Tuesday, August 30, 2011
Schizophrenia is characterized by positive & negative symptoms. Positive symptoms are the presence of something that should not be there (such as psychosis) and negative symptoms are the absence of something that should be there (such as flatness of affect, avolition). I could talk for a long time about various types of delusions & hallucinations and other symptoms of thought disorder; however, for simplicity sake, I will cover the basic criteria of schizophrenia.
· Two or more of the following characteristic symptoms, present for a significant portion of the time over a one-month period
· Disorganized speech (such as frequent derailment or incoherence)
· Grossly disorganized or catatonic behavior
· Negative symptoms (flatness of affect, avolition)
· Social or occupational dysfunction – achievement in work or social life that is below the level of functioning previously experienced
· Duration – symptoms must be present for a minimum of 6 months, with at least one month of characteristic symptoms.
· Can't also have Schizoaffective or mood disorder; rule this out by ensuring no major depressive, manic or mixed episodes that have occurred concurrently with active-phase symptoms.
· Disturbance cannot be caused by a medical condition or be the effects of a substance.
· If there is autism or other PDD, the diagnosis of schizophrenia can only be made if prominent delusions or hallucinations are present for at least a month.
Specifiers for subtype are paranoid type (295.30), characterized by prominent delusions and hallucinations; disorganized type (295.10), characterized by disorganized speech or behavior & flat or inappropriate affect; catatonic type (295.20), characterized by marked immobility, excessive motor activity, mutism, echolalia (repeating what you say), echopraxia (imitating your physical movements), or peculiar voluntary movements; undifferentiated type (295.60), characterized by not meeting the criteria for another subtype; and lastly, residual type (295.60), characterized by having one schizophrenic episode, but the current clinical picture lacks prominent positive symptoms, but there are ongoing negative symptoms & the presence of milder forms of psychosis (odd behavior, strange beliefs, or mildly disorganized behavior). Other specifiers describe the course and current symptomology, and you can refer to the DSM to learn more about those specifiers.