Tuesday, July 8, 2014

DSM 5 and Schizophrenia Spectrum and Other Psychotic Disorders

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Changes to the Diagnosis (from the DSM IV-TR to DSM 5)

1) Schizophrenia is characterized by:

  • delusions
  • hallucinations
  • disorganized speech  and behavior
  • other symptoms that cause social and occupational dysfunction

2) Symptoms present for 6 months and at least 1 month active symptoms

3) Patient exhibit at least 2 of the specified symptoms

4) No longer identify subtypes (paranoid, disorganized, catatonic, undifferentiated, and residual), since patient's symptoms often changed from one subtype to another and present an overlap

5) Some of the subtypes are now speficiers to provide detail to diagnosis (used also in other disorders like bipolar and major depresssive disorders).

Source - http://www.dsm5.org/Documents/Schizophrenia%20Fact%20Sheet.pdf

Schizophrenia Spectrum and Other Psychotic Disorders (87)

The following specifiers apply to Schizophrenia Spectrum and Other Psychotic Disorders
where indicated:

a) Specify if: The following course specifiers are only to be used after a 1-year duration of the disorder:
First episode, currently in acute episode; First episode, currently in partial remission;
First episode, currently in full remission; Multiple episodes, currently in acute episode; Multiple
episodes, currently in partial remission; Multiple episodes, currently in full remission;
Continuous; Unspecified
b) Specify if: With catatonia (use additional code 293.89 [F06.1])
c) Specify current severity of delusions, hallucinations, disorganized speech, abnormal psychomotor
behavior, negative symptoms, impaired cognition, depression, and mania symptoms

301.22 (F21) Schizotypal (Personality) Disorder (90)

297.1 (F22) Delusional Disorder a, c (90)
Specify whether: Erotomanie type. Grandiose type. Jealous type. Persecutory  type. Somatic type. Mixed type. Unspecified type
Specify if: With bizarre content

298.8 (F23) Brief Psychotic Disorder b, c (94)
Specify if: With marked stressor(s). Without marked stressor(s). With
postpartum onset

295.40 (F20.81) Schizophreniform Disorder b, c (96)
Specify if: With good prognostic features. Without good prognostic features

295.90 (F20.9) Schizophrenia b, c (99)

Schizoaffective Disorder a,b,c (105)
Specify whether:
295.70 (F25.0) Bipolar type

295.70 (F25.1) Depressive type
Substance/Medication-Induced Psychotic Disorder c (110)

Note: See the criteria set and corresponding recording procedures for substance-specific codes and ICD-9-CM and ICD-IO-CM coding.
Specify if: With onset during intoxication. With onset during withdrawal 

Psychotic Disorder Due to Another Medical Condition c (115)
Specify whether:
293.81 (F06.2) With delusions
293.82 (F06.0) With hallucinations

293.89 (F06.1) Catatonia Associated With Another Mental Disorder (Catatonia Specifier) (119)

293.89 (F06.1) Catatonic Disorder Due to Another Medical Condition (120)

293.89 (F06.1) Unspecified Catatonia (121)
Note: Code first 781.99 (R29.818) other symptoms involving nervous and musculoskeletal systems.

298.8 (F28) Other Specified Schizophrenia Spectrum and Other Psychotic Disorder (122)
298.9 (F29) Unspecified Schizophrenia Spectrum and Other Psychotic Disorder (122)

Previous posts/related links on Schizophrenia: