Schizophrenia Spectrum Diagnostic Criteria
Characteristic symptoms: Two (or more) of the following, each present for a significant portion of time during a one-month period (or less if successfully treated):
1. Delusions
2. Hallucinations
3. Disorganized speech (e.g., frequent derailment or incoherence)
4. Grossly disorganized or catatonic behavior
5. 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.
Social/occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning, such as work, interpersonal relations, or self-care, are markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement).
Duration: Continuous signs of the disturbance persist for at least six months. This six-month period must include at least one month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).
Schizoaffective and mood disorder exclusion: Schizoaffective disorder and mood disorder with psychotic features have been ruled out because either (1) no major depressive, manic, or mixed episodes have occurred concurrently with the active-phase symptoms; or (2) if mood episodes have occurred during active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods.
In addition, the disturbance must not be due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition, including a pervasive developmental disorder (unless prominent delusions or hallucinations are also present for at least a month (or less if successfully treated)).
Overall, diagnosis of schizophrenia should be based on characteristic patterns of illness and signs on the mental status examination. Clinical features that help confirm a diagnosis of schizophrenia include deteriorating function, thought disorder, and bizarre behavior. Schizophrenia is characterized by positive and negative symptoms.
Positive symptoms: Delusions, hallucinations, pressured speech
Negative symptoms: Poor hygiene, flat affect, paucity of speech, lack of motivation
(DSM V)
1. Delusions
2. Hallucinations
3. Disorganized speech (e.g., frequent derailment or incoherence)
4. Grossly disorganized or catatonic behavior
5. 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.
Social/occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning, such as work, interpersonal relations, or self-care, are markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement).
Duration: Continuous signs of the disturbance persist for at least six months. This six-month period must include at least one month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).
Schizoaffective and mood disorder exclusion: Schizoaffective disorder and mood disorder with psychotic features have been ruled out because either (1) no major depressive, manic, or mixed episodes have occurred concurrently with the active-phase symptoms; or (2) if mood episodes have occurred during active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods.
In addition, the disturbance must not be due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition, including a pervasive developmental disorder (unless prominent delusions or hallucinations are also present for at least a month (or less if successfully treated)).
Overall, diagnosis of schizophrenia should be based on characteristic patterns of illness and signs on the mental status examination. Clinical features that help confirm a diagnosis of schizophrenia include deteriorating function, thought disorder, and bizarre behavior. Schizophrenia is characterized by positive and negative symptoms.
Positive symptoms: Delusions, hallucinations, pressured speech
Negative symptoms: Poor hygiene, flat affect, paucity of speech, lack of motivation
(DSM V)
Schizoaffective Disorder*
Schizoaffective disorder is a neuropsychiatric disorder that encompasses clinical features found in both mood disorders and schizophrenia.
DSM-V Criteria:
DSM-V Criteria:
- A period during which there is a major mood disorder, either depression or mania, that occurs at the same time as schizophrenia symptoms
- Delusions or hallucinations for two or more weeks without a major mood episode.
- Symptoms that mark a major mood episode are present for the majority of the illness.
- The abuse of drugs or a medication are not responsible for the symptoms.
- Major Depressive Disorder
- Bipolar disorders
- Schizophrenia Disorder
- Autism Spectrum Disorder
Assessment & Tools
- Brief Psychiatric Rating Scale (BPRS)
- Positive and Negative Syndrome Scale (PANSS) can help to assess the presence or absence of positive and negative symptoms, but is not validated for use in children/adolescents.
- The Scale for Assessment of Positive Symptoms
- The Scale for Assessment of Negative Symptoms
- The Clinical Assessment Interview for Negative Symptoms (manual)
Position Papers & Practice Parameters
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Practice Parameter for the Assessment and Treatment of Children and Adolescents with Schizophrenia (2013)
Articles
- Psychosis in children and youth: focus on early-onset schizophrenia (Abidi, 2013)
- Is Schizoaffective Disorder a Distinct Categorical Diagnosis? A Critical Review of the Literature (Abrams, et al, 2008)
Resources
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Organizations
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*Schizoaffective content originally curated by Mariah Woodbury, BS.