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CLINICAL FEATURES AND DIAGNOSIS Presented by Dr Pavan kumar Chaired by Dr Safeekh A.T

INTRODUCTION • Kraepelin in 1899 classified dementia praecox into hebephrenic, catatonic, and paranoid groups. • E. Bleuler (1911) added simple schizophrenia as 4th group. • Cameron (1947) classified in accordance with behavioristic concepts into 3 main groups: • the aggressive, • the submissive, and • the detached.

• Each of 3 groups subdivided, • the aggressive group into persecuted, grandiose, and selfpunitive, • the submissive group into compliant, dedicated, and transformed, • the detached group into avoidant and adient. • Cameron seems to have dispensed with simple schizophrenia and to have renamed • paranoid, aggressive • catatonic, as submissive and • hebephrenic, detached forms .

.the thought withdrawal syndrome – experience of alienation of one’s own acts and Gedankenlautwerden ( thoughts becoming loud) . Schneider(1942) described three symptom-complexes in schizophrenia as disorder of complexes of functions in CNS.the desultory syndrome – disorders of social feeling and bodily hallucination and .• C. • These syndromes are .the drivelling syndrome – primary delusions.

or religious experiences.Thought withdrawal syndrome • Thought withdrawal associated with fragmentation of thought. • The experience of loss of personal control over one’s actions frequently occurs so that the patients experience their own actions as being made or forced upon them from outside. and blocking. . verbal derailment. • Inspirations or sudden delusional ideas which appear to come from natural sources are also a part of this syndrome. • Patients have cosmic. • The outstanding affective disorder in this syndrome is perplexity (confusion). universal.

or despair. but may pass into states of anger. • Affect is flattened • Patients are unable to feel happy or sad.Desultory syndrome • Characterized by desultory (disconnected) thinking.e. anxiety. whining. • Lack of inner drive. • Feel changed in themselves and have bodily hallucinations. . unable to react quickly and adequately to environmental changes. i. thought makes jumps and therefore proceeds in an irregular way.

.Drivelling syndrome • Vague drivelling (silly) thinking • No gross grammatical disorder • Although speech and thinking are superficially integrated. the content is drivel. • Delusions of significance and primary delusional experiences • Affect is inadequate • Lack of interest in real things and values.

• “Typical schizophrenia” made up of many subgroups which are due to different neurological system illnesses. marked remissions • Greater genetic loading than typical.• Kleist from Frankfurt school regards schizophrenia as a disease of nervous system which may be confined to one neurological system or which may affect different systems within neurological system. . • More insidious in onset. more steadily progressive • “Atypical schizophrenia” due to disorders of many different neurological systems • More episodic.

into 4 typical forms . • confused into 3 typical and 2 atypical forms and • Hebephrenia . • He divided • Paranoid into 7 typical and one atypical form. • catatonia into 7 typical and one atypical form. catatonic. hebephrenic and confused • Confused schizophrenia .• He divides schizophrenia into 4 major groups • Paranoid.severe disorder of speech or thought which gives rise to grossly muddled expressions.

he separated from schizophrenia a group of nonaffective functional psychoses having favorable outcome called “cycloid psychoses” • • • • • The Cycloid Psychosis Anxiety-Elation Psychosis Exited-Inhibited Confused Psychosis Hyperkinetic. • Like Kleist.• Leonard (1936) who studied chronic schizophrenia classified • “systematic” and “non-systematic types” which correspond to Kleist's typical and atypical forms.Akinetic Motility Psychosis He considers non-systemic schizophrenias more closely related to cycloid psychoses than to systemic psychoses. .

• The Unsystematic Schizophrenias – Affective Paraphrenia – Cataphasia (Schizophasia) – Periodic Catatonia • The Systematic Schizophrenias – Simple Systematic Schizophrenias • Catatonic Forms – Parakinetic Catatonia – Manneristic Catatonia – Proskinetic Catatonia – Negativistic Catatonia – Speech-Prompt Catatonia – Sluggish Catatonia .

• Hebephrenic Forms – Foolish Hebephrenia – Eccentric Hebephrenia – Shallow Hebephrenia – Autistic Hebephrenia • Paranoid Forms – Hypochondrical Paraphrenia – Phonemic Paraphrenia – Incoherrent Paraphrenia – Fantastic Paraphrenia – Confabulatory Paraphrenia – Expansive Paraphrenia – Combined Systematic Schizophrenias • Combined Systematic Catatonias • Combined Systematic Hebephrenias • Combined Systematic Paraphrenias .

formal thought disorder. 1983) Positive symptoms hallucinations. Asociality Apathy. Anhedonia. delusions. bizarre behaviour Negative symptoms Avolition Affective blunting. Alogia (impoverished thinking and speech). disturbance of attention .Clinical Syndromes in chronic schizophrenia Positive and Negative symptoms (Andreasen et al.

lack of vocal inflection Disorganization syndrome • disorganization: inappropriate affect. • hallucinations Psychomotor Poverty Syndrome • poverty of speech. 1992) . incoherent speech. Negative. and disorganization syndromes (Liddle. poverty of content of speech • syndromes are validated by recent factor-analytic and neuroimaging studies (Liddle et al. paucity of expressive gesture.• Positive. decreased spontaneous movement. 1987) Reality Distortion Syndrome • delusions. unchanging facial expression. lack of affective responsiveness.

• Deficit syndrome (Carpenter et al. depressed mood) • • • • Continuum of psychosis (Crow. Greisinger. . 1988) • Primary.Parkinsonism. schizoaffective disorders occupy intermediate position. affective disorders least severe. with schizophrenia most severe.g. 1870) single psychosis. enduring negative symptoms reflect a distinct neural substrate • emphasis on distinguishing primary from secondary negative symptoms (e. 1990.

poorer response to treatment. Type I Type II positive symptoms. good response to treatment. . relatively better outcome relatively poor outcome. negative symptoms. MRI changes.• Crow classified schizophrenia patients into • Type 1 and type 2 • On basis of presence or absence of positive(productive) and negative (deficit) symptoms.

schizoaffective disorder. abnormal personality.• Neurodevelopmental classification (Murray et al. 1992) • Congenital schizophrenia • abnormality is present at birth • more likely to involve minor physical abnormalities. or social impairment in childhood • more likely to be male and have a poor outcome • Adult-onset schizophrenia • more likely to exhibit positive and affective symptoms • may have a genetic predisposition to manifest symptomatology anywhere along a continuum from bipolar disorder. to schizophrenia .

• • • • • • Late-onset schizophrenia presents after the age of 60 good premorbid functioning more common in females often associated with auditory and visual sensory deprivation organic brain dysfunction is often present .


ICD 10 ICD 9 ICD 8 .


particularly of the auditory variety. often paranoid delusions. • Disturbances of affect. are not prominent. . and catatonic symptoms. and perceptual disturbances. and speech. volition.Paranoid schizophrenia • Commonest type • dominated by relatively stable. usually accompanied by hallucinations.

. or jealousy. bodily change. humming. exalted birth. • (c)hallucinations of smell or taste. or of sexual or other bodily sensations. visual hallucinations may occur but are rarely predominant. special mission. • (b)hallucinatory voices that threaten the patient or give commands. reference. such as whistling.• Examples of the most common paranoid symptoms are: • (a)delusions of persecution. or auditory hallucinations without verbal form. or laughing.

. but a minor degree of incongruity is common. and suspicion. • Affect is usually less blunted than in other varieties of schizophrenia. as are mood disturbances such as irritability. sudden anger. fearfulness.• Thought disorder may be obvious in acute states. but if so it does not prevent the typical delusions or hallucinations from being described clearly.

with partial or complete remissions. • In chronic cases. • The course of paranoid schizophrenia may be episodic. the florid symptoms persist over years and it is difficult to distinguish discrete episodes. . The onset tends to be later than in the hebephrenic and catatonic forms. or chronic.• "Negative” symptoms such as blunting of affect and impaired volition are often present but do not dominate the clinical picture.

and catatonic symptoms must be relatively inconspicuous. • In addition. influence. • Includes: paraphrenic schizophrenia . and persecutory beliefs of various kinds are the most characteristic. or passivity. and disturbances of affect.Diagnostic guidelines • general criteria for diagnosis of schizophrenia be satisfied. hallucinations and/or delusions must be prominent. volition and speech. • Delusions can be of almost any kind but delusions of control.

8). paranoia (F22.0) . • exclude epileptic and drug-induced psychoses. and to remember that persecutory delusions might carry little diagnostic weight in people from certain countries or cultures.• Differential diagnosis. • Excludes: involutional paranoid state (F22.

. catatonic symptoms. • C. sexual or other bodily sensations). The general criteria for Schizophrenia must be met. Delusions or hallucinations must be prominent (such as delusions of persecution. hallucinations of smell or taste. bodily change or jealousy.DCR 10 • F20. threatening or commanding voices.0 Paranoid schizophrenia • A. reference. Flattening or incongruity of affect. exalted birth. although they may be present to a mild degree. • B. special mission. or incoherent speech must not dominate the clinical picture.

disorganized or catatonic behavior. • B.DSM IV TR • 295. . Preoccupation with one or more delusions or frequent auditory hallucinations. None of the following is prominent: disorganized speech. or flat or inappropriate affect.30 Paranoid Type • A type of Schizophrenia in which the following criteria are met: • A.

Paranoid schizophrenia ICD 10 uses prominent and DSM 4 TR uses preoccupied DSM-IV-TR diagnostic criteria for paranoid schizophrenia include a preoccupation with one or more paranoid delusions. disorganized behavior. or frequent auditory hallucinations along with no prominent symptoms of disorganized speech. ICD-10 diagnostic criteria are similar to those of the DSM-IV-TR but exclude paranoia and involutional paranoid state. . which may be systematized. or flat/inappropriate affect.

• The mood is shallow and inappropriate and • often accompanied by giggling or self-satisfied. pranks. or by a lofty manner. hypochondriacal complaints. grimaces. • delusions and hallucinations fleeting and fragmentary. .F20. • self-absorbed smiling.1 Hebephrenic schizophrenia A form of schizophrenia in which • affective changes are prominent. and • mannerisms common. • behaviour irresponsible and unpredictable. mannerisms. and reiterated phrases.

tendency to remain solitary. and behaviour seems empty of purpose and feeling. particularly flattening of affect and loss of volition. This form of schizophrenia usually starts between the ages of 15 and 25 years and • tends to have a poor prognosis because of the rapid development of "negative" symptoms. .• • • • • Thought is disorganized and speech rambling and incoherent.

. • A superficial and manneristic preoccupation with religion. disturbances of affect and volition. so that the patient's behaviour becomes characteristically aimless and empty of purpose. and other abstract themes may add to the listener's difficulty in following the train of thought. • Hallucinations and delusions may be present but are not usually prominent. philosophy. • Drive and determination are lost and goals abandoned. and thought disorder are usually prominent.• In addition.

• The premorbid personality is characteristically. in order to ensure that the characteristic behaviours described above are sustained. but not necessarily. • Hebephrenia should normally be diagnosed for the first time only in adolescents or young adults. rather shy and solitary.Diagnostic guidelines • The general criteria for a diagnosis of schizophrenia must be satisfied. a period of 2 or 3 months of continuous observation is usually necessary. • Includes: disorganized schizophrenia • hebephrenia . • For a confident diagnosis of hebephrenia.

(2) Definite and sustained incongruity or inappropriateness of affect. B. C. Either (1) or (2): (1) Behaviour which is aimless and disjointed rather than goal-directed. Hallucinations or delusions must not dominate the clinical picture.1 Hebephrenic schizophrenia • • • • • • • • A. although they may be present to a mild degree. . Either (1) or (2): (1) Definite and sustained flattening or shallowness of affect. rambling or incoherent. (2) Definite thought disorder. The general criteria for Schizophrenia above must be met. D. manifesting as speech which is disjointed.DCR 10 F20.

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.10 Disorganized Type • A type of Schizophrenia in which the following criteria are met: • A.DSM IV TR • Diagnostic criteria for 295. .

Disorganized or hebephrenic schizophrenia
ICD 10 requires flat or inappropriate affect AND either disorganized speech OR disorganized behavior DSM 4 tr def is more severe in that disorganized speech, disorganized behavior AND flat or inappropriate affect are all required.

DSM-IV-TR diagnostic criteria include disorganized speech, disorganized behavior, and flat/inappropriate affect and exclude catatonia and delusions and hallucinations that are systematized into a lucid theme.

ICD-10 criteria are similar to DSM-IV-TR criteria but add that the disorganized/hebephrenic subtype should normally be diagnosed for the first time only in adolescents or young adults, with a period of 2–3 months of observation ensuring sustained characteristic features. ICD-10 also indicates that the premorbid personality of these individuals includes timid and solitary behavior.

ICD 10 • F20.2 Catatonic schizophrenia • Prominent psychomotor disturbances are essential and dominant features and • may alternate between extremes such as hyperkinesis and stupor, or automatic obedience and negativism. • Constrained attitudes and postures may be maintained for long periods. • Episodes of violent excitement may be a striking feature of the condition. • For reasons that are poorly understood, catatonic schizophrenia is now rarely seen in industrial countries, though it remains common elsewhere. • These catatonic phenomena may be combined with a dreamlike (oneiroid) state with vivid scenic hallucinations.

Diagnostic guidelines • general criteria for diagnosis of schizophrenia be satisfied. • Transitory and isolated catatonic symptoms may occur in the context of any other subtype of schizophrenia, but for a diagnosis of catatonic schizophrenia one or more of the following behaviours should dominate the clinical picture: • (a)stupor (marked decrease in reactivity to the environment and in spontaneous movements and activity) or mutism; • (b)excitement (apparently purposeless motor activity, not influenced by external stimuli); • (c)posturing (voluntary assumption and maintenance of inappropriate or bizarre postures);

• (f) waxy flexibility (maintenance of limbs and body in externally imposed positions).and perseveration of words and phrases. • (e)rigidity (maintenance of a rigid posture against efforts to be moved).• (d)negativism (an apparently motiveless resistance to all instructions or attempts to be moved. or movement in the opposite direction). and • (g)other symptoms such as command automatism (automatic compliance with instructions). • Includes: catatonic stupor • schizophrenic catalepsy • schizophrenic catatonia • schizophrenic flexibilitas cerea .

though this may not be possible initially if the patient is uncommunicative. The general criteria for Schizophrenia must eventually be met. For a period of at least two weeks one or more of the following catatonic behaviours must be prominent: • (1) Stupor or mutism.2 Catatonic schizophrenia • A.DCR 10 • F20. • (2) Excitement • (3) Posturing • (4) Negativism . • B.

. including brain disease and metabolic disturbances. have been excluded. Other possible precipitants of catatonic behaviour.• • • • (5) Rigidity (6) Waxy flexibility (7) Command automatism C.

Diagnostic criteria for 295. prominent mannerisms. or prominent grimacing • (5) echolalia or echopraxia .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 or mutism • (4) peculiarities of voluntary movement as evidenced by posturing (voluntary assumption of inappropriate or bizarre postures). stereotyped movements.

Differential diagnosis includes brain disease. substance abuse. or mood disorderssuch as bipolar disorder. rigidity. meaningless resistance toward instructions or attempts to be moved. excitement not influenced by external stimuli. metabolic instability.Catatonic schizophrenia ICD 10 – one ore more predominating DSM 4 TR – minimum of 2 Share most features in common except for echolalia and echopraxia (in DSM 4 TR) and command automatism (only in ICD 10) DSM-IV-TR diagnosis includes two or more and ICD-10 specifies at least one of the following behaviors: stupor (marked reduction or suspended sensibility) or mutism. waxy flexibility. . and echolalia or echopraxia. bizarre postures.

F20.F20. or • exhibiting the features of more than one of them without a clear predominance of a particular set of diagnostic characteristics.3 Undifferentiated schizophrenia • Conditions meeting the general diagnostic criteria for schizophrenia but not conforming to any of the above subtypes (F20.5.4.2). F20.0-F20. • This rubric should be used only for psychotic conditions (i. are excluded) and • after an attempt has been made to classify the condition into one of the three preceding categories.e. residual schizophrenia. and post-schizophrenic depression. .

• Includes: atypical schizophrenia . • (b)either without sufficient symptoms to meet the criteria for only one of the subtypes F20.1).0).5. F20.2. F20. F20.4.Diagnostic guidelines • This category should be reserved for disorders that: • (a)meet the general criteria for schizophrenia. hebephrenic (F20.0. or F20. or • with so many symptoms that the criteria for more than one of the paranoid (F20.1.2) subtypes are met. or catatonic (F20.

• (2) There are so many symptoms that the criteria for more than one of the subtypes listed in B(1) above are met.4.DCR 10 • • • • F20. Either (1) or (2): (1) There are insufficient symptoms to meet the criteria of any of the sub-types F20.1.0. . .5.3 Undifferentiated schizophrenia A. or . B. . The general criteria for Schizophrenia above must be met.

DSM IVTR • Diagnostic criteria for 295. but the criteria are not met for the Paranoid. Disorganized.90 Undifferentiated Type • A type of Schizophrenia in which symptoms that meet Criterion A are present. . or Catatonic Type.

Undifferentiated schizophrenia ICD 10 – either insufficient symptoms or more than one of the subtype DSM 4TR. ICD-10. . includes the stipulation that undifferentiated schizophrenia should not satisfy the criteria for residual schizophrenia or Post-schizophrenia depression. although following DSM-IV-TR criteria.cases that don’t meet criteria any of other subtype Individuals should meet criterion A of DSM-IV-TR (APA 2000) and should not have symptoms of catatonia or paranoid and disorganized schizophrenia.

arising in the aftermath of a schizophrenic illness. • Some schizophrenic symptoms must still be present but no longer dominate the clinical picture. • These persisting schizophrenic symptoms may be "positive" or "negative“. though the latter are more common. .4 Post-schizophrenic depression • A depressive episode. which may be prolonged.• F20.

• This depressive disorder is associated with an increased risk of suicide. • to what extent the depressive symptoms have merely been uncovered by the resolution of earlier psychotic symptoms (rather than being a new development) or • are an intrinsic part of schizophrenia rather than a psychological reaction to it.• It is uncertain. and immaterial to the diagnosis.2 and F32. • They are rarely sufficiently severe or extensive to meet criteria for a severe depressive episode (F32. • it is often difficult to decide • which of the patient's symptoms are due to depression and which to neuroleptic medication or to the impaired volition and affective flattening of schizophrenia itself. .3).

0.-).2. • (b)some schizophrenic symptoms are still present. or F20.1. and have been present for at least 2 weeks.3). F20. .-).• Diagnostic guidelines • The diagnosis should be made only if: • (a)the patient has had a schizophrenic illness meeting the general criteria for schizophrenia within the past 12 months. the diagnosis should remain that of the appropriate schizophrenic subtype (F20. • If schizophrenic symptoms are still florid and prominent. F20. a depressive episode should be diagnosed (F32. • If the patient no longer has any schizophrenic symptoms. fulfilling at least the criteria for a depressive episode (F32. and • (c)the depressive symptoms are prominent and distressing.

.2 e. One of F20 G1. • B.F20. f.0 . severe and extensive to meet criteria for at least • a mild depressive episode (F32. g or h must still be present. but are not met at the present time.4 Post-schizophrenic depression • A.3 above) must have been met within the past twelve • months. • C. The depressive symptoms must be sufficiently prolonged. The general criteria for schizophrenia (F20.0).• F20.

• Do not include symptoms that are better accounted for as medication side effects or negative symptoms of Schizophrenia. • C. The Major Depressive Episode is superimposed on and occurs only during the residual phase of Schizophrenia. • B.• Research criteria for postpsychotic depressive disorder of Schizophrenia • A. . • Note: The Major Depressive Episode must include Criterion Al : depressed mood. The Major Depressive Episode is not due to the direct physiological effects of a substance or a general medical condition. Criteria are met for a Major Depressive Episode.


though not necessarily irreversible. .5 Residual schizophrenia • A chronic stage in the development of a schizophrenic disorder in which there has been a • clear progression from an early stage (comprising one or more episodes with psychotic symptoms meeting the general criteria for schizophrenia described above) • to a later stage characterized by long-term. "negative" symptoms.• F20.

eye contact. i. . voice modulation. blunting of affect. poor nonverbal communication by facial expression. psychomotor slowing. poverty of quantity or content of speech. passivity and lack of initiative. and posture. • (b)evidence in the past of at least one clear-cut psychotic episode meeting the diagnostic criteria for schizophrenia. underactivity.e. poor self-care and social performance.diagnosis • (a)prominent "negative" schizophrenic symptoms.

• (c)a period of at least 1 year during which the intensity and frequency of florid symptoms such as delusions and hallucinations have been minimal or • substantially reduced and the "negative" schizophrenic syndrome has been present. and • of chronic depression or institutionalism sufficient to explain the negative impairments. . • (d)absence of dementia or other organic brain disease or disorder.

• If adequate information about the patient's previous history cannot be obtained. it may be necessary to make a provisional diagnosis of residual schizophrenia. and it • therefore cannot be established that criteria for schizophrenia have been met at some time in the past. • Includes: chronic undifferentiated schizophrenia • "Restzustand" • schizophrenic residual state .

DCR 10 • F20. but are not met at the present time. • B. The general criteria for Schizophrenia must have been met at some time in the past. • (5) Poor non-verbal communication by facial expression. • (6) Poor social performance or self-care. • (4) Poverty of either the quantity or the content of speech. At least four of the following 'negative' symptoms have been present throughout the previous twelve months: • (1) Psychomotor slowing or underactivity. . voice modulation or posture. • (3) Passivity and lack of initiative. eye contact.5 Residual schizophrenia • A. • (2) Definite blunting of affect.

• B. Absence of prominent delusions.DSM 4 TR • Diagnostic criteria for 295. • present in an attenuated form (e. There is continuing evidence of the disturbance. and gross ly • disorganized or catatonic behavior.g . ..60 Residual Type • A type of Schizophrenia in which the following criteria are met: • A. unusual perceptual experiences). disorganized speech. as indicated by the presence of negative • symptoms or two or more symptoms listed in Criterion A for Schizophrenia. hall ucina tions. odd beliefs.


vagrancy may ensue and the individual may then become self-absorbed.g. . blunting of affect. idle. inability to meet the demands of society. paranoid. • The characteristic "negative" features of residual schizophrenia (e. • With increasing social impoverishment. and the disorder is less obviously psychotic than the hebephrenic.F20. loss of volition) develop without being preceded by any overt psychotic symptoms. and aimless. • Delusions and hallucinations are not evident. and decline in total performance.6 Simple schizophrenia • An uncommon disorder in which there is an insidious but progressive development of oddities of conduct. and catatonic subtypes of schizophrenia.

• Includes: schizophrenia simplex .5 above) • without any history of hallucinations. or other manifestations of an earlier psychotic episode. delusions. idleness. and social withdrawal over a period of at least one year. and • with significant changes in personal behaviour. • manifest as a marked loss of interest.• Diagnostic guidelines • Simple schizophrenia is a difficult diagnosis to make with any confidence because • it depends on establishing the slowly progressive development of the characteristic "negative" symptoms of residual schizophrenia (see F20.

DCR 10 • F20. paucity of speech. • (2) Gradual appearance and deepening of "negative" symptoms such as marked apathy. or occupational performance. blunting of affect. . and poor non-verbal communication (by facial expression. • (3) Marked decline in social. manifest as • loss of drive and interests. passivity and lack of initiative. underactivity.6 Simple schizophrenia • A. eye contact. and social withdrawal. aimlessness. voice modulation and posture). idleness. a selfabsorbed attitude. scholastic. Slowly progressive development over a period of at least one year. of all three of the following: • (1) A significant and consistent change in the overall quality of some aspects of personal behaviour.

i.0 .• B. of any symptoms referred to in G1 in F20.F20. or any other psychotic disorder. at any time. and of hallucinations or wellformed • delusions of any kind. Absence.3. Absence of evidence of dementia or any other organic mental disorder listed in section F0. • C. the subject must never have met the criteria for any other type of schizophrenia.e. .

DSM 4 TR • Research criteria for simple deteriorative disorder • (simple Schizophrenia) 771 • A. alogia. and avolition • (3) poor interpersonal rapport. social isolation. or social withdrawal . Progressive development over a period of at least a year of all of the following: • (1) marked decline in occupational or academic functioning • (2) gradual appearance and deepening of negative symptoms such as affective flattening.

an Anxiety Disorder. • e. The symptoms are not better accounted for by Schizotypal or Schizoid Personality Disorder. a Psychotic Disorder. Criterion A for Schizophrenia has never been met. .• B. or Mental Retardation and are not due to the direct physiological effects of a substance or a general medical condition. a Mood Disorder. a dementia.


2) F20. unspecified .2) latent schizophrenia (F23.8 Other schizophrenia Includes: cenesthopathic schizophrenia schizophreniform disorder NOS Excludes: acute schizophrenia-like disorder (F23.• • • • • • • F20.2) cyclic schizophrenia (F25.9 Schizophrenia.

") • Specify if: • Without Good Prognostic Features • With Good Prognostic Features: as evidenced by two (or more) of the following: • (1) onset of prominent psychotic symptoms within 4 weeks of the first noticeable change in usual behavior or functioning • (2) confusion or perplexity at the height of the psychotic episode . D. and residual phases) lasts at least 1 month but less than 6 months. Criteria A. An episode of the disorder (including prodromal.40 • A. and E of Schizophrenia are met. active. it should be qualified as "Provisional. • B. (When the diagnosis must be made without waiting for recovery.Schizophreniform Disorder 295.

• (3) good pre morbid social and occupational functioning • (4) absence of blunted or flat affect .


• As a result. and are not heritable. other subtypes are rarely diagnosed. . The current classic subtypes of schizophrenia provide a poor description of the • heterogeneity of schizophrenia. it is proposed that these subtypes of schizophrenia be eliminated from DSM-5. • do not exhibit distinctive patterns of treatment response or longitudinal course. • have low diagnostic stability.DSM V • Deletion of Subtypes. • Except for the paranoid and undifferentiated subtypes.

• Dimensions will be assessed on a 0-4 scale cross-sectionally. but mild . • The relative severity of symptoms across these domains varies across the course of illness and among patients. and course.Present and moderate • 1.Present and severe • 2. prognostic implications. • This is a major change that will potentially be of great clinical value and will also be of additional research utility • 0.Present. • There are distinct psychopathological domains in psychotic illnesses (most clearly noted in schizophrenia) with distinctive patterns of treatment-response.Equivocal 4.Not Present 3. with severity assessment based on past month.