Schizophrenia,Symptoms and DiagnosisE. KENT ROGERS

DSM Diagnostic Criteria

Two or more of the following symptoms present for at least one month:1. Delusions

2. Hallucinations

3. Disorganized speech

4. Disorganized or catatonic behavior

5. Negative symptoms

Social/occupational dysfunction Some symptoms for at least 6 months Other causes (such as drug induced psychosis) ruled out

Symptoms

Symptoms can be divided into a few ways, the most common way is “positive” and “negative” symptoms. This is useful because those who have mostly negative symptoms respond differently to treatment.

Generally, those with predominantly positive symptoms respond to medication BETTER than those with negative symptoms.

Some people also include a category “psychosomatic” symptoms—problems in regulating behavior and movement. DSM inlcudes these as positive symptoms, so we will do that here.

Positive Symptoms: “An excess or distortion of normal functions”

Perceptual disturbances: seeing/hearing things more vividly or potently or having alterations in perceptions of things that actually exist. For example, you may see colors or patterns on a wall where others do not see them.

Hallucinations: Seeing, hearing, smelling, feeling, tasting things that do not exist. Most schizophrenics hear voices or sounds. Often the voices argue with each other or persecute the individual.

Delusions: Beliefs that are not based in facts and which despite evidence, cannot easily be altered. Often these are persecutory such as “The CIA is tracking me with sattelites” or “someone has poisoned my food.” Sometimes they are grandiose, “I am Jesus.”

Disorganized Speech: disruption in thinking and verbal communication

Disorganized or Catatonic Behavior: Catatonic stupor, catatonic rigidity; waxy flexibility, posturing, etc.

Negative Symptoms: lessening or loss of normal functioning

Alogia: literally means “no thought.” The person shows significant restriction in speech reflecting diminished thought. No answers, or very brief verbal responses.

Avolition: literally “no will” or “no motivation.” The person may sit for long periods of time doing nothing. Has no apparent drive to engage in activity.

Blunted and flat affect: Significantly limited or no emotional responses (respectively).

Anhedonia: literally “No pleasure” The individual has significantly diminished sense of pleasure in normally pleasurable activitiesl.

Subtypes

There are three major subtypes:

1. Paranoid Type

2. Disorganized Type

3. Catatonic Type

There are two other subtypes:

1. Undifferentiated Type

2. Residual Type

Paranoid Type

Main symptoms are delusions and hallucinations

Less manifestation of these symptoms: Disorganized speech, disorganized/catatonic behavior, flat or inappropriate affect

Disorganized Type

All of the following are prominent:

1. Disorganized speech

2. Disorganized behavior

3. Flat or inappropriate affect

And criteria Catatonic Type isn’t met

Catatonic Type

At least two of the following:

1. Catatonic stupor or waxy flexibility

2. Excessive motor activity that is meaningless

3. Pointless refusal to respond to all instruction (rigidity, being mute, not doing anything people ask)

4. Peculiar voluntary movement: Posturing, stereotyped movements, grimacing etc.

5. Echolalia (repeating whatever the individual hears) or echopraxia (imitating the movement of others)

Undifferentiated Type

A diagnosis of schizophrenia that doesn’t fit neatly into any of the above three categories

Residual Type

Schizophrenia after most symptoms have diminished or disappeared, but some remain.

Controversies of Dx

In the latest version of the DSM, DSM 5, there are no subtypes. This is because it was found that there was very little inter-rater reliability from one doctor to another, very little validity, and that treatment for the different subtypes was the same so there seemed to be no point in differentiating them.