A. Criteria are met for a Major Depressive Episode. Note: The Major Depressive Episode must include Criterion A1: depressed mood. Do not include symptoms that are better accounted for as medication side effects or negative symptoms of Schizophrenia.
B. The Major Depressive Episode is superimposed on and occurs only during the residual phase of Schizophrenia.
C. The Major Depressive Episode is not due to the direct physiological effects of a substance or a general medical condition.
In DSM-IV, individuals whose presentation meets these research criteria would be diagnosed as having Depressive Disorder Not Otherwise Specified
Mood Disorder Due to a General Medical Condition is distinguished from this disturbance by the fact that the depressive symptoms are due to the direct physiological effects of a general medical condition (e.g., hypothyroidism). Substance-Induced Mood Disorder is distinguished from the disturbance by the fact that the depressive symptoms are due to the direct physiological effects of a drug of abuse (e.g., alcohol, cocaine) or the side effects of a medication.
Individuals with Schizophrenia are often on maintenance neuroleptic medications, which can cause dysphoria or Medication-Induced Movement Disorders as side effects. These side effects can be confused with depressive symptoms. Neuroleptic-Induced Parkinsonism with akinesia is characterized by a reduced ability to initiate or sustain behaviors, which can lead to a lack of spontaneity or anhedonia. Neuroleptic-Induced Akathisia may be mistaken for anxiety or agitation, and depressed mood or suicidal ideation may be associated. Adjusting the medication type or dose may assist in reducing these side effects and clarifying the cause of such symptoms.
The differential diagnosis between postpsychotic depressive symptoms and the negative symptoms of Schizophrenia (i.e., avolition, alogia, affective flattening) may be particularly difficult. Negative symptoms must be distinguished from the other symptoms of depression (e.g., sadness, guilt, shame, hopelessness, helplessness, and low self-esteem). In Schizoaffective Disorder and Mood Disorder With Psychotic Features, there must be a period of overlap between the full psychotic episode and the mood episode. In contrast this proposed disorder requires that the symptoms of a Major Depressive Episode occur only during the residual phase of Schizophrenia.
Demoralization may occur during the course of Schizophrenia but should not be considered postpsychotic depression unless the full criteria for a Major Depressive Episode are met.
Adjustment Disorder With Depressed Mood is distinguished from postpsychotic depressive symptoms in Schizophrenia because the depressive symptoms in Adjustment Disorder do not meet the criteria for a Major Depressive Episode.