Questions and Answers
Schizophrenia in DSM-5 requires the presence of at least three specified symptoms for at least one month.
False
One of the required symptoms for diagnosing schizophrenia in DSM-5 can be disorganized speech.
True
Impaired functioning in social and occupational domains is required for the diagnosis of schizophrenia in DSM-5.
True
The 6-month period of disturbance in DSM-5 includes intermittent symptoms that meet Criterion A.
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ICD-10 includes 'Hebephrenic' as a sub-type of schizophrenia.
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In DSM-5, if there is a history of autism spectrum disorder, schizophrenia is diagnosed only if there are delusions or hallucinations for at least 1 month.
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DSM-5 includes 'Brief psychotic disorder' under schizophrenia-like disorders.
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ICD-10 classifies schizotypal disorder as a separate condition from the spectrum of schizophrenic disorders.
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DSM-5 does not divide schizophrenia into classical subtypes like ICD-10.
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ICD-10 includes 'Substance/medication-induced psychotic disorder' as a classification.
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ICD-10 and DSM-5 both classify 'Schizoaffective disorder'.
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DSM-5 includes conditions such as schizophrenia-like disorders secondary to substance use within the schizophrenia chapter.
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ICD-10 includes 'Schizophreniform disorder' under its classification of schizophrenia-like disorders.
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DSM-5 categorizes 'Postschizophrenic depression' as a type of schizophrenia.
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DSM-5 and ICD-10 both classify 'Induced delusional disorder'.
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A similarity between ICD-10 and DSM-5 is that both include 'Unspecified schizophrenia spectrum and other psychotic disorder'.
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Schizophrenia was once believed to be a part of a single mental disorder entity called Einheitpsychose.
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In the 1960s, US psychiatrists typically identified schizophrenia using Schneider's first-rank symptoms.
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Emil Kraepelin described schizophrenia as occurring in clear consciousness and consisting of a series of states.
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The discrepancies in schizophrenia diagnosis between the USA and UK led to the development of ICD-10 and DSM-5 criteria for schizophrenia.
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Kahlbaum described catatonia in the year 1852.
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First-admission rates for schizophrenia were higher in the UK than in the USA during the 1960s.
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Morel's classification of mental disorders was based on cause, symptoms, and outcome.
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Hecker’s account of a condition called hebephrenia was written after Kahlbaum described catatonia.
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Eugen Bleuler was mainly concerned with prognosis rather than the mechanisms of symptom formation.
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The term 'schizophrenia' was used by Eugen Bleuler to denote a 'splitting' of psychic functions.
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Bleuler viewed hallucinations and delusions as primary symptoms of schizophrenia.
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Bleuler believed there was a possible neuropathological cause for schizophrenia.
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Kleist used Bleuler's diagnostic framework in his study on associations between brain pathology and subtypes of psychotic illness.
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Leonhard classified schizophrenia into progressive and systematic groups.
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Schizophrasia is characterized by grossly disordered speech.
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Langfeldt proposed a distinction between true schizophrenia and schizophreniform states, with the latter having a good prognosis.
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Psychogenic psychosis is classified as a mood disorder in modern diagnostic schemes.
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There is a debate on whether schizophrenia should be abolished and replaced with the term 'psychosis spectrum syndrome'.
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Steroids and dopamine agonists are known to cause florid psychotic states.
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Alcohol misuse is never considered in the presentation of schizophrenia-like psychoses.
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Urine or hair testing has no role in the diagnosis of drug-induced psychosis.
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A clear distinction between drug-induced psychosis and schizophrenia is always possible.
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The degree and persistence of the mood disorder is irrelevant in distinguishing schizophrenia from affective psychosis.
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A family history of mood disorder can sometimes help clarify the diagnosis of affective psychosis.
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In delusional disorders, many areas of the mental state are unremarkable besides the chronic, systematized paranoid delusions.
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Borderline personality disorder patients always exhibit permanent psychotic symptoms.
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For a diagnosis of schizophrenia according to ICD-10, symptoms must be present for a period of 1 month or more.
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DSM-5 recognizes traditional subtypes of schizophrenia.
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ICD-10 places weight on Schneider’s first-rank symptoms for diagnosing schizophrenia.
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ICD-10 requires a duration of illness of 6 months for diagnosing schizophrenia.
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Schizotypal disorder is categorized as a personality disorder in ICD-10.
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For a diagnosis of brief psychotic disorder in DSM-5, the syndrome must last for at least 1 month.
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Persistent hallucinations in any modality, even without delusions or overvalued ideas, are sufficient for a diagnosis of schizophrenia in ICD-10.
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According to ICD-10, negative symptoms such as marked apathy must not be due to depression or neuroleptic medication for a diagnosis of schizophrenia.
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DSM-5 uses the term schizophreniform disorder for syndromes lasting more than 1 month but less than 3 months.
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ICD-10 recognizes delusional disorders as a form of schizophrenia-like disorders.
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Schizoaffective disorder is classified under schizoaffective disorder in both DSM-5 and ICD-10.
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According to DSM-5, schizoaffective disorder requires an uninterrupted period of illness during which there is a minor depressive or manic episode concurrent with symptoms that meet criterion A for schizophrenia.
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Kasanin used the term schizoaffective disorder for the first time to describe a small group of young patients with severe mental disorders characterized by sudden onset and emotional turmoil.
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ICD-10 classifies schizoaffective disorder according to whether the mood disturbance is obsessive, compulsive, or mixed.
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The current definitions of schizoaffective disorder specify that the diagnosis should only be made when there are definite schizophrenic and affective symptoms equally prominent and present simultaneously, or within a few days of each other.
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DSM-5 specifies schizoaffective disorder as bipolar type only.
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Postschizophrenic depression is classified in ICD-10 when prominent depressive symptoms have been present for at least 2 weeks while some symptoms of schizophrenia still remain.
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The outcome of schizoaffective disorder is generally thought to be worse than that for schizophrenia.
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People who have shown full clinical symptoms of schizophrenia in the past but no longer meet all criteria are classified as having transient schizophrenia in ICD-10.
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Schizotypal personality disorder according to DSM-5 is considered part of the schizophrenia spectrum.
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Schizotypal disorder meets all criteria for schizophrenia.
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Bipolar disorder is categorized under cases with affective and psychotic symptoms in differential diagnosis of schizophrenia.
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Visual, olfactory, and gustatory hallucinations suggest an organic aetiology.
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Obsessive-compulsive disorder is categorized under schizophrenia-like disorders attributable to a specific cause.
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Temporal lobe epilepsy can be a cause of organic schizophrenia-like disorders.
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The distinction between schizophrenia and organic schizophrenia-like disorders is clear and well-defined.
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In London, the study mentioned found that 3.7% of 'first-episode schizophrenia' cases had an organic cause other than substance misuse.
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Delusional disorder is considered a variant of schizophrenia.
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General paralysis of the insane is an example of a primary cause of schizophrenia.
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Psychotic depression falls under the category of schizophrenia-like disorders attributable to a specific cause.
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Study Notes
Classification of Schizophrenia and Schizophrenia-Like Disorders
ICD-10 Classification
- Schizophrenia:
- Paranoid
- Hebephrenic
- Catatonic
- Undifferentiated
- Residual
- Simple schizophrenia
- Postschizophrenic depression
- Other schizophrenia
- Unspecified schizophrenia
- Schizoaffective disorder
- Persistent delusional disorders:
- Delusional disorder
- Other persistent delusional disorders
- Acute and transient psychotic disorder:
- Acute schizophrenia-like psychotic disorder
- Acute polymorphic psychotic disorder
- Other acute psychotic disorders
- Induced delusional disorder
- Other non-organic psychotic disorders
- Unspecified non-organic psychosis
- Schizotypal disorder
DSM-5 Classification
- Schizophrenia
- Schizoaffective disorder
- Delusional disorder
- Brief psychotic disorder
- Schizophreniform disorder
- Other specified schizophrenia spectrum and other psychotic disorder
- Unspecified schizophrenia spectrum and other psychotic disorder
- Substance/medication-induced psychotic disorder
- Psychotic disorder due to another medical condition
Criteria for Schizophrenia in DSM-5
- Two or more symptoms present for at least 1 month (or less if successfully treated):
- Delusions
- Hallucinations
- Disorganized speech
- Grossly disorganized or catatonic behavior
- Negative symptoms (i.e., diminished emotional expression or avolition)
- Impaired level of functioning in one or more domains (e.g., work, relationships) for a significant portion of the time since onset
- Continuous signs of the disturbance persist for at least 6 months
- The patient does not meet criteria for schizoaffective disorder, or a mood disorder with psychotic features
- The disturbance is not attributable to the psychological effects of a substance or another medical condition
- If there is a history of autism spectrum disorder, the additional diagnosis of schizophrenia is made only if there are prominent delusions or hallucinations present for at least 1 month
DSM-5 vs ICD-10
- ICD-10 places more emphasis on specific types of psychotic symptoms, including first-rank symptoms
- DSM-5 does not divide schizophrenia into classical subtypes such as paranoid, hebephrenic, or catatonic
- ICD-10 considers schizotypal disorder among the spectrum of schizophrenic disorders, whereas in DSM-5 it is classified as a personality disorder
- ICD-10 includes a group of acute and transient psychotic disorders that have an acute onset and complete recovery within 2-3 months
Historical Development of Ideas about Schizophrenia
- The concept of schizophrenia has undergone significant changes over time
- Different views and traditions have influenced the diagnosis and classification of schizophrenia
- The development of standardized diagnostic criteria has improved consistency and reliability in diagnosis
Consensus on Diagnostic Criteria
- Cross-national studies of diagnostic practice (e.g., US-UK Diagnostic Project and International Pilot Study of Schizophrenia) led to a consensus on diagnostic criteria
- Standardized methods for defining and identifying diagnostic criteria have improved consistency and reliability in diagnosis
Schizophrenia-Like Disorders
- Cases that resemble schizophrenia but do not meet the criteria for diagnosis can be considered schizophrenia-like disorders
- Examples include brief psychotic disorder, schizophreniform disorder, and psychotic disorder accompanied by prominent affective symptoms
- Delusional disorders are a type of schizophrenia-like disorder characterized by chronic, systematized paranoid delusions without other symptoms of schizophrenia### Differential Diagnosis of Schizophrenia
- Brief psychotic disorder, delusional disorder, and schizotypal disorder are cases that meet some but not all criteria for schizophrenia
Affective and Psychotic Symptoms
- Schizoaffective disorder, psychotic depression, and bipolar disorder are cases with affective and psychotic symptoms that must be differentiated from schizophrenia
Schizophrenia-like Disorders Due to Specific Causes
- Schizophrenia-like disorder due to psychoactive substance use and organic schizophrenia-like disorder are cases attributable to a specific cause that must be differentiated from schizophrenia
Other Disorders
- Autism and related disorders, obsessive-compulsive disorder, body dysmorphic disorder, schizoid personality disorder, and paranoid personality disorder are other disorders that must be differentiated from schizophrenia
Challenges in Differential Diagnosis
- The boundary between schizophrenia and schizophrenia-like disorders is blurred and arbitrary
- The distinction between disorders considered variants of schizophrenia and those in its differential diagnosis is unclear
- The distinction between schizophrenia and organic schizophrenia-like disorders is also becoming increasingly blurred
- The classification of schizophrenia is limited by the unknown validity of the syndrome(s) and the lack of empirically validated markers
Organic Syndromes
- Acute schizophrenia can be mistaken for delirium, especially if there is pronounced thought disorder and a rapidly fluctuating affect and mental state
- Careful observation is needed to distinguish between the two, looking for features such as clouding of consciousness, disorientation, and other features of delirium
- Schizophrenia-like disorders can occur in clear consciousness in a range of neurological and medical disorders, such as temporal lobe epilepsy, general paralysis of the insane, and metachromatic leukodystrophy
- Visual, olfactory, and gustatory hallucinations are suggestive of an organic aetiology
- A careful medical history and physical examination (and investigations, if indicated) are essential in all patients to rule out organic causes
- One study found that 10 out of 268 cases (3.7%) of 'first-episode schizophrenia' had an organic cause other than substance misuse
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Description
This quiz covers the classification of schizophrenia and schizophrenia-like disorders according to the ICD-10 and DSM-5 systems, including subtypes and related conditions.
