Schizophrenia Revisions To DSM V

  • Today's focus will be on the revisions to the DSM for the schizophrenia category. The DSM V is set for release in May 2013.


    On the Mental Health Networking LinkedIn group, the issue of "To DSM or Not DSM?" was debated hotly in a recent discussion. This psychiatric bible is currently the only one in use in the U.S. to diagnose people. You won't see yourself in this book, just the signs and symptoms of your illness. It is simply a diagnostic tool, and used accurately and wisely, it can help you get the right treatment for the symptoms you're experiencing now.


    I will link to the DSM V Web site at the end of this SharePost so that you can read about bipolar and other illnesses should you want to.

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    Proposed Changes:


    Schizophrenia:


    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). At least one of these should include 1-3
    1. Delusions
    2. Hallucinations
    3. Disorganized speech
    4. Grossly abnormal psychomotor behavior, such as catatonia
    5. Negative symptoms, i.e., restricted affect or avolition/asociality


    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 or Manic Episodes have occurred concurrently with the activephase 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 or other communication disorder of childhood onset, 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).


  • Schizophrenia Subtypes
    The work group is recommending that these subtypes not be included in DSM-5.


    Classification of Longitudinal Course for Schizophrenia
    The course specifiers are to be worked on and potential change is not reflected in the current documents.

     

    According to the DSM V Web site:

     

    Dimensions will be assessed on a 0-4 scale cross-sectionally, with severity assessment based on past month. There are distinct psychopathological domains in psychotic illnesses (most clearly noted in schizophrenia) with distinctive patterns of treatment-response, prognostic implications, and course. The relative severity of symptoms across these domains varies across the course of illness and among patients. This is a major change that will potentially be of great clinical value and will also be of additional research utility.

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    The current DSM IV version lists the following diagnostic criteria:


    Schizophrenia


    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):
    (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.


    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 activephase 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).


    Schizophrenia Subtypes


    The subtypes of Schizophrenia are defined by the predominant symptomatology at the time of evaluation.


    295.30 Paranoid Type
    A type of Schizophrenia in which the following criteria are met:
    A. Preoccupation with one or more delusions or frequent auditory hallucinations.

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    B. None of the following is prominent: disorganized speech, disorganized or catatonic behavior, or flat or inappropriate affect.


    295.10 Disorganized Type
    A type of Schizophrenia in which the following criteria are met:
    A. All of the following are prominent:
    (1) disorganized speech
    (2) disorganized behavior
    (3) flat or inappropriate affect
    B. The criteria are not met for Catatonic Type.


    295.20 Catatonic Type
    A type of Schizophrenia in which the clinical picture is dominated by at least two of the following:
    (1) motoric immobility as evidenced by catalepsy (including waxy flexibility) or stupor
    (2) excessive motor activity (that is apparently purposeless and not influenced by external stimuli)
    (3) extreme negativism (an apparently motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved) or mutism
    (4) peculiarities of voluntary movement as evidenced by posturing (voluntary assumption of inappropriate or bizarre postures), stereotyped movements, prominent mannerisms, or prominent grimacing
    (5) echolalia or echopraxia


    295.90 Undifferentiated Type
    A type of Schizophrenia in which symptoms that meet Criterion A are present, but the criteria are not met for the Paranoid, Disorganized, or Catatonic Type.


    295.60 Residual Type
    A type of Schizophrenia in which the following criteria are met:
    A. Absence of prominent delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior.
    B. There is continuing evidence of the disturbance, as indicated by the presence of negative symptoms or two or more symptoms listed in Criterion A for Schizophrenia, present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).


    Classification of Longitudinal Course for Schizophrenia
    These specifiers can be applied only after at least 1 year has elapsed since the initial onset of active-phase symptoms:


    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 betweenthe 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.


  • Continuous. 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.

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    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.

     

    Links:

     

    DSM V Web site

     

    Rationale for Schizophrenia Changes to DSM

     

    DSM FAQs

     

Published On: February 20, 2012