The DSM-IV-TR Diagnosis
the US concept of s shifted from broad def to a def that narrows the range of patients diagnosed as s in 5
1) the diagnostic criteria are presented in explicit and considerable detail
2) patients with symptoms of a mood disorder are specifically excluded. Scizoaffective disorder comprises
a mixture of symp of s and mood disorders.
3) DSM-IV-TR requires at least 6 months of disturbances for the diagnosis. The 6 month period must
include at least one month of the active phase, which is defined by the presence of at least two of the
following: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic beh and
the remaining time required within the minimum six months can be either a prodormal (before the active
phase) or a residual (after the active phase) period. Problems during the prodormal and residual phases
include social withdrawal, impaired role functioning, blunted or inappropriate affect, lack of initiative,
vague and circumstantial speech, impairment in hygiene and grooming, odd beliefs or magical thinking
and unusual perceptual experiences. These criteria eliminate patients who have a brief psychotic episode
which is often stress related and then recover quickly. The symp of s dis are the same as those of s but last
only from one to six months. Brief psychotic dis lasts from one day to one month and is often brought on
by extreme stress such as bereavement
4) some of what DSM-II regarded as mild forms of s are now diagnosed as personality dis
5) DSM-IV-TR differentiates between paranoid s and delusional disorder. A person with delusional
disorder is troubled by persistent persecutory delusions or by delusional jealousy, which is the unfounded
conviction that a spouse or lover is unfaithful. There are also delusions of being followed, somatic
delusions and delusions of erotomania (believing that one is loved by some other person, usually a
complete stranger with a higher social status).
Unlike person with paranoid s the person with delusional dis does not have disorganized speech or
hallucinations. Delusional dis is quite rare and typically begins later on in life than s. in most families it
appears to be related to s perhaps genetically
Categories of s in DSM-IV-TR
Three types of s included are disorganized (hebephrenic) catatonic and paranoid
K hebephrenic form of s is called disorganized s in dsm-iv-tr.
Speech is disorganized and hard for a listener to follow. Ppl may speak incoherently, stringing together
similar sounding words and even inventing new words often accompanied by silliness or laugher.
They may have flat affect or experience constant shifts of emotion, breaking into inexplicable fits of
laughter and crying, their beh is generally disorganized and not goal directed
Ppl sometimes deteriate to the point of incontinence, voiding anywhere and at any time and completely
neglect their appearance
Catatonic s Ppl typically alternate between catatonic immobility and wild excitement but one of these symp may
These patients resist instructions and suggestions and often echo (repeat back) the speech of others.
The onset of this may be more sudden than the onset of other forms of s although the person is likely to
have previously sown some apathy and withdrawal from reality.
Catatonic s is barley seen today prob cuz of drug therapy and how effective it is on these bizarre motor
Lethargica (sleeping sickness)