- 1 DSM-II
- 2 DSM-III
- 2.1 Disorders
- 2.2 Diagnostic Criteria
- 2.3 Classification of course
- 2.4 Differential Diagnosis
- 2.4.1 Organic Mental Disorders
- 2.4.2 Paranoid Disorders
- 2.4.3 Affective Disorders
- 2.4.4 Schizoaffective Disorder
- 2.4.5 Schizophreniform Disorder
- 2.4.6 Atypical Psychosis
- 2.4.7 Pervasive Developmental Disorders
- 2.4.8 Obsessive Compulsive Disorder, Hypochondriasis, and Phobic Disorder
- 2.4.9 Factitious Disorder
- 2.4.10 Personality Disorders
- 2.4.11 Subcultural beliefs and experiences
- 2.4.12 Mental Retardation
- 3 DSM-IV
- 3.1 Disorders
- 3.2 Diagnostic Criteria
- 3.3 Subtypes and Course Specifiers
- 3.4 Recording Procedures
- 3.5 Differential Diagnosis
- 3.5.1 Psychotic Disorder Due to a General Medical Condition
- 3.5.2 Substance-Related Disorders
- 3.5.3 Mood Disorders and Schizoaffective Disorder
- 3.5.4 Schizophreniform Disorder and Brief Psychotic Disorder
- 3.5.5 Delusional Disorder
- 3.5.6 Psychotic Disorder Not Otherwise Specified
- 3.5.7 Pervasive Developmental Disorders
- 3.5.8 Schizotypal, Schizoid, and Paranoid Personality Disorders
- 4 DSM-5
- 4.1 Diagnostic Criteria
- 4.2 Specifiers
- 4.3 Differential Diagnosis
- 4.3.1 Major depressive or bipolar disorder with psychotic or catatonic features
- 4.3.2 Schizoaffective disorder
- 4.3.3 Schizophreniform disorder and brief psychotic disorder
- 4.3.4 Delusional disorder
- 4.3.5 Schizotypal personality disorder
- 4.3.6 Obsessive-compulsive disorder and body dysmorphic disorder
- 4.3.7 Posttraumatic stress disorder
- 4.3.8 Autism spectrum disorder or communication disorders
- 4.3.9 Other mental disorders associated with a psychotic episode
This large category includes a group of disorders manifested by characteristic disturbances of thinking, mood and behavior. Disturbances in thinking are marked by alterations of concept formation which may lead to misinterpretation of reality and sometimes to delusions and hallucinations, which frequently appear psychologically self-protective. Corollary mood changes include ambivalent, constricted and inappropriate emotional responsiveness and loss of empathy with others. Behavior may be withdrawn, regressive and bizarre. The schizophrenias, in which the mental status is attributable primarily to a thought disorder, are to be distinguished from the Major affective illnesses which are dominated by a mood disorder. The Paranoid states are distinguished from schizophrenia by the narrowness of their distortions of reality and by the absence of other psychotic symptoms.
- Schizophrenia, simple type
- Schizophrenia, hebephrenic type
- Schizophrenia, catatonic type
- Schizophrenia, paranoid type
- Acute schizophrenic episode
- Schizophrenia, latent type
- Schizophrenia, residual type
- Schizophrenia, schizo-affective type
- Schizophrenia, childhood type
- Schizophrenia, chronic undifferentiated type
- Schizophrenia, other [and unspecified] types
- Schizophrenia, Disorganized Type
- Schizophrenia, Catatonic Type
- Schizophrenia, Paranoid Type
- Schizophrenia, Undifferentiated Type
- Schizophrenia, Residual Type
A. At least one of the following during a phase of the illness:
- bizarre delusions (content is patently absurd and has no possible basis in fact), such as delusions of being controlled, thought broadcasting, thought insertion, or thought withdrawal
- somatic, grandiose, religious, nihilistic, or other delusions without persecutory or jealous content
- delusions with persecutory or jealous content if accompanied by hallucinations of any type
- auditory hallucinations in which either a voice keeps up a running commentary on the individual's behavior or thoughts, or two or more voices converse with each other
- auditory hallucinations on several occasions with content of more than one or two words, having no apparent relation to depression or elation
- incoherence, marked loosening of associations, markedly illogical thinking, or marked poverty of content of speech if associated with at least one of the following:
- a. blunted, flat, or inappropriate affect
- delusions or hallucinations
- catatonic or other grossly disorganized behavior
B. Deterioration from a previous level of functioning in such areas as work, social relations, and self-care.
C. Duration: Continuous signs of the illness for at least six months at some time during the person's life, with some signs of the illness at present. The six-month period must include an active phase during which there were symptoms from A, with or without a prodromal or residual phase, as defined below.
- Prodromal phase: A clear deterioration in functioning before the active phase of the illness not due to a disturbance in mood or to a Substance Use Disorder and involving at least two of the symptoms noted below.
- Residual phase: Persistence, following the active phase of the illness, of at least two of the symptoms noted below, not due to a disturbance in mood or to a Substance Use Disorder.
Prodromal or Residual Symptoms
- social isolation or withdrawal
- marked impairment in role functioning as wage-earner, student, or homemaker
- markedly peculiar behavior (e.g., collecting garbage, talking to self in public, or hoarding food)
- marked impairment in personal hygiene and grooming
- blunted, flat, or inappropriate affect
- digressive, vague, overelaborate, circumstantial, or metaphorical speech
- odd or bizarre ideation, or magical thinking, e.g., superstitiousness, clairvoyance, telepathy, "sixth sense," "others can feel my feelings," overvalued ideas, ideas of reference
- unusual perceptual experiences, e.g., recurrent illusions, sensing the presence of a force or person not actually present.
Examples: Six months of prodromal symptoms with one week of symptoms from A; no prodromal symptoms with six months of symptoms from A; no prodromal symptoms with two weeks of symptoms from A and six months of residual symptoms; six months of symptoms from A, apparently followed by several years of complete remission, with one week of symptoms in A in current episode.
D. The full depressive or manic syndrome (criteria A and B of major depressive or manic episode), if present, developed after any psychotic symptoms, or was brief in duration relative to the duration of the psychotic symptoms in A.
E. Onset of prodromal or active phase of the illness before age 45.
Classification of course
The time from the beginning of the illness, during which the individual began to show signs of the illness (including prodromal, active, and residual phases) more or less continuously, is less than two years but at least six months.
Same as above, but greater than two years.
Subchronic with Acute Exacerbation
Reemergence of prominent psychotic symptoms in an individual with a subchronic course who has been in the residual phase of the illness.
Chronic with Acute Exacerbation
Reemergence of prominent psychotic symptoms in an individual with a chronic course who has been in the residual phase of the illness.
This should be used when an individual with a history of Schizophrenia, now is free of all signs of the illness (whether or not on medication). The differentiation of Schizophrenia In Remission from no mental disorder requires consideration of the period of time since the last period of disturbance, the total duration of the disturbance, and the need for continued evaluation or prophylactic treatment.
When the course is noted as "in remission," the phenomenologic type should describe the last episode of Schizophrenia, e.g., Schizophrenia, Catatonic Type, In Remission. When the phenomenology of the last episode is unknown, it should be noted as Undifferentiated.
Organic Mental Disorders often present with symptoms that suggest Schizophrenia, such as delusions, hallucinations, incoherence, and blunted or inappropriate affect. In particularly, Organic Delusional Syndromes, such as those due to amphetamines or phencyclidine, may cross-sectionally be identical in symptomatology with Schizophrenia. Even though an active phase of Schizophrenia may begin with confusion, the presence of disorientation or memory impairment strongly suggests an Organic Mental Disorder. (Of course, it is possible for an individual with Schizophrenia to have a superimposed Organic Mental Disorder.)
Paranoid Disorders are distinguished from Schizophrenia by the absence of prominent hallucinations, incoherence, loosening of associations, or bizarre delusions, such as delusions of being controlled or thought broadcasting.
In Affective Disorders there often are withdrawal and deterioration in functioning. These should not be mistaken for prodromal signs of Schizophrenia. In Affective Disorders the development of delusions or hallucinations follows a period of affective disturbance. For this reason the diagnosis of Schizophrenia is not made unless an affective syndrome, if present, developed after any psychotic symptoms or was brief in duration relative to the duration of the characteristic psychotic symptoms. The differential diagnosis of Schizophrenia from the psychotic forms of the Affective Disorders, particularly Bipolar Disorder, is of special importance because of the different long-term treatment implications. A manic episode with anger and paranoid delusions needs to be distinguished from Schizophrenia, Paranoid Type. However, an Atypical Affective Disorder or Adjustment Disorder with Depressed Mood may be superimposed on Schizophrenia, Residual Type. An example would be an individual with Schizophrenia, Residual Type, Chronic, who could develop a major depressive episode of several months' duration without any psychotic symptoms. In such a case both Schizophrenia and Atypical Depression should be diagnosed.
The diagnosis of Schizoaffective Disorder should be made whenever the clinician is unable to make a differential diagnosis between Schizophrenia and Affective Disorder. Although no criteria for Schizoaffective Disorder are provided in this manual, several examples of clinical situations in which this diagnosis might be appropriate are given.
In Schizophreniform Disorder, by definition the duration of the illness is less than six months. The cross-sectional symptom picture may be indistinguishable from Schizophrenia, but emotional turmoil and confusion are more likely to occur in Schizophreniform Disorder. It should be noted that the six-month duration of illness required for Schizophrenia refers to a continuous period of illness. Thus, an individual with several episodes of Schizophreniform Disorder from each of which there has been full recovery would not be diagnosed as having Schiozphrenia merely because the total period of illness exceeded six months.
Atypical Psychosis is diagnosed when there is a nonaffective psychotic disorder but there is insufficient information to make a diagnosis of Schizophrenia. It is also diagnosed in those unusual instances in which one of the psychotic symptoms of Schizophrenia such as an encapsulated delusion of bodily change is present, but there is apparently no deterioration from a previous level of functioning.
In a Pervasive Developmental Disorder, the cross-sectional picture, particularly of the Residual State, may resemble Schizophrenia, Residual Type. However, there is no history of delusions, hallucinations, or incoherence.
In Obsessive Compulsive Disorder, Hypochondriasis, and more rarely Phobic Disorder, in order to account for the symptoms the individual may develop overvalued ideas that are difficult to distinguish from delusions. However, individuals with these disorders recognize, at least to some degree, that their symptoms and thinking are irrational, even if they are dominated by them.
In Factitious Disorder with Psychological Symptoms, "psychotic" symptoms are under the individual's voluntary control and are likely to be present only when the individual thinks he or she is being observed.
In Personality Disorders, especially Schizotypal, Borderline, Schizoid, and Paranoid types transient psychotic symptoms may occur. However, a return within hours or days to the usual level of functioning distinguishes these disorders from Schizophrenia. It is more difficult to distinguish severe forms of Paranoid and Schizotypal Personality Disorders from Schizophrenia because of the difficulty in determining whether the paranoid ideation is of delusional intensity and whether the oddities of communication and perception are severe enough to meet the criteria for Schizophrenia. Furthermore, it is often difficult to differentiate the prodromal phase of Schizophrenia from the manifestations of some of the Personality Disorders since both Personality Disorders and Schizophrenia usually develop during adolescence or early adult life.
Subcultural beliefs and experiences
Beliefs or experiences of members of religious or other subcultural groups may be difficult to distinguish from delusions or hallucinations. When such experiences are shared and accepted by a cultural group they should not be considered evidence of psychosis.
In Mental Retardation, low level of social functioning, oddities of behavior, and impoverished affect and cognition all may suggest Schizophrenia. Both diagnoses should be made in the same individual only when there is certainty that the symptoms suggesting Schizophrenia, such as delusions or hallucinations, are definitely present and are not the result of difficulties in communication.
- Schizophrenia, Paranoid Type
- Schizophrenia, Disorganized Type
- Schizophrenia, Catatonic Type
- Schizophrenia, Undifferentiated Type
- Schizophrenia, Residual Type
A. Characteristic symptoms: Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated):
- 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.
B. 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).
C. Duration: Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 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).
D. 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.
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) or a general medical condition.
F. Relationship to a Pervasive Developmental Disorder: If there is a history of Autistic 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 a month (or less if successfully treated).
Classification of longitudinal course (can be applied only after at least 1 year has elapsed since the initial onset of active-phase symptoms):
- Episodic With Interepisode Residual Symptoms (episodes are defined by the reemergence of prominent psychotic symptoms); also specify if: With Prominent Negative Symptoms
- Episodic With No Interepisode Residual Symptoms
- Continuous (prominent psychotic symptoms are present throughout the period of observation); also specify if: With Prominent Negative Symptoms
- Single Episode In Partial Remission; also specify if: With Prominent Negative Symptoms
- Single Episode in Full Remission
- Other or Unspecified Pattern
Subtypes and Course Specifiers
The diagnosis of a particular subtype is based on the clinical picture that occasioned the most recent evaluation or admission to clinical care and may therefore change over time. Separate text and criteria are provided for each of the following subtypes:
- Paranoid Type
- Disorganized Type
- Catatonic Type
- Undifferentiated Type
- Residual Type
The following specifiers may be used to indicate the characteristic course of symptom of Schizophrenia over time. These specifiers can be applied only after at least 1 year has elapsed since the initial onset of active-phase symptoms. During this initial 1-year period, no course specifiers can be given.
Episodic With Interepisode Residual Symptoms
This specifier applies when the course is characterized by episodes in which Criterion A for Schizophrenia is met and there are clinically significant residual symptoms between the episodes. With Prominent Negative Symptoms can be added if prominent negative symptoms are present during these residual periods.
Episodic With No Interepisode Residual Symptoms
This specifier applies when the course is characterized by episodes in which Criterion A for Schizophrenia is met and there are no clinically significant residual symptoms between the episodes.
This specifier applies when characteristic symptoms of Criterion A are met throughout all (or most) of the course. With Prominent Negative Symptoms can be added if prominent negative symptoms are also present.
Single Episode In Partial Remission
This specifier applies when there has been a single episode in which Criterion A for Schizophrenia is met and some clinically significant residual symptoms remain. With Prominent Negative Symptoms can be added if these residual symptoms include prominent negative symptoms.
Single Episode In Full Remission
This specifier applies when there has been a single episode in which Criterion A for Schizophrenia has been met and no clinically significant residual symptoms remain.
Other or Unspecified Pattern
This specifier is used if another or an unspecified course pattern has been present.
In recording the name of the disorder, the course specifiers are noted after the appropriate subtype (e.g., Schizophrenia, Paranoid Type, Episodic With Interepisode Residual Symptoms, With Prominent Negative Symptoms).
A wide variety of general medical conditions can present with psychotic symptoms. Psychotic Disorder Due to a General Medical Condition, delirium, or dementia is diagnosed when there is evidence from the history, physical examination, or laboratory tests that indicates that the delusions or hallucinations are the direct physiological consequence of a general medical condition (e.g., Cushing's syndrome, brain tumor).
Substance-Induced Psychotic Disorder, Substance-Induced Delirium, and Substance-Induced Persisting Dementia are distinguished from Schizophrenia by the fact that a substance (e.g., a drug of abuse, a medication, or exposure to a toxin) is judged to be etiologically related to the delusions or hallucinations. Many different types of Substance-Related Disorders may produce symptoms similar to those of Schizophrenia (e.g., sustained amphetamine or cocaine use may produce delusions or hallucinations; phencyclidine use may produce a mixture of positive and negative symptoms). Based on a variety of features that characterize the course of Schizophrenia and Substance-Related Disorders, the clinician must determine whether the psychotic symptoms have been initiated and maintained by the substance use. Ideally, the clinician should attempt to observe the individual during a sustained period (e.g., 4 weeks) of abstinence. However, because such prolonged periods of abstinence are often difficult to achieve, the clinician may need to consider other evidence, such as whether the psychotic symptoms appear to be exacerbated by the substance and to diminish when it has been discontinued, the relative severity of psychotic symptoms in relation to the amount and duration of substance use, and knowledge of the characteristic symptoms produced by a particular substance (e.g., amphetamines typically produce delusions and stereotypies, but not affective blunting or prominent negative symptoms).
Distinguishing Schizophrenia from Mood Disorder With Psychotic Features and Schizoaffective Disorder is made difficult by the fact that mood disturbance is common during the prodromal, active, and residual phases of Schizophrenia. If psychotic symptoms occur exclusively during periods of mood disturbance, the diagnosis is Mood Disorder With Psychotic Features. In Schizoaffective Disorder, there must be a mood episode that is concurrent with the active-phase symptoms of Schizophrenia, mood symptoms must be present for a substantial portion of the total duration of the disturbance, and delusions or hallucinations must be present for at least 2 weeks in the absence of prominent mood symptoms. In contrast, mood symptoms in Schizophrenia either have a duration that is brief in relation to the total duration of the disturbance, occur only during the prodromal or residual phases, or do not meet full criteria for a mood episode. When mood symptoms that meet full criteria for a mood episode are superimposed on Schizophrenia and are of particular clinical significance, an additional diagnosis of Depressive Disorder Not Otherwise Specified or Bipolar Disorder Not Otherwise Specified may be given. Schizophrenia, Catatonic Type, may be difficult to distinguish from a Mood Disorder With Catatonic Features.
By definition, Schizophrenia differs from Schizophreniform Disorder on the basis of duration. Schizophrenia involves the presence of symptoms (including prodromal or residual symptoms) for at least 6 months, whereas the total duration of symptoms in Schizophreniform Disorder must be at least 1 month but less than 6 months. Schizophreniform Disorder also does not require a decline in functioning. Brief Psychotic Disorder is defined by the presence of delusions, hallucinations, disorganized speech, or grossly disorganized or catatonic behavior lasting for at least 1 day but for less than 1 month.
The differential diagnosis between Schizophrenia and Delusional Disorder rests on the nature of the delusions (nonbizarre in Delusional Disorder) and the absence of other characteristic symptoms of Schizophrenia (e.g., hallucinations, disorganized speech or behavior, or prominent negative symptoms). Delusional Disorder is particularly difficult to differentiate from the Paranoid Type of Schizophrenia, because this subtype does not include prominent disorganized speech, disorganized behavior, or flat or inappropriate affect and is often associated with less decline in functioning than is characteristic of the other subtypes of Schizophrenia. When poor psychosocial functioning is present in Delusional Disorder, it arises directly from the delusional beliefs themselves.
A diagnosis of Psychotic Disorder Not Otherwise Specified may be made if insufficient information is available to choose between Schizophrenia and other Psychotic Disorders (e.g., Schizoaffective Disorder) or to determine whether the presenting symptoms are substance induced or are the result of a general medical condition. Such uncertainty is particularly likely to occur early in the course of the disorder.
Although Schizophrenia and Pervasive Developmental Disorders (e.g., Autistic Disorder) share disturbances in language, affect, and interpersonal relatedness, they can be distinguished in a number of ways. Pervasive Developmental Disorders are characteristically recognized during infancy or early childhood (usually before age 3 years), whereas such early onset is rare in Schizophrenia. Moreover, in Pervasive Developmental Disorders, there is an absence of prominent delusions and hallucinations; more pronounced abnormalities in affect; and speech that is absent or minimal and characterized by stereotypies and abnormalities in prosody. Schizophrenia may occasionally develop in individuals with a Pervasive Developmental Disorder; a diagnosis of Schizophrenia is warranted in individuals with a preexisting diagnosis of Autistic Disorder or another Pervasive Developmental Disorder only if prominent hallucinations or delusions have been present for at least a month. Childhood-onset Schizophrenia must be distinguished from childhood presentations combining disorganized speech (from a Communication Disorder) and disorganized behavior (from Attention-Deficit/Hyperactivity Disorder).
Schizophrenia shares features (e.g., paranoid ideation, magical thinking, social avoidance, and vague and digressive speech) with and may be preceded by Schizotypal, Schizoid, or Paranoid Personality Disorder. An additional diagnosis of Schizophrenia is appropriate when the symptoms are severe enough to satisfy Criterion A of Schizophrenia. The preexisting Personality Disorder may be noted followed by "Premorbid" in parentheses [e.g., Schizotypal Personality Disorder (Premorbid)].
A. Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3):
- Disorganized speech (e.g., frequent derailment or incoherence).
- Grossly disorganized or catatonic behavior.
- Negative symptoms (i.e., diminished emotional expression or avolition).
B. For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning).
C. Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 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 by two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).
D. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either 1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or 2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.
F. If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1 month (or less if successfully treated).
The following course specifiers are only to be used after a 1-year duration of the disorder and if they are not in contradiction to the diagnostic course criteria.
- First episode, currently in acute episode: First manifestation of the disorder meeting the defining diagnostic symptoms and time criteria. An acute episode is a time period in which the symptom criteria are fulfilled.
- First episode, currently in partial remission: Partial remission is a period of time during which an improvement after a previous episode is maintained and in which the defining criteria of the disorder are only partially fulfilled.
- First episode, currently in full remission: Full remission is a period of time after a previous episode during which no disorder-specific symptoms are present.
- Multiple episodes, currently in acute episode: Multiple episodes may be determined after a minimum of two episodes (i.e., after a first episode, a remission and a minimum of one relapse).
- Multiple episodes, currently in partial remission
- Multiple episodes, currently in full remission
- Continuous: Symptoms fulfilling the diagnostic symptom criteria of the disorder are remaining for the majority of the illness course, with subthreshold symptom periods being very brief relative to the overall course.
- With catatonia (Note: Record catatonia associated with schizophrenia to indicate the presence of the comorbid catatonia.)
Specify current severity:
Severity is rated by a quantitative assessment of the primary symptoms of psychosis, including delusions, hallucinations, disorganized speech, abnormal psychomotor behavior, and negative symptoms. Each of these symptoms may be rated for its current severity (most severe in the last 7 days) on a 5-point scale ranging from 0 (not present) to 4 (present and severe).
Note: Diagnosis of schizophrenia can be made without using this severity specifier.
A. The clinical picture is dominated by three (or more) of the following symptoms:
- Stupor (i.e., no psychomotor activity; not actively relating to environment).
- Catalepsy (i.e., passive induction of a posture held against gravity).
- Waxy flexibility (i.e., slight, even resistance to positioning by examiner).
- Mutism (i.e., no, or very little, verbal response [exclude if known aphasia]).
- Negativism (i.e., opposition or no response to instructions or external stimuli).
- Posturing (i.e., spontaneous and active maintenance of a posture against gravity).
- Mannerism (i.e., odd, circumstantial caricature of normal actions).
- Stereotypy (i.e., repetitive, abnormally frequent, non-goal-directed movements).
- Agitation, not influenced by external stimuli.
- Echolalia (i.e., mimicking another's speech).
- Echopraxia (i.e., mimicking another's movements).
Major depressive or bipolar disorder with psychotic or catatonic features
The distinction between schizophrenia and major depressive or bipolar disorder with psychotic features or with catatonia depends on the temporal relationship between the mood disturbance and the psychosis, and on the severity of the depressive or manic symptoms. If delusions or hallucinations occur exclusively during a major depressive or manic episode, the diagnosis is depressive or bipolar disorder with psychotic features.
A diagnosis of schizoaffective disorder requires that a major depressive or manic episode occur concurrently with the active-phase symptoms and that the mood symptoms be present for a majority of the total duration of the active periods.
These disorders are of shorter duration than schizophrenia as specified in Criterion C, which requires 6 months of symptoms. In schizophreniform disorder, the disturbance is present less than 6 months, and in brief psychotic disorder, symptoms are present at least 1 day but less than 1 month.
Delusional disorder can be distinguished from schizophrenia by the absence of the other symptoms characteristic of schizophrenia (e.g., delusions, prominent auditory or visual hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms).
Schizotypal personality disorder may be distinguished from schizophrenia by subthreshold symptoms that are associated with persistent personality features.
Individuals with obsessive-compulsive disorder and body dysmorphic disorder may present with poor or absent insight, and the preoccupations may reach delusional proportions. But these disorders are distinguished from schizophrenia by their prominent obsessions, compulsions, preoccupations with appearance or body odor, hoarding, or body-focused repetitive behaviors.
Posttraumatic stress disorder may include flashbacks that have a hallucinatory quality, and hypervigilance may reach paranoid proportions. But a traumatic event and characteristic symptom features relating to reliving or reacting to the event are required to make the diagnosis.
These disorders may also have symptoms resembling a psychotic episode but are distinguished by their respective deficits in social interaction with repetitive and restricted behaviors and other cognitive and communication deficits. An individual with autism spectrum disorder or communication disorder must have symptoms that meet full criteria for schizophrenia, with prominent hallucinations or delusions for at least 1 month, in order to be diagnosed with schizophrenia as a comorbid condition.
Other mental disorders associated with a psychotic episode
The diagnosis of schizophrenia is made only when the psychotic episode is persistent and not attributable to the physiological effects of a substance or another medical condition. Individuals with a delirium or major or minor neurocognitive disorder may present with psychotic symptoms but these would have a temporal relationship to the onset of cognitive changes consistent with those disorders. Individuals with substance/medication-induced psychotic disorder may present with symptoms characteristic of Criterion A for schizophrenia, but the substance/medication-induced psychotic disorder can usually be distinguished by the chronological relationship of substance use to the onset and remission of the psychosis in the absence of substance use.