How is schizophrenia diagnosed in dsm 5
Schizophrenia Explained (Includes DSM-5 Criteria & Delusion Examples)
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schizophrenia is a mental disorder
characterized by impairments in the way
reality is perceived with associated
changes in behavior
schizo means split and phrenia means
mind in greek but it's important to
remember it is not meant to mean split
personality which is a separate
condition
schizophrenia affects how people think
feel and behave and the symptoms are
divided into three main types
psychotic or positive symptoms
negative symptoms
and cognitive symptoms
psychotic symptoms include
hallucinations
meaning sensing something that is not
there and auditory hallucinations are
particularly common thought to occur in
80 of patients at some point
delusions are a fixed belief that
something is true despite having
evidence that it is not
in schizophrenia paranoid delusions are
common for example believing the fbi is
following them or that they are being
poisoned
delusions of reference are also common
in schizophrenia where a person believes
messages are meant specifically for them
for example believing a news reader on
tv is talking directly to them there can
be delusions of control where a person
believes that someone else is
controlling their thoughts such as the
fbi placing thoughts in their minds
there can be delusions of grandeur
meaning being a figure of great
importance
and delusions of erotomania
meaning believing a person typically of
higher status is in love with them
another positive symptom is disorganized
speech or thinking which can manifest as
jumping from topic to topic or speech
that makes no sense termed word salad
another example would be stopping in the
middle of a sentence
abnormal and often repetitive movements
are also included here as is
disorganized behavior a classic example
is being dressed inappropriately for an
event or for the climate
negative symptoms are deficits in normal
emotions or thoughts and are split into
the five a's blunted affect meaning
showing little emotion or expression a
lodger which is a lack of content in
speech
anedonia which is the inability to feel
pleasure
asociality which is a lack of desire to
interact or form social relationships
and avolition which is a lack of
motivation
the cognitive symptoms are a predictor
of day-to-day functioning and are
amongst the earliest symptoms to appear
problems manifest as low attention
levels poor decision making and
problem-solving abilities
the onset of these symptoms typically
follow a prodromal phase where there is
a gradual development of primarily
cognitive and negative symptoms followed
by the first episode of psychosis
following this patients often return to
baseline or a residual phase before
beginning another gradual worsening
the time between the onset of the first
episode of psychosis and treatment is
known as the duration of untreated
psychosis and this is a factor in
overall functional outcome
according to the dsm 5 for a diagnosis
of schizophrenia to be made at least two
diagnostic symptoms must be present
these are delusions hallucinations
disorganized speech disorganized or
catatonic behavior or negative symptoms
for the diagnosis
one of the two symptoms needs to be
delusions hallucinations or disorganized
speech which means you don't have to
have delusions or hallucinations to be
diagnosed on top of this the two
symptoms need to have been actively
present for most of the time for one
month with a significant impact on
functioning for at least six months
the symptoms should also not be the
result of substance abuse or other
medical conditions and schizoaffective
bipolar or depressive disorder with
psychotic features must have been ruled
out some important changes to note from
the dsm-4
is that the subtypes have been removed
as they were not shown to improve the
outcome for patients and less emphasis
is placed on schneider's first rank
symptoms of schizophrenia
the exact cause is not clear but it is
thought to be multifactorial
the main hypothesis is neurochemical
abnormalities suggesting an imbalance of
particularly dopamine and glutamate
being responsible
the four dopamine pathways are the
nigrostriatal
mesocortical
mesolimbic and tubero infundibular
pathways and it is thought that positive
symptoms are the result of excess
activation of d2 receptors in the
mesolimbic pathway
motor symptoms due to the low levels of
dopamine in the nigrostriatal pathways
and negative symptoms due to low levels
in the mesocortical pathway
genetics are thought to play a role with
46 concordance rates documented in
monozygotic twins
and a 40 chance of developing the
condition if both parents are affected
environmental factors include several
points relating to birth such as low
birth weight gestational diabetes
preeclampsia
emergency cesarean section delivery and
even winter birthing associated with a
10
higher risk
the risk is also higher in patients
living in urban areas by around two to
four percent
and there is a suggestion of a 40
increase in risk in cannabis smokers
the lifetime prevalence is around 1
and it seems to be more common in those
of african american descent the typical
age is around the mid-20s with the peak
being slightly earlier in males than in
females it is also slightly more common
in males than it is in females
early treatment following onset of
psychosis is associated with better
outcomes
antipsychotic medications are a main
feature as they are effective in the
acute setting and they are useful in
preventing relapses and it is estimated
that 80 of untreated patients will
relapse within one year
maintenance can be through long-acting
injections or through tablets
examples include risperidone and
olanzipine
if the initial agent is not effective
then another is used and the response
assessed
antipsychotics can have significant side
effect profiles and some such as
clozapine will require regular
monitoring
psychotherapies or talking therapies
like cognitive behavioral therapy are
used particularly against the negative
symptoms
and are used in combination with
medication in order to try and improve
the overall functioning of the person
and maintain that status
treatment resistant schizophrenia is
defined as no response to at least two
antipsychotics over at least 12 weeks
and in these cases clozapine is an
option
you
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