stimulus
- vivid and clear, not under voluntary control
- auditory hallucinations are most common in schizophrenia
- may be normal part of religious experiences
D. Disorganized Thinking (Speech)
- disorganized thinking (formal thought disorder) is inferred from undividual speech
- may switch from one topic to another
- answers to the questions may be completely unrelated
- speech is incomprehensible, resembles receptive aphasia (word salad)
E. Grossly Disorganized or Abnormal Motor Behavior (including Catatonia)
- may manifest in variety of ways, from childlike silliness to unpredictable agitation
- leading to difficulties in performing activities of daily living
- catatonic behavior is a marked decreased in reactivity to environment
F. Negative Symptoms
a. Diminished Emotional Expression
- reduction in the expression of emotion
b. Avolition
- decrease in motivated self-initiated purposeful activities
c. Alogia
- diminished speech output
d. Anhedonia
- decreased ability to experience pleasure from positive stimuli
e. Asociality
- apparent lack of interest in social interactions
1) Schizotypical Personality Disorder
- pervasive patten of social and interpersonal deficits
- reduced capacity for close relationships
- cognitive or perceptual distortions
- beginning by early adulthood
- ideas of reference
- odd beliefs or magical thinking influences behavior
- unusual perceptual experiences, bodily illusions
- odd thinking and speech
- suspiciousness and paranoid ideation
- lack of close friends other than first degree relatives
- excessive social anxiety
- paranoid fears rather than negative judgments about self
- rule out: schizophrenia, bipolar disorder, depressive disorder, psychotic features or another psychotic and autism spectrum disorder
2) Delusional Disorder
- the presence of one or more delusions with 1 month duration or longer
- criterion A for schizophrenia never met
- functioning is not markedly impaired and behavior not obviously bizarre or odd
- brief relative to the duration of delusion if manic or depressive episode occur
- rule out: physiological effects of substance, another mental disorders, body dysmorphic disorder, OCD
- specifier: erotomanic type, grandiose type, jealous type, persecutory type, somatic type, mixed type, unspecified type
3) Brief Psychotic Disorder
- 1 or more symptoms; delusions, hallucinations, disorganized speech, catatonic behavior
- duration is atleast 1 day but less than one month with eventual full return to premorbid level of functioning
- rule out: major depressive or bipolar disorder, another psychotic disorders, physiological effects of substance
- specify if; with marked stressors, with marited stressor, with postpartum onset, with catatonia
4) Schizophreniform Disorder
- 2 or more, during 1 month period (or less if successfully treated) at least one of these; delusions, hallucinations, disorganized speech, catatonic behavior, negative symptoms
- lasts at least 1 month but less than 6 months, diagnosis must be made without waiting for recovery, qualified as "provisional"
- rule out: schizoaffective, depressive, and bipolar disorder with psychotic feature, physiological effects of substance, another medical condition
- specify if; with good prognostic features, (4 weeks noticeable change, good premorbid social and occupational functioning, absence of flat affect), without good prognostic features (2 or more above features have not been present) or with catatonia.
5) Schizophrenia
- 2 or more of the ff, during one month period (or less if treated) at least one these; hallucinations, delusions, disorganized speech, catatonic behavior, negative symptoms
- level of functioning in one or more major areas is markedly below the level achieved prior to the onset
- continious signs of disturbance persist for at least 6 months
- rule out: schizoaffective, depressive, and bipolar disorder with psychotic feature, physiological effects of substance, another medical condition
- if there is a history of ASD or communication disorder of childhood onset, additional diagnosis of schizophrenia is made only if delusions and hallucinations or other symptoms of schizophrenia are present for at least 1 month (if successfully treated)
- specify if: first episode-currently in acute episode (1st manifestation meeting the diagnostic symptoms and time criteria), first episode-currently in partial remission (improvement after a previous episode is maintained, defining criteria are partially fulfilled), first episode-currently in full remission (after previous episode with no specific symptoms are present), multiple episodes-currently in acute episode, multiple episodes-currently in partial remission, multiple episodes-currently in full remission continious, unspecified (with catatonia)
- risk and prognostic factors; environmental or genetic/physiological
6) Schizoaffective Disorder
- uninterrupted period of illness during major mood episode (major depressive or manic) concurrent with criterion A of schizophrenia
- delusions or hallucinations for 2 or more weeks in the absence of major mood
- symptoms that meet criteria for major mood episode are present
- rule out; effects of substance or another medical condition
- specify if; Bipolar Type, Depressive Type, Catatonia
7) Substance/Medication-Induced Psychotic Disorder
- one of the ff: delusions, hallucinations
- there is an evidence from history or physical examination or laboratory findings
- rule out: psychotic disorder that is not substance induced, during delirium
- causes clinically significant distress in social, occupational, or other areas of functioning
8) Psychotic Disorder Due to Medical Condition
- prominent hallucinations or delusions
- there is an evidence from history or physical examination or laboratory findings
- rule out: another mental disorder, during delirium
- causes clinically significant distress in social, occupational, or other areas of functioning
- specify if; with delusions, with hallucinations
9) Catatonia
- can occur in the context of several disorders, including neurodevelopmental, psychotic, bipolar, depressive, and other medical conditions
- psychomotor disturbance, decreased motor activity, decreased engagement during interview or excessive peculiar motor activity
10) Catatonia Associated with Another Mental Disorder (Catatonia Specifier)
- dominated by three or more of the ff symptoms
a. Stupor - no psychomotor activity
b. Catalepsy - passive induction of posture
c. Waxy Flexibility - resistance to positioning by examiner
d. Mutism - no or very little verbal response (exclude if aphasia)
e. Negativism - no response or opposition to instructions
f. Posturing - active maintenance of posture against gravity
g. Mannerism - odd caricature of normal actions
h. Stereotypy - abnormally frequent non-goal directed movements
i. Agitation, not influenced by external stimuli
j. Grimacing
k. Echolalia - mimicking another's speech
l. Echopraxia - mimicking another's movements
11) Catatonic Disorder Due to Another Medical Condition
- dominated by three or more or the ff:
a. Stupor - no psychomotor activity
b. Catalepsy - passive induction of posture
c. Waxy Flexibility - resistance to positioning by examiner
d. Mutism - no or very little verbal response (exclude if aphasia)
e. Negativism - no response or opposition to instructions
f. Posturing - active maintenance of posture against gravity
g. Mannerism - odd caricature of normal actions
h. Stereotypy - abnormally frequent non-goal directed movements
i. Agitation, not influenced by external stimuli
j. Grimacing
k. Echolalia - mimicking another's speech
l. Echopraxia - mimicking another's movements
- there is an evidence from history, physical examination and laboratory findings
- not better explained by another mental disorder
- nor during the course of delirium
- causes clinically significant distress in social, occupational, or other areas of functioning
12) Unspecified Catatonia
13) Other Specified Schizophrenia Spectrum and Psychotic Disorder
a. Persistent Auditory Hallucinations
b. Delusions with overlapping mood episodes
c. Attenuated Psychosis Syndrome
d. Delusional Symptoms in partner with Individual Delusional Disorder
14) Unspecified Schizophrenia Spectrum and Other Psychotic Disorders
