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Diagnosis

9 evidence topics · 8 sources

DSM-5 diagnostic criteria for schizophrenia

Criterion	Quoted text
A: characteristic symptoms	“Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3):”
A1	“delusions”
A2	“hallucinations”
A3	“disorganized speech (e.g., frequent derailment or incoherence)”
A4	“grossly disorganized or catatonic behavior”
A5	“Negative symptoms (i.e., diminished emotional expression or avolition).”
B: functioning	“For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic, or occupational functioning).”
C: duration	“Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms.”
D: mood disorder exclusion	“Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either (1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or (2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.”
E: substance and medical exclusion	“The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.”
F: developmental disorder	“If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1 month (or less if successfully treated).”

DSM-5-TR and ICD-10 as the diagnostic systems in use

“The 2 systems used in diagnosing schizophrenia are DSM-5-TR and ICD-10, which have slight variations.” (opens the source at this quote in a new tab)
“Continuous signs must persist for at least 6 months, including at least 1 month of active-phase symptoms, which might be less if treated.” (opens the source at this quote in a new tab)
“Schizoaffective, depressive, or bipolar disorders with psychotic features must be excluded. The symptoms should not be due to substance use, medication, or another medical condition.” (opens the source at this quote in a new tab)

Clinical diagnosis with no confirmatory test

“No laboratory, psychometric, or radiologic studies currently exist for diagnosing schizophrenia.” (opens the source at this quote in a new tab)
“Schizophrenia is primarily a clinical diagnosis and necessitates specific laboratory and radiographic investigations to exclude other potential causes.” (opens the source at this quote in a new tab)
“The clinical diagnosis of schizophrenia is made after obtaining a detailed psychiatric history and mental status examination and after ruling out other psychiatric and medical causes of psychosis.” (opens the source at this quote in a new tab)

Initial assessment: American Psychiatric Association guideline statements 1 and 2

“APA recommends (1C) that the initial assessment of a patient with a possible psychotic disorder include the reason the individual is presenting for evaluation; the patient's goals and preferences for treatment; a review of psychiatric symptoms and trauma history; an assessment of tobacco use and other substance use; a psychiatric treatment history; an assessment of physical health; an assessment of psychosocial and cultural factors; a mental status examination, including cognitive assessment; and an assessment of risk of suicide and aggressive behaviors, as outlined in APA's Practice Guidelines for the Psychiatric Evaluation of Adults (3rd edition).” (opens the source at this quote in a new tab)
“APA recommends (1C) that the initial psychiatric evaluation of a patient with a possible psychotic disorder include a quantitative measure to identify and determine the severity of symptoms and impairments of functioning that may be a focus of treatment.” (opens the source at this quote in a new tab)

Assessment in secondary care: NICE guideline

“Carry out a comprehensive multidisciplinary assessment of people with psychotic symptoms in secondary care. This should include assessment by a psychiatrist, a psychologist or a professional with expertise in the psychological treatment of people with psychosis or schizophrenia.” (opens the source at this quote in a new tab)

Differential diagnosis

“Examples of conditions that can mimic schizophrenia in their initial presentation include neurosyphilis, Huntington’s disease, Wilson’s disease, and anti-N-methyl-d-aspartate (NMDA) receptor encephalitis (Lieberman and First 2018).” (opens the source at this quote in a new tab)
“Psychotic symptoms can also occur in the context of other neurological and systemic illnesses, with or without delirium, and such acute states can at times be mistaken for an acute exacerbation of schizophrenia.” (opens the source at this quote in a new tab)

“Major depressive or bipolar disorder with psychotic or catatonic features: If hallucinations or delusions occur only during major depressive or manic episodes, the diagnosis is a depressive or bipolar disorder with psychotic features, depending on the timing and severity of mood disturbances.” (opens the source at this quote in a new tab)
“Schizoaffective disorder: This diagnosis requires concurrent depressive or manic episodes with active-phase schizophrenia symptoms, with mood symptoms prevalent for most of the active phase.” (opens the source at this quote in a new tab)

Laboratory and imaging evaluation to exclude other causes

“Drug toxicology screen: This screen may be clinically indicated to detect substance use that could cause psychotic symptoms.” (opens the source at this quote in a new tab)
“Imaging: Brain imaging, either CT or MRI (with MRI preferred), may be indicated based on the neurological examination or history.” (opens the source at this quote in a new tab)

Rating scales used in practice and research

“A 6-item version of the Positive and Negative Syndrome Scale (PANSS-6; Bech et al. 2018; Østergaard et al. 2018b) consists of the PANSS items for delusions, conceptual disorganization, hallucinations, blunted affect, social withdrawal, and lack of spontaneity and flow of conversation (Kay et al. 1987).” (opens the source at this quote in a new tab)
“Other clinician-rated scales are commonly used for monitoring psychopathology in research but are likely to be too lengthy for routine clinical use. These include the PANSS-30 (Kay et al. 1987), the Scale for the Assessment of Negative Symptoms (SANS; Andreasen 1984a), the Scale for the Assessment of Positive Symptoms (SAPS; Andreasen 1984b), and the Brief Psychiatric Rating Scale” (opens the source at this quote in a new tab)

“The PANSS-30 is a comprehensive tool that includes 30 items, subdivided into positive symptoms, negative symptoms, and general psychopathology.” (opens the source at this quote in a new tab)

“Based on two established psychiatric rating systems, the 30-item PANSS was conceived as an operationalized, drug-sensitive instrument that provides balanced representation of positive and negative symptoms and gauges their relationship to one another and to global psychopathology.” (opens the source at this quote in a new tab)

Duration of untreated psychosis in United States community settings

“Participants were 404 individuals (ages 15-40) who presented for treatment for first-episode psychosis at 34 nonacademic clinics in 21 states.” (opens the source at this quote in a new tab)
“Median DUP was 74 weeks (mean=193.5±262.2 weeks; 68% of participants had DUP of greater than six months).” (opens the source at this quote in a new tab)

“Long DUP correlated statistically significantly with poor general symptomatic outcome, more severe positive and negative symptoms, lesser likelihood of remission and poor social functioning and global outcome (correlations 0.13-0.18). Long DUP was not associated with employment, quality of life or hospital treatment.” (opens the source at this quote in a new tab)