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Schizophrenia
and Schizoaffective
Disorder
DSM-IV-TRTM
American Psychiatric Association: Diagnostic and Statistical
Manual of Mental Disorders, Fourth Edition, Text Revision.
Washington, DC, American Psychiatric Association, 2000
 Russell L. Smith, M.S.,
LPA, HSP-PA, CCBT, MAC, FABFCE, NCP
In Schizophrenia,
“Psychotic” refers to
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delusions,
any prominent hallucinations,
disorganized speech, or
disorganized or catatonic
behavior.
Subtypes
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295.30
295.10
295.20
295.90
295.60
Paranoid
Disorganized
Catatonic
Undifferentiated
Residual
Course Specifiers
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Episodic With Interepisode
Residual Symptoms
Episodic With No Interepisode
Residual Symptoms
Continuous
Single Episode in Partial
Remission*
Single Episode in Full Remission*
Other Or Unspecified Pattern
*With Prominent Negative
Symptoms can be added ...
Range of Emotional &
Cognitive Dysfunction*
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Perception
Inferential thinking
Language & communication
Behavioral monitoring
Affect
Fluency & productivity of
thought & speech
Hedonic capacity
Volition & drive
Attention
* Associated with impaired
occupational or social functioning
Positive Symptoms
Reflect an excess or
distortion of normal functions
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“psychotic dimension ”
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Thought content
Perception
“disorganization dimension ”
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Language & thought
processes
Self-monitoring of behavior
Negative Symptoms
A decrease or loss of normal
functions
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Range & intensity of emotional
expression
Fluency & productivity of
thought and speech
Initiation of goal-directed
behavior
Schizophrenia
Diagnostic Criterion A
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A. Characteristic symptoms:
two or more ... for significant
portion of 1-month (or less if
successfully treated):
1.
2.
3.
4.
5.
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.
Schizophrenia
Diagnostic Criterion B
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B. Social/Occupational
Dysfunction ...
• ... for a significant portion of time
since onset ...
• one or more major areas of
functioning such as work,
interpersonal relations, or self-care
... markedly below level prior to
onset
• If onset in childhood or adolescence
... failure to achieve expected level
of interpersonal, academic, or
occupational achievement
Schizophrenia
Diagnostic Criterion C
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C. Duration
• Continuous signs persist for at least
6 months
at least one month meet
Criterion A (less than month if
effectively treated)
may include prodromal or
residual symptoms
• may be manifested by only
negative symptoms or two or more
symptoms listed in Criterion A
presented in an attenuated form
(e.g., odd beliefs, unusual
perceptual experiences).
Schizophrenia
Diagnostic Criterion D
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D. Schizoaffective and Mood
Disorder have been ruled out
because either
• there has been no Major
Depressive, Manic, or Mixed
Episodes, or
• if mood episodes have occurred
during the active-phase
symptoms, their total duration
has been brief relative to the
duration of the active and
residual periods.
Schizophrenia
Diagnostic Criterion E
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E. 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)
• The disturbance is not due to
a general medical condition.
Schizophrenia
Diagnostic Criterion F
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F. Relationship to Pervasive
Developmental Disorder
• If there is a history of Autism
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 one month (or
less if successfully treated).
295.30 Paranoid Type
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Preoccupation with one or
more delusions or frequent
auditory hallucinations.
None of the following is
prominent:
• disorganized speech
• disorganized or catatonic
behavior
• flat or inappropriate affect.
295.10
Disorganized Type
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All of the following are
prominent:
disorganized speech
disorganized behavior
flat or inappropriate affect.
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The criteria are not met for
Catatonic Type.
295.20 Catatonic Type
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At least two of the following:
 motoric immobility as evidenced by
catalepsy (including waxy flexibility)
or stupor
 excessive motor activity
(purposeless and not influenced by
external stimuli)
 extreme negativism or mutism
 peculiarities of voluntary movement
as evidenced by posturing,
stereotyped movements, prominent
mannerisms, or prominent
grimacing
 echolalia or echopraxia
295.90
Undifferentiated Type
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... the presence of symptoms
that meet Criterion A of
Schizophrenia but that do
not meet criteria for the
Paranoid, Disorganized, or
Catatonic Type.
295.60 Residual Type
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Absence of prominent delusions,
hallucinations, disorganized
speech, and grossly disorganized
or catatonic behavior.
There is continuing evidence of
the disturbance ...
 presence of negative symptoms,
or
 two or more of the symptoms listed
in Criterion A but in an attenuated
form (e.g., odd beliefs, unusual
perceptual experiences).
Schizophrenia:
Features
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Cultural & Socioeconomic
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Beliefs & Religion
Language, Emotional Expression &
Nonverbal style
Industrial vs Developing
Men: Onset 18-25 years ... more
negative symptoms (flat affect,
avolition, social withdrawal)
Women: Onset 25 to mid-30s
(3% to 10% onset after 40) ...
better permorbid functioning,
more affective symptoms,
paranoid delusions, and
hallucinations
295.70 Schizoaffective
Disorder
A. An uninterrupted period of
illness during which, at least
some time, there is either a
Major Depressive Episode, a
Manic Episode, or a Mixed
Episode concurrent with
symptoms that meet Criterion A
for Schizophrenia.
B. During the same period of
illness, there have been
delusions or hallucinations for
at least 2 weeks in the absence
of prominent mood symptoms.
295.70 Schizoaffective
Disorder
C. Symptoms that meet criteria for
a mood episode are present for
a substantial portion of the
total duration of the active and
residual periods of the illness.
D. Not due to drug of abuse,
medication or a general medical
condition.
Specify Type:
Bipolar Type: ... if Manic or Mixed Episodes
(or Manic or Mixed and Major Depressive
Episodes)
Depressive Type: Major Depressive
Episodes
TO BE OR NOT
MALADAPTIVE (B-)
ADAPTIVE (B+)
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