Schizophrenia and Schizoaffective Disorder DSMIVTRTM American Psychiatric Association

Schizophrenia and Schizoaffective Disorder DSM-IV-TRTM American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000 8 Russell L. Smith, M. S. , LPA, HSP-PA, CCBT, MAC, FABFCE, NCP

In Schizophrenia, “Psychotic” refers to n n delusions, any prominent hallucinations, disorganized speech, or disorganized or catatonic behavior.

Subtypes n n n 295. 30 295. 10 295. 20 295. 90 295. 60 Paranoid Disorganized Catatonic Undifferentiated Residual

Course Specifiers n n n 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* n n n n n 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 n “psychotic dimension ” n n n Thought content Perception “disorganization dimension ” n n Language & thought processes Self-monitoring of behavior

Negative Symptoms A decrease or loss of normal functions n n n Range & intensity of emotional expression Fluency & productivity of thought and speech Initiation of goal-directed behavior

Schizophrenia Diagnostic Criterion A n A. Characteristic symptoms: two or more. . . for significant portion of 1 -month (or less if successfully treated): 1. 2. 3. 4. 5. Delusions Hallucinations Disorganized speech (e. g. , frequent derailment or incoherence) Grossly disorganized or catatonic behavior 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.

Schizophrenia Diagnostic Criterion B n 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

Schizophrenia Diagnostic Criterion C n C. Duration • Continuous signs persist for at least 6 months üat least one month meet Criterion A (less than month if effectively treated) ümay 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).

Schizophrenia Diagnostic Criterion D n 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.

Schizophrenia Diagnostic Criterion E n 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.

Schizophrenia Diagnostic Criterion F n F. Relationship to Pervasive Developmental Disorder • If there is a history of Autism Disorder or another Pervasive Developmental Disorder. . . üthe additional diagnosis of Schizophrenia is made only if prominent delusions or hallucinations are also present. . . üfor at least one month (or less if successfully treated).

295. 30 Paranoid Type n n 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. 10 Disorganized Type n All of the following are prominent: üdisorganized speech üdisorganized behavior üflat or inappropriate affect. n The criteria are not met for Catatonic Type.

295. 20 Catatonic Type n At least two of the following: ü motoric immobility as evidenced by catalepsy (including waxy flexibility) or stupor ü excessive motor activity (purposeless and not influenced by external stimuli) ü extreme negativism or mutism ü peculiarities of voluntary movement as evidenced by posturing, stereotyped movements, prominent mannerisms, or prominent grimacing ü echolalia or echopraxia

295. 90 Undifferentiated Type n . . . 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 n n Absence of prominent delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior. There is continuing evidence of the disturbance. . . ü presence of negative symptoms, or ü two or more of the symptoms listed in Criterion A but in an attenuated form (e. g. , odd beliefs, unusual perceptual experiences).

Schizophrenia: Features n Cultural & Socioeconomic n n n 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-30 s (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