Question:
DSM IV Diagnostic Criteria (Schizophrenia)?
Answer:
Diagnostic Criteria
Information from the Diagnostic and Statistical Manual of Mental
Disorders, 4th. Ed. 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):
delusions hallucinations 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. 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).
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).
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.
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.
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).
Diagnostic Criteria of Schizophrenia Subtypes
Paranoid Type
A type of Schizophrenia in which the following criteria are met:
Preoccupation with one or more delusions or frequent auditory
hallucinations.
None of the following is prominent: disorganized speech, disorganized or
catatonic behavior, or flat or inappropriate affect.
Catatonic Type
A type of Schizophrenia in which the clinical picture is dominated by at
least two of the following:
motoric immobility as evidenced by catalepsy (including waxy
flexibility) or stupor
excessive motor activity (that is apparently purposeless and not
influenced by external stimuli)
extreme negativism (an apparently motiveless resistance to all
instructions or maintenance of a rigid posture against attempts to be
moved) or mutism
peculiarities of voluntary movement as evidenced by posturing (voluntary
assumption of inappropriate or bizarre postures), stereotyped movements,
prominent mannerisms, or prominent grimacing
echolalia or echopraxia
Disorganized Type
A type of Schizophrenia in which the following criteria are met:
All of the following are prominent:
disorganized speech
disorganized behavior
flat or inappropriate affect
The criteria are not met for Catatonic Type.
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.
Residual Type
A type of Schizophrenia in which the following criteria are met:
Absence of prominent delusions, hallucinations, disorganized speech, and
grossly disorganized or catatonic behavior.
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).
According to the diagnostic criteria below if you have no other
symptoms than hearing voices on a regular basis you are a 'paranoid
schizophrenic' - which is what I said is happening in the "diagnostic"
world (in Britain, at least). I know many people who display no other
symptoms than this - they complain about their "voices" - and
get "diagnosed" as paranoid schizophrenic. An elderly psychiatrist
recently said on British TV: "Maybe just because people hear voices doesn't mean that they are
schizophrenic?"
Once a psychiatrist has detailed in a patient's medical records the
various symptoms of schizophrenia - which the patient MAY NOT be
experiencing - the symptoms may exist only in the doctors perception of
the patient's behaviour, or may be unsubstantiated reports from the
family - then the patient is forevermore said to have "suffered a bout
of schizophrenia".
Then - the influence of psychiatric drugs begin - and that's another
story altogether. A lot of people have their first experience of visual
hallucinations and major thought disorder, etc., only after being given
psychiatric drugs in a hospital environment.
I realized after I posted it (I re-read it). I conceded in the following post.
Geeeeeeeeeeeez! I fit the full criteria. It doesn't make me schizophrenic though. These Pdocs are barmy! I have read the DSM IV diagnostic criteria for sz several times in the past
(my wife has a copy) and I agree with it. It seems perfectly logical to me.
I disagree however that hearing voices makes one a paranoid sz. Doesn't
there have to be a prevalence of feelings of paranoia or persecution to
deserve the label paranoid? Some sz's hear voices that are not paranoid or
persecutory in nature. I wouldn't classify them as paranoid sz. Of course
I haven't actually read the entire diagnostic criteria lately. I'm just
using what seems to be some common sense.
