Schizophrenia
Hello everyone, thank you for taking the time out to read yet another one of my posts. I’m very appreciative of everyone that reads my blog, and I probably don’t say it enough. Today’s post will break down the DSM criteria for Schizophrenia as well as the specifiers that could be added onto this diagnosis. Moving forward any post regarding diagnostic criteria for any disorder will be done in this fashion. I will also write follow up posts for the past disorders focusing on their specifiers as well. So, without further ado, let’s get into it.
According to the DSM-5, schizophrenia is listed under the Schizophrenia Spectrum and other Psychotic Disorders. These are described as, “Schizophrenia spectrum and other psychotic disorders include schizophrenia, other psychotic disorders, and schizotypal (personality) disorder. They are defined by abnormalities in one or more of the following five domains: delusions, hallucinations, disorganized thinking (speech), grossly disorganized or abnormal motor behavior (including catatonia), and negative symptoms. “ (DSM-5). As explained these disorders are focused around less than normal functioning in the identified domains. But if you have read through this blog up until this point, you know that it isn’t as simple as that. Let’s get started with the first of 6 criterions.
Criterion A
In this criterion, for at least a month there has to be significant amount of time where two of the following are present;
1. Delusions
a. Fixed beliefs about person, place, thing, situation, etc.
2. Hallucinations
a. Visual or auditory disturbances that aren’t explained by any “natural” occurrence
3. Disorganized Speech
a. Imagine having conversation with someone about the weather and they go on a tangent about something else that has nothing to do with the weather. There was no natural link between the weather conversation and the tangent that they went on.
4. Grossly disorganized or catatonic behavior
a. Some examples would be no movement for hours to days, strange movements in general, staying in uncomfortable positions for hours to days, erratic/extreme movements, repetition of words or behavior (echolalia)
i. Examples provided by Very Well Mind
5. Negative emotions
a. Flat affect
i. Lack of emotional responses to any stimuli
Once this criterion is met we move on to the next one…
Criterion B
In this criterion, it looks at the level of functioning in the areas of work, interpersonal relations, and self-care. For this criterion the individual’s level of functioning in one or more of the listed areas must have diminished or is lower than what it used to be before the beginning of the symptoms for this disorder. Let’s take a look at the example of the made-up individual Jane. Jane worked with a company for 5 years up to this point. Overall she was an above average employee. Approximately over a month ago her work ethic began to decline with each passing day. Her supervisors and co-workers complained that they would catch her not moving for extended periods of time and often unresponsive when they call out to her. They also noticed that during conversations that she would jump from topic to topic with no connection to the initial conversation at hand. Due to this reporting, one could say that the criterion has been met due to the impact her symptoms have had on her employment. The same can be said for those that have similar issues in their personal life as well.
Criterion C
For this criterion to be met, it has to last for at least 6 months. However this is where it gets a bit tricky in diagnosing. Out of that 6 months, at least one month the individual would have been actively experiencing symptoms (active-phase). Throughout the remaining months there must be evidence of prodromal or residual symptoms, as listed in Criterion A.
- Prodromal would be defined as the symptoms that the individual would be experiencing in the beginning stages of this disorder. You could say these would have been the symptoms that Jane would have been observed experiencing in that initial month
- Active-Phase would be defined as the symptoms that the individual has been experiencing on a day to day basis during the “peak” of the disorder
- Residual would be defined as the less severe and less frequent symptoms of schizophrenia.
You could think about this in terms of stages. In the beginning when a person is initially diagnosed they may be in the active-phase however when they began exhibiting symptoms they would be in the prodromal stage. After years of therapy/medication, they may get over to the residual stage where the symptoms are less frequent and less severe than when they were initially diagnosed.
Criterion D
In this criterion we would rule out the possibility of schizoaffective disorder, depressive disorder and bi-polar disorder. The DSM-5 lists out 2 ways to do this.
1. There weren’t any major depressive or manic episodes during the active-phase stage of the disorder
a. I will do a post on manic episodes in the near future to provide a reference of understanding.
2. If there were any mood episodes (major depressive/manic) it was a minority in the entirety of the disorder
This is to say that if the mood episodes were more prominent during the active-phase or residual, this may fall under a different disorder such as bipolar disorder with psychotic features.
Criterion E
In this criterion we would rule out the possibility of the symptoms being the result of substance use or another medical condition.
Criterion F
In this criterion it is focused on the possible diagnosis the individual could have gotten as an adolescent. Let’s take another look at Jane. If she was diagnosed with autism spectrum disorder or communication disorder as a child, the only way that she could be diagnosed with schizophrenia would be if ALL the previous criterion has been met AND hallucinations/delusions have been the more prominent symptom so far (in addition to two or more symptoms of criterion A).
Once all the criterion has been met you can diagnose someone with schizophrenia, as per the DSM-5. Now let’s take a look at some of the specifiers for this diagnosis. I will list and explain under each specifier.
Specifiers after a 1-year period
- First episode, currently in acute episode
o This would be the first time that the disorder would be recognized. Acute refers to the time period of the episode.
- First episode, currently in partial remission
o Partial remission refers to the fact after the episode was done there was an improvement in their mental health.
o At this point the criteria for the diagnosis is only partially met
- First episode, currently in full remission
o Full remission refers to after the time their last episode there are no symptoms of the disorder
- Multiple episodes, currently in acute episode
o Minimum of two episodes. See First episode, currently in acute episode for a definition of acute.
- Multiple episodes, currently in partial remission
o Refer to First episode, currently in partial remission.
- Multiple episodes, currently in full remission
o Refer to First episode, currently in full remission
- Continuous
o The individual with this specifier is currently experiencing symptoms throughout the course of the illness
- Unspecified
o This specifier has no real definition because it’s more so explanatory. Basically it’s a specifier that you can attribute to the diagnosis if you don’t have the full scope of the disorder or the individual doesn’t fall under any of the above criteria
Specify if,
- With catatonia
o As per the DSM-5 Catatonia (when used in conjunction with a psychiatric disorder) is when there are three or more factors that dominate the diagnosis. These are;
§ Stupor
§ Catalepsy
§ Wavy Flexibility
§ Mutism
§ Negativism
§ Posturing
§ Mannerism
§ Stereotypy
§ Agitation
§ Grimacing
§ Echolalia
§ Echopraxia
o This would have to be further explored in a future post.
Severity specifier
- This will be discussed in a later post due to how in-depth this specific information can get
Due to the length of this post, I will create a separate post solely on treatment in the next few days.