Schizophrenia

and Schizoaffective Disorder

DSM-IV-TRTM

Russell L. Smith, M.S.,LPA, HSP-PA, CCBT, MAC, FABFCE, NCP

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000

In Schizophrenia, “Psychotic” refers to

delusions, any prominent

hallucinations, disorganized speech, or disorganized or catatonic

behavior.

Subtypes

295.30 Paranoid 295.10 Disorganized 295.20 Catatonic 295.90 Undifferentiated 295.60 Residual

Course Specifiers

Episodic With Interepisode Residual Symptoms

Episodic With No Interepisode Residual Symptoms

Continuous Single Episode in Partial

Remission* Single Episode in Full

Remission* Other Or Unspecified Pattern

*With Prominent Negative Symptoms can be added ...

Range of Emotional & Cognitive Dysfunction*

Perception Inferential thinking Language &

communication Behavioral monitoring Affect Fluency & productivity of

thought & speech Hedonic capacity Volition & drive Attention* Associated with impaired

occupational or social functioning

Positive Symptoms

Reflect an excess or distortion of normal functions

“psychotic dimension ” Thought content Perception

“disorganization dimension ” Language & thought

processes Self-monitoring of

behavior

Negative Symptoms

A decrease or loss of normal functions

Range & intensity of emotional expression

Fluency & productivity of thought and speech

Initiation of goal-directed behavior

SchizophreniaDiagnostic Criterion A A. Characteristic symptoms:

two or more ... for significant portion of 1-month (or less if successfully treated):

1. Delusions2. Hallucinations3. Disorganized speech (e.g., frequent

derailment or incoherence)4. Grossly disorganized or catatonic

behavior5. Negative symptoms, i.e., affective

flattening, alogia, or avolition

Note: Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person’s behavior or thoughts, or two or more voices conversing with each other.

SchizophreniaDiagnostic Criterion B

B. Social/Occupational Dysfunction ...

• ... for a significant portion of time since onset ...

• one or more major areas of functioning such as work, interpersonal relations, or self-care ... markedly below level prior to onset

• If onset in childhood or adolescence ... failure to achieve expected level of interpersonal, academic, or occupational achievement

SchizophreniaDiagnostic Criterion C

C. Duration• Continuous signs persist for at

least 6 months at least one month meet

Criterion A (less than month if effectively treated)

may include prodromal or residual symptoms

• may be manifested by only negative symptoms or two or more symptoms listed in Criterion A presented in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

SchizophreniaDiagnostic Criterion D

D. Schizoaffective and Mood Disorder have been

ruled out because either• there has been no Major

Depressive, Manic, or Mixed Episodes, or

• if mood episodes have occurred during the active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods.

SchizophreniaDiagnostic Criterion E

E. Substance/general medical condition exclusion:

• The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication)

• The disturbance is not due to a general medical condition.

SchizophreniaDiagnostic Criterion F

F. Relationship to Pervasive Developmental Disorder

• If there is a history of Autism Disorder or another Pervasive Developmental Disorder ...

the additional diagnosis of Schizophrenia is made only if prominent delusions or hallucinations are also present ...

for at least one month (or less if successfully treated).

295.30 Paranoid Type

Preoccupation with one or more delusions or frequent auditory hallucinations.

None of the following is prominent:• disorganized speech• disorganized or catatonic

behavior• flat or inappropriate affect.

295.10Disorganized Type

All of the following are prominent: disorganized speech disorganized behavior flat or inappropriate affect.

The criteria are not met for Catatonic Type.

295.20 Catatonic Type

At least two of the following: motoric immobility as

evidenced by catalepsy (including waxy flexibility) or stupor

excessive motor activity (purposeless and not influenced by external stimuli)

extreme negativism or mutism peculiarities of voluntary

movement as evidenced by posturing, stereotyped movements, prominent mannerisms, or prominent grimacing

echolalia or echopraxia

295.90 Undifferentiated Type

... the presence of symptoms that meet Criterion A of Schizophrenia but that do not meet criteria for the Paranoid, Disorganized, or Catatonic Type.

295.60 Residual Type

Absence of prominent delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior.

There is continuing evidence of the disturbance ... presence of negative symptoms,

or two or more of the symptoms

listed in Criterion A but in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

Schizophrenia:Features

Cultural & Socioeconomic Beliefs & Religion Language, Emotional Expression &

Nonverbal style Industrial vs Developing

Men: Onset 18-25 years ... more negative symptoms (flat affect, avolition, social withdrawal)

Women: Onset 25 to mid-30s (3% to 10% onset after 40) ... better permorbid functioning, more affective symptoms, paranoid delusions, and hallucinations

295.70 Schizoaffective Disorder

A. An uninterrupted period of illness during which, at least some time, there is either a Major Depressive Episode, a Manic Episode, or a Mixed Episode concurrent with symptoms that meet Criterion A for Schizophrenia.

B. During the same period of illness, there have been delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms.

295.70 Schizoaffective Disorder

C. Symptoms that meet criteria for a mood episode are present for a substantial portion of the total duration of the active and residual periods of the illness.

D. Not due to drug of abuse, medication or a general medical condition.

Specify Type:Bipolar Type: ... if Manic or Mixed Episodes (or Manic or Mixed and Major Depressive Episodes)Depressive Type: Major Depressive Episodes

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