DSM-5 Update For Counselors & Students

 From the blog In thought of Aaron Norton
http://www.aaronlmhc.blogspot.com/2013/06/reflections-on-dsm-5-strengths-and.html

I also like that the classification system is less dichotomous.  Several disorders have been merged together and conceptualized as varying points on a spectrum.  The truth is that two people with the same diagnosis can experience dramatically different levels of severity and functioning.  

Finally, the DSM-5 is overall a somewhat more simplified and streamlined product than the DSM-IVTR.  Its shorter in length with several examples of less convoluted wording.  Some old diagnostic labels that have become pejorative labels have been renamed (e.g. "Mental Retardation" became "Intellectual Disability"). 

All in all, I think the DSM-5 is an improved product in comparison to the DSM-IVTR. Its imperfect and flawed, like any organizational system, but it's probably the best that we have for now.  We'll see what changes with future revisions. 

Aaron Norton, LMHC, a psychotherapist and Adjunct Instructor at the University of South Florida's Dept. of Rehabilitation & Mental Health Counseling, and Henry Tenenbaum, Ph.D., a clinical psychologist, walk students and alumni of three graduate degree programs through changes in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

DSM-5 Update For Counselors & Students, Part 1 
Sourrce link - http://youtu.be/cWFRIAy2FGc


DSM-5 Update For Counselors & Students, Part 2 
https://www.youtube.com/watch?v=QksM3beRUo8


DSM-5 Update for Counselors & Students, Part 3 
https://www.youtube.com/watch?v=i1KXYlDUSpU


The Embedded PDF below source link is - http://www.anorton.com/DSM5ResourcePage.en.html




Another nice presentation here -
http://www.anorton.com/userfiles/688392/file/DSM5ASAM(1).pdf   (it is a big file at 26 MB)

Timeline: Treatments for Mental Illness

This is an interesting timeline although it is not updated that it ended in 1992. So many things had already happened since then and I hope to provide update - so I need to do some research 1993 onwards.  

It can be observed that the bias of this timeline is on institutionalization and psychopharmacology or use of drugs and not psychotherapy.


Source link - http://www.pbs.org/wgbh/amex/nash/timeline/index.html

400 B.C.	The Greek physician Hippocrates treats mental disorders as diseases to be understood in terms of disturbed physiology, rather than reflections of the displeasure of the gods or evidence of demonic possession, as they were often treated in Egyptian, Indian, Greek, and Roman writings. Later, Greek medical writers set out treatments for mentally ill people that include quiet, occupation, and the use of drugs such as the purgative hellebore. Family members care for most people with mental illness in ancient times.
Middle Ages	In general, medieval Europeans allow the mentally ill their freedom -- granted they are not dangerous. However, less enlightened treatment of people with mental disorders is also prevalent, with those people often labeled as witches and assumed to be inhabited by demons. Some religious orders, which care for the sick in general, also care for the mentally ill. Muslim Arabs, who establish asylums as early as the 8th century, carry on the quasi-scientific approach of the Greeks.
1407	The first European establishment specifically for people with mental illness is probably established in Valencia, Spain, in 1407.
1600s	Europeans increasingly begin to isolate mentally ill people, often housing them with handicapped people, vagrants, and delinquents. Those considered insane are increasingly treated inhumanely, often chained to walls and kept in dungeons.
Late 1700s	Concern about the treatment of mentally ill people grows to the point that occasional reforms are instituted. After the French Revolution, French physician Phillippe Pinel takes over the Bicêtre insane asylum and forbids the use of chains and shackles. He removes patients from dungeons, provides them with sunny rooms, and also allows them to exercise on the grounds. Yet in other places, mistreatment persists.
1840s	U.S. reformer Dorothea Dix observes that mentally ill people in Massachusetts, both men and women and all ages, are incarcerated with criminals and left unclothed and in darkness and without heat or bathrooms. Many are chained and beaten. Over the next 40 years, Dix will lobby to establish 32 state hospitals for the mentally ill. On a tour of Europe in 1854-56, she convinces Pope Pius IX to examine how cruelly the mentally ill are treated.
1883	Mental illness is studied more scientifically as German psychiatrist Emil Kraepelin distinguishes mental disorders. Though subsequent research will disprove some of his findings, his fundamental distinction between manic-depressive psychosis and schizophrenia holds to this day.
Late 1800s	The expectation in the United States that hospitals for the mentally ill and humane treatment will cure the sick does not prove true. State mental hospitals become over-crowded and custodial care supersedes humane treatment. New York World reporter Nellie Bly poses as a mentally ill person to become an inmate at an asylum. Her reports from inside result in more funding to improve conditions.
Early 1900s	The primary treatments of neurotic mental disorders, and sometimes psychosis, are psychoanalytical therapies ("talking cures") developed by Sigmund Freud and others, such as Carl Jung. Society still treats those with psychosis, including schizophrenia, with custodial care.
1908	Clifford Beers publishes his autobiography, A Mind That Found Itself, detailing his degrading, dehumanizing experience in a Connecticut mental institution and calling for the reform of mental health care in America. Within a year, he will spearhead the founding of the National Committee for Mental Hygiene, an education and advocacy group. This organization will evolve into the National Mental Health Association, the nation's largest umbrella organization for aspects of mental health and mental illness.
1930s	Drugs, electro-convulsive therapy, and surgery are used to treat people with schizophrenia and others with persistent mental illnesses. Some are infected with malaria; others are treated with repeated insulin-induced comas. Others have parts of their brain removed surgically, an operation called a lobotomy, which is performed widely over the next two decades to treat schizophrenia, intractable depression, severe anxiety, and obsessions.
1935	Schizophrenia is treated by inducing convulsions, first induced by the injection of camphor, a technique developed by psychiatrist Ladislaus Joseph von Meduna in Budapest. In 1938 doctors run electric current through the brain -- the beginning of electro-shock therapy -- to induce the convulsions, but the process proves more successful in treating depression than schizophrenia.
1946	July 3: President Harry Truman signs the National Mental Health Act, calling for a National Institute of Mental Health to conduct research into mind, brain, and behavior and thereby reduce mental illness. As a result of this law, NIMH will be formally established on April 15, 1949.
1949	Australian psychiatrist J. F. J. Cade introduces the use of lithium to treat psychosis. Prior to this, drugs such as bromides and barbiturates had been used to quiet or sedate patients, but they were ineffective in treating the basic symptoms of those suffering from psychosis. Lithium will gain wide use in the mid-1960s to treat those with manic depression, now known as bipolar disorder. 1950s A series of successful anti-psychotic drugs are introduced that do not cure psychosis but control its symptoms. The first of the anti-psychotics, the major class of drug used to treat psychosis, is discovered in France in 1952 and is named chlorpromazine (Thorazine). Studies show that 70 percent of patients with schizophrenia clearly improve on anti-psychotic drugs. Mid-1950s The numbers of hospitalized mentally ill people in Europe and America peaks. In England and Wales, there were 7,000 patients in 1850, 120,000 in 1930, and nearly 150,000 in 1954. In the United States, the number peaks at 560,000 in 1955. A new type of therapy, called behavior therapy, is developed, which holds that people with phobias can be trained to overcome them. 1961 Psychiatrist Thomas Szasz's book, The Myth of Mental Illness, argues that there is no such disease as schizophrenia. Sociologist Erving Goffman's book, Asylums, also comes out. Another critic of the mental health establishment's approach, Goffman claims that most people in mental hospitals exhibit their psychotic symptoms and behavior as a direct result of being hospitalized. 1962 Counterculture author Ken Kesey's best-selling novel, One Flew Over the Cuckoo's Nest is based on his experiences working in the psychiatric ward of a Veterans' Administration hospital. Kesey is motivated by the premise that the patients he sees don't really have mental illnesses; they simply behave in ways a rigid society is unwilling to accept. In 1975, Kesey's book will be made into an influential movie starring Jack Nicholson as anti-authoritarian anti-hero Randle McMurphy. Mid-1960s Many seriously mentally ill people are removed from institutions. In the United States they are directed toward local mental health homes and facilities. The number of institutionalized mentally ill people in the United States will drop from a peak of 560,000 to just over 130,000 in 1980. Some of this deinstitutionalization is possible because of anti-psychotic drugs, which allow many psychotic patients to live more successfully and independently. However, many people suffering from mental illness become homeless because of inadequate housing and follow-up care. 1963 In the U.S., passage of the Mental Retardation Facilities and Community Mental Health Centers Construction Act provides the first federal money for developing a network of community-based mental health services. Advocates for deinstitutionalization believe that people with mental illness will voluntarily seek out treatment at these facilities if they need it, although in practice this will not always be the case. 1979 A support and advocacy organization, the National Alliance for the Mentally Ill, is founded to provide support, education, advocacy, and research services for people with serious psychiatric illnesses. 1980s An estimated one-third of all homeless people are considered seriously mentally ill, the vast majority of them suffering from schizophrenia. 1986 Advocacy groups band together to form the National Alliance for Research on Schizophrenia and Depression. In pursuit of improved treatments and cures for schizophrenia and depression, it will become the largest non-government, donor-supported organization that distributes funds for brain disorder research. 1990s A new generation of anti-psychotic drugs is introduced. These drugs prove to be more effective in treating schizophrenia and have fewer side effects. 1992 A survey of American jails reports that 7.2 percent of inmates are overtly and seriously mentally ill, meaning that 100,000 seriously mentally ill people have been incarcerated. Over a quarter of them are held without charges, often awaiting a bed in a psychiatric hospital.

NAMI Fact Sheet on Cognitive Behavior Therapy

(Image source - http://psychologist-nh.com/wp-content/uploads/2011/10/Cognitive-Behavioral-Therapy-5A.png)

What is Cognitive Behavioral Therapy?

Cognitive behavioral therapy (CBT) is a form of treatment that focuses on examining the
relationships between thoughts, feelings and behaviors. By exploring patterns of thinking
that lead to self-destructive actions and the beliefs that direct these thoughts, people with
mental illness can modify their patterns of thinking to improve coping. CBT is a type of
psychotherapy that is different from traditional psychodynamic psychotherapy in that the
therapist and the patient will actively work together to help the patient recover from their
mental illness. People who seek CBT can expect their therapist to be problem-focused, and
goal-directed in addressing the challenging symptoms of mental illnesses. Because CBT is
an active intervention, one can also expect to do homework or practice outside of sessions.

A person who is depressed may have the belief, "I am worthless," and a person with panic
disorder may have the belief, "I am in danger." While the person in distress likely believes
these to be ultimate truths, with a therapist’s help, the individual is encouraged to challenge
these irrational beliefs. Part of this process involves viewing such negative beliefs as
hypotheses rather than facts and to test out such beliefs by “running experiments.”

Furthermore, people who are participating in CBT are encouraged to monitor and write down
the thoughts that pop into their minds (called "automatic thoughts"). This allows the patient
and their therapist to search for patterns in their thinking that can cause them to have
negative thoughts which can lead to negative feelings and self-destructive behaviors.


When is CBT used as a form of therapy?

Scientific studies of CBT have demonstrated its usefulness for a wide variety of mental
illnesses including mood disorders, anxiety disorders, personality disorders, eating
disorders, substance abuse disorders, sleep disorders and psychotic disorders. Studies have
shown that CBT actually changes brain activity in people with mental illnesses who receive
this treatment, suggesting that the brain is actually improving its functioning as a result of
engaging in this form of therapy.

CBT has been shown to be as useful as antidepressant medications for some individuals
with depression and may be superior in preventing relapse of symptoms. Patients receiving
CBT for depression are encouraged to schedule positive activities into their daily calendars
in order to increase the amount of pleasure they experience. In addition, depressed patients
learn how to change (“restructure”) negative thought patterns in order to interpret their
environment in a less negatively-biased way. As regular sleep has been found to be very
important in both depression and bipolar disorder, therapists will also target sleeping
patterns to improve and regulate sleep schedules with their patients. Studies indicate that
patients who receive CBT in addition to treatment with medication have better outcomes
than patients who do not receive CBT as an additional treatment.

CBT is also a useful treatment for anxiety disorders. Patients who experience persistent
panic attacks are encouraged to test out beliefs they have related to such attacks, which
can include specific fears related to bodily sensations, and to develop more realistic
responses to their experiences. This is beneficial in decreasing both the frequency and
intensity of panic attacks. Patients who experience obsessions and compulsions are guided
to expose themselves to what they fear in a safe and controlled therapeutic environment.
Beliefs surrounding their fears (of contamination, illness, inflicting harm, etc.) are identified
and changed to decrease the anxiety connected with such fears.

The same is true for people with phobias, including phobias of animals or phobias of
evaluation by others (termed Social Anxiety Disorder). Those in treatment are exposed to
what they fear and beliefs that have served to maintain such fears are targeted for
modification. CBT is often referred to as a “first line treatment” in many anxiety disorders
including generalized anxiety disorder, posttraumatic stress disorder, panic disorder, and
obsessive-compulsive disorder and specific phobias.

Over the past two decades, CBT for schizophrenia has received considerable attention in the
United Kingdom and elsewhere abroad. While this treatment continues to develop in the
United States, the results from studies in the United Kingdom and other countries have
encouraged therapists in the U.S. to incorporate this treatment into their own practices. In
this treatment, often referred to as Cognitive Behavioral Therapy for Psychosis (CBT-P),
patients are encouraged to identify their own delusional or paranoid beliefs and to explore
how these beliefs negatively impact their lives.

Therapists will then help patients to engage in experiments to test these beliefs. Treatment
focuses on thought patterns that cause distress and also on developing more realistic
interpretations of events. Delusions are treated by developing an understanding of the kind
of evidence that a person uses to support their beliefs and encouraging them to recognize
evidence that may have been overlooked, evidence that does not support the belief. For
example, a person who thinks that they are being videotaped by aliens may feel less worried
when their therapist helps them to discover that there are no hidden cameras in the waiting
room, or that a television remote does not contain any Alien technology within it.

CBT’s focus on thoughts and beliefs is applicable to a wide variety of symptoms. While the
above summary is certainly not comprehensive, it provides an overview of the principles of
CBT and how they apply to the treatment of various mental illnesses. Because CBT has
excellent scientific data supporting its use in the clinical treatment of mental illness, it has
achieved wide popularity both for therapists and patients alike. A growing number of
psychologists, psychiatrists, social workers, and psychiatric nurses have training in CBT.


Reviewed by Ken Duckworth, M.D., and Jacob L. Freedman, M.D., July 2012
NAMI • The National Alliance on Mental Illness • 1 (800) 950-NAMI • www.nami.org
3803 N. Fairfax Drive, Suite 100, Arlington, Va. 22203

NAMI Publications on Schizophrenia

Schizophrenia is a serious mental illness that affects more than 2 million adult American men and women. While the condition is rare in childhood, it can begin onset in the mid- to late teen years. Reading this brochure is an important first step to answering your questions and understanding recovery for people living with schizophrenia.

People living with schizophrenia have talents, goals and feelings just like anyone else. But, if left untreated, their illness can have a profoundly negative effect on their own lives, their families and their communities. Because the illness may cause unusual, inappropriate and sometimes unpredictable and disorganized behavior, people who are not effectively treated are often shunned and can become the targets of social prejudice. People living with schizophrenia may also face poverty, homelessness and high risk for suicide.

Lack of services has left many people living with schizophrenia inappropriately placed in jails and prisons. Medication, rehabilitation and other community-based supports can often help people living with schizophrenia lead meaningful, satisfying lives.

This brochure will explain the symptoms, discuss treatment options and explore the latest in schizophrenia research. You’ll also find information on where you can turn for medical care and find the support needed to manage this persistent illness.

Stay up-to-date on emerging research and treatments at www.nami.org/research.

The National Alliance on Mental Illness (NAMI) is the nation's largest

grassroots mental health organization dedicated to building better lives

for the millions of Americans affected by mental illness. NAMI has more

than 1,100 State Organizations and Affiliates across the country that

engage in advocacy, research, support and education. Members are

families, friends and people living with mental illnesses such as major

depression, schizophrenia, bipolar disorder, obsessive compulsive disorder

(OCD), panic disorder, posttraumatic stress disorder (PTSD) and borderline

personality disorder.

Written by Ken Duckworth, M.D. with additional input by Irving

Gottesman, Ph.D., and Charles Schulz, M.D. Copyright 2011 by the

National Alliance on Mental Illness. Copies of this publication can be

purchased at www.nami.org/store.

NAMI, 3803 N. Fairfax Dr., Suite 100, Arlington VA 22203

www.nami.org

HelpLine: 1 (800) 950-NAMI (6264)

Twitter: NAMICommunicate

Facebook: www.facebook.com/officialnami

Source - http://www.nami.org/Template.cfm?Section=Schizophrenia9&Template=/ContentManagement/ContentDisplay.cfm&ContentID=118290



Source - http://www.nami.org/SchizophreniaSurvey/SchizeExecSummary.pdf 

The survey results also reveal major gaps between what the public believes to be true about

schizophrenia, what science tell us, and the real experiences and realities of individuals affected by

the illness.

• Early intervention and treatment are critical to preventing long-term effects of the illness,
but there is an enormous delay, averaging 8.5 years, between first experiencing symptoms to
receiving treatment for schizophrenia.

• Many people with schizophrenia report that they have difficulty accessing other healthcare
services and do not receive proper attention to other health concerns; this may be one
reason why people with schizophrenia die on average 25 years sooner than the general
population.3

• Public familiarity with schizophrenia is low, and public concern and fear is high. People
recognize that it is a medical illness and that treatment works, presenting a paradox relative
to attitudes.
• The public feels differently about people in treatment than it feels about people not in
treatment; but still, to a large degree, people don’t want to date, work for, or work with
people with schizophrenia.

• Caregivers face many challenges in caring for their loved ones, both in terms of making sure
the person they care for has access to treatment and services, as well as taking care of
themselves. They report that they often feel isolated, lonely, worried, and burned out.

• Access to appropriate medications and services remains elusive for many, if not most,
families and individuals.

• In spite of the tremendous hardship of the personal experience, the resilience of the human
spirit emerges as one of hope, faith, and triumph for many.

Finally, NAMI’s analysis offers recommendations that narrow the knowledge gap by dispelling myths and promoting understanding and the potential for recovery:

• Increase public education and awareness

• Close the gap between onset of symptoms and treatment

• Provide ready access to primary healthcare

• Increase access to treatment and services, including housing

• Ensure education and support for families and individuals living with schizophrenia

• Invest in scientific and medical research advances

We must make a commitment to individual dignity and recognize that with proper treatment,

services, and supports, horizons for people living with the illness can be restored. It is time to make

recovery real.

Source - http://www.nami.org/SchizophreniaSurvey/SchizophreniaAttitudesandAwareness.pdf

Specifically, this research seeks to:

•  Identify gaps in knowledge and understanding among the general adult public
•  Establish a baseline of attitudes toward the illness and those living with it
•  Understand the experiences of caregivers and individuals living with schizophrenia
•  Identify areas where more or better services are needed for those living with schizophrenia

The results of this study will be used by NAMI to help raise awareness about schizophrenia with the goal of reducing the stigma associated with this condition and improve the care available to those living with it.

NIH on Schizophrenia

                     Image source - http://www.nlm.nih.gov/medlineplus/ency/imagepages/17239.htm

Schizophrenia is a serious brain illness. People who have it may hear voices that aren't there. They may think other people are trying to hurt them. Sometimes they don't make sense when they talk. The disorder makes it hard for them to keep a job or take care of themselves.

Symptoms of schizophrenia usually start between ages 16 and 30. Men often develop symptoms at a younger age than women. People usually do not get schizophrenia after age 45. There are three types of symptoms:

• Psychotic symptoms distort a person's thinking. These include hallucinations (hearing or seeing things that are not there), delusions (beliefs that are not true), trouble organizing thoughts, and strange movements.
• "Negative" symptoms make it difficult to show emotions and to function normally. A person may seem depressed and withdrawn.
• Cognitive symptoms affect the thought process. These include trouble using information, making decisions, and paying attention.

No one is sure what causes schizophrenia. Your genes, environment, and brain chemistry may play a role.

There is no cure. Medicine can help control many of the symptoms. You may need to try different medicines to see which works best. You should stay on your medicine for as long as your doctor recommends. Additional treatments can help you deal with your illness from day to day. These include therapy, family education, rehabilitation, and skills training.

NIH: National Institute of Mental Health

Source - http://www.nlm.nih.gov/medlineplus/schizophrenia.html

Additional link - http://www.nlm.nih.gov/medlineplus/ency/article/000928.htm 

ICD 10 on Schizophrenia, Schizotypal and Delusional Disorders

                     
                   Image source http://www.imcanz.com.au/Images/community/Schizophrenia.jpg

International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) Version for 2010

Chapter V
Mental and behavioural disorders
(F00-F99)

Schizophrenia, schizotypal and delusional disorders
(F20-F29)

This block brings together schizophrenia, as the most important member of the group, schizotypal disorder, persistent delusional disorders, and a larger group of acute and transient psychotic disorders. Schizoaffective disorders have been retained here in spite of their controversial nature.

F20Schizophrenia

The schizophrenic disorders are characterized in general by fundamental and characteristic distortions of thinking and perception, and affects that are inappropriate or blunted. Clear consciousness and intellectual capacity are usually maintained although certain cognitive deficits may evolve in the course of time. The most important psychopathological phenomena include thought echo; thought insertion or withdrawal; thought broadcasting; delusional perception and delusions of control; influence or passivity; hallucinatory voices commenting or discussing the patient in the third person; thought disorders and negative symptoms.

The course of schizophrenic disorders can be either continuous, or episodic with progressive or stable deficit, or there can be one or more episodes with complete or incomplete remission. The diagnosis of schizophrenia should not be made in the presence of extensive depressive or manic symptoms unless it is clear that schizophrenic symptoms antedate the affective disturbance. Nor should schizophrenia be diagnosed in the presence of overt brain disease or during states of drug intoxication or withdrawal. Similar disorders developing in the presence of epilepsy or other brain disease should be classified under F06.2, and those induced by psychoactive substances under F10-F19 with common fourth character .5.

Excl.:

schizophrenia:

• acute (undifferentiated) (F23.2)
• cyclic (F25.2)

schizophrenic reaction (F23.2)

schizotypal disorder (F21)

F20.0Paranoid schizophrenia

Paranoid schizophrenia is dominated by relatively stable, often paranoid delusions, usually accompanied by hallucinations, particularly of the auditory variety, and perceptual disturbances. Disturbances of affect, volition and speech, and catatonic symptoms, are either absent or relatively inconspicuous.

Paraphrenic schizophrenia

Excl.:

involutional paranoid state (F22.8)

paranoia (F22.0)

F20.1Hebephrenic schizophrenia

A form of schizophrenia in which affective changes are prominent, delusions and hallucinations fleeting and fragmentary, behaviour irresponsible and unpredictable, and mannerisms common. The mood is shallow and inappropriate, thought is disorganized, and speech is incoherent. There is a tendency to social isolation. Usually the prognosis is poor because of the rapid development of "negative" symptoms, particularly flattening of affect and loss of volition. Hebephrenia should normally be diagnosed only in adolescents or young adults.

Disorganized schizophrenia

Hebephrenia

F20.2Catatonic schizophrenia

Catatonic schizophrenia is dominated by prominent psychomotor disturbances that may alternate between extremes such as hyperkinesis and stupor, or automatic obedience and negativism. Constrained attitudes and postures may be maintained for long periods. Episodes of violent excitement may be a striking feature of the condition. The catatonic phenomena may be combined with a dream-like (oneiroid) state with vivid scenic hallucinations.

Catatonic stupor

Schizophrenic:

• catalepsy
• catatonia
• flexibilitas cerea

F20.3Undifferentiated schizophrenia

Psychotic conditions meeting the general diagnostic criteria for schizophrenia but not conforming to any of the subtypes in F20.0-F20.2, or exhibiting the features of more than one of them without a clear predominance of a particular set of diagnostic characteristics.

Atypical schizophrenia

Excl.:

acute schizophrenia-like psychotic disorder (F23.2)

chronic undifferentiated schizophrenia (F20.5)

post-schizophrenic depression (F20.4)

F20.4Post-schizophrenic depression

A depressive episode, which may be prolonged, arising in the aftermath of a schizophrenic illness. Some schizophrenic symptoms, either "positive" or "negative", must still be present but they no longer dominate the clinical picture. These depressive states are associated with an increased risk of suicide. If the patient no longer has any schizophrenic symptoms, a depressive episode should be diagnosed (F32.-). If schizophrenic symptoms are still florid and prominent, the diagnosis should remain that of the appropriate schizophrenic subtype (F20.0-F20.3).

F20.5Residual schizophrenia

A chronic stage in the development of a schizophrenic illness in which there has been a clear progression from an early stage to a later stage characterized by long- term, though not necessarily irreversible, "negative" symptoms, e.g. psychomotor slowing; underactivity; blunting of affect; passivity and lack of initiative; poverty of quantity or content of speech; poor nonverbal communication by facial expression, eye contact, voice modulation and posture; poor self-care and social performance.

Chronic undifferentiated schizophrenia

Restzustand (schizophrenic)

Schizophrenic residual state

F20.6Simple schizophrenia

A disorder in which there is an insidious but progressive development of oddities of conduct, inability to meet the demands of society, and decline in total performance. The characteristic negative features of residual schizophrenia (e.g. blunting of affect and loss of volition) develop without being preceded by any overt psychotic symptoms.

F20.8Other schizophrenia

Cenesthopathic schizophrenia

Schizophreniform:

• disorder NOS
• psychosis NOS

Excl.:

brief schizophreniform disorders (F23.2)

F20.9Schizophrenia, unspecified

F21Schizotypal disorder

A disorder characterized by eccentric behaviour and anomalies of thinking and affect which resemble those seen in schizophrenia, though no definite and characteristic schizophrenic anomalies occur at any stage. The symptoms may include a cold or inappropriate affect; anhedonia; odd or eccentric behaviour; a tendency to social withdrawal; paranoid or bizarre ideas not amounting to true delusions; obsessive ruminations; thought disorder and perceptual disturbances; occasional transient quasi-psychotic episodes with intense illusions, auditory or other hallucinations, and delusion-like ideas, usually occurring without external provocation. There is no definite onset and evolution and course are usually those of a personality disorder.

Incl.:

Latent schizophrenic reaction

Schizophrenia:

• borderline
• latent
• prepsychotic
• prodromal
• pseudoneurotic
• pseudopsychopathic

Schizotypal personality disorder

Excl.:

Asperger syndrome (F84.5)

schizoid personality disorder (F60.1)

F22Persistent delusional disorders

Includes a variety of disorders in which long-standing delusions constitute the only, or the most conspicuous, clinical characteristic and which cannot be classified as organic, schizophrenic or affective. Delusional disorders that have lasted for less than a few months should be classified, at least temporarily, under F23.-.

F22.0Delusional disorder

A disorder characterized by the development either of a single delusion or of a set of related delusions that are usually persistent and sometimes lifelong. The content of the delusion or delusions is very variable. Clear and persistent auditory hallucinations (voices), schizophrenic symptoms such as delusions of control and marked blunting of affect, and definite evidence of brain disease are all incompatible with this diagnosis. However, the presence of occasional or transitory auditory hallucinations, particularly in elderly patients, does not rule out this diagnosis, provided that they are not typically schizophrenic and form only a small part of the overall clinical picture.

Paranoia

Paranoid:

• psychosis
• state

Paraphrenia (late)

Sensitiver Beziehungswahn

Excl.:

paranoid:

• personality disorder (F60.0)
• psychosis, psychogenic (F23.3)
• reaction (F23.3)
• schizophrenia (F20.0)

F22.8Other persistent delusional disorders

Disorders in which the delusion or delusions are accompanied by persistent hallucinatory voices or by schizophrenic symptoms that do not justify a diagnosis of schizophrenia (F20.-).

Delusional dysmorphophobia

Involutional paranoid state

Paranoia querulans

F22.9Persistent delusional disorder, unspecified

F23Acute and transient psychotic disorders

A heterogeneous group of disorders characterized by the acute onset of psychotic symptoms such as delusions, hallucinations, and perceptual disturbances, and by the severe disruption of ordinary behaviour. Acute onset is defined as a crescendo development of a clearly abnormal clinical picture in about two weeks or less. For these disorders there is no evidence of organic causation. Perplexity and puzzlement are often present but disorientation for time, place and person is not persistent or severe enough to justify a diagnosis of organically caused delirium (F05.-). Complete recovery usually occurs within a few months, often within a few weeks or even days. If the disorder persists, a change in classification will be necessary. The disorder may or may not be associated with acute stress, defined as usually stressful events preceding the onset by one to two weeks.

F23.0Acute polymorphic psychotic disorder without symptoms of schizophrenia

An acute psychotic disorder in which hallucinations, delusions or perceptual disturbances are obvious but markedly variable, changing from day to day or even from hour to hour. Emotional turmoil with intense transient feelings of happiness or ecstasy, or anxiety and irritability, is also frequently present. The polymorphism and instability are characteristic for the overall clinical picture and the psychotic features do not justify a diagnosis of schizophrenia (F20.-). These disorders often have an abrupt onset, developing rapidly within a few days, and they frequently show a rapid resolution of symptoms with no recurrence. If the symptoms persist the diagnosis should be changed to persistent delusional disorder (F22.-).

Bouffée délirante without symptoms of schizophrenia or unspecified

Cycloid psychosis without symptoms of schizophrenia or unspecified

F23.1Acute polymorphic psychotic disorder with symptoms of schizophrenia

An acute psychotic disorder in which the polymorphic and unstable clinical picture is present, as described in F23.0; despite this instability, however, some symptoms typical of schizophrenia are also in evidence for the majority of the time. If the schizophrenic symptoms persist the diagnosis should be changed to schizophrenia (F20.-).

Bouffée délirante with symptoms of schizophrenia

Cycloid psychosis with symptoms of schizophrenia

F23.2Acute schizophrenia-like psychotic disorder

An acute psychotic disorder in which the psychotic symptoms are comparatively stable and justify a diagnosis of schizophrenia, but have lasted for less than about one month; the polymorphic unstable features, as described in F23.0, are absent. If the schizophrenic symptoms persist the diagnosis should be changed to schizophrenia (F20.-).

Acute (undifferentiated) schizophrenia

Brief schizophreniform:

• disorder
• psychosis

Oneirophrenia

Schizophrenic reaction

Excl.:

organic delusional [schizophrenia-like] disorder (F06.2)

schizophreniform disorders NOS (F20.8)

F23.3Other acute predominantly delusional psychotic disorders

Acute psychotic disorders in which comparatively stable delusions or hallucinations are the main clinical features, but do not justify a diagnosis of schizophrenia (F20.-). If the delusions persist the diagnosis should be changed to persistent delusional disorder (F22.-).

Paranoid reaction

Psychogenic paranoid psychosis

F23.8Other acute and transient psychotic disorders

Any other specified acute psychotic disorders for which there is no evidence of organic causation and which do not justify classification to F23.0-F23.3.

F23.9Acute and transient psychotic disorder, unspecified

Brief reactive psychosis NOS

Reactive psychosis

F24Induced delusional disorder

A delusional disorder shared by two or more people with close emotional links. Only one of the people suffers from a genuine psychotic disorder; the delusions are induced in the other(s) and usually disappear when the people are separated.

Incl.:

Folie à deux

Induced:

• paranoid disorder
• psychotic disorder

F25Schizoaffective disorders

Episodic disorders in which both affective and schizophrenic symptoms are prominent but which do not justify a diagnosis of either schizophrenia or depressive or manic episodes. Other conditions in which affective symptoms are superimposed on a pre-existing schizophrenic illness, or co-exist or alternate with persistent delusional disorders of other kinds, are classified under F20-F29. Mood-incongruent psychotic symptoms in affective disorders do not justify a diagnosis of schizoaffective disorder.

F25.0Schizoaffective disorder, manic type

A disorder in which both schizophrenic and manic symptoms are prominent so that the episode of illness does not justify a diagnosis of either schizophrenia or a manic episode. This category should be used for both a single episode and a recurrent disorder in which the majority of episodes are schizoaffective, manic type.

Schizoaffective psychosis, manic type

Schizophreniform psychosis, manic type

F25.1Schizoaffective disorder, depressive type

A disorder in which both schizophrenic and depressive symptoms are prominent so that the episode of illness does not justify a diagnosis of either schizophrenia or a depressive episode. This category should be used for both a single episode and a recurrent disorder in which the majority of episodes are schizoaffective, depressive type.

Schizoaffective psychosis, depressive type

Schizophreniform psychosis, depressive type

F25.2Schizoaffective disorder, mixed type

Cyclic schizophrenia

Mixed schizophrenic and affective psychosis

F25.8Other schizoaffective disorders

F25.9Schizoaffective disorder, unspecified

Schizoaffective psychosis NOS

F28Other nonorganic psychotic disorders

Delusional or hallucinatory disorders that do not justify a diagnosis of schizophrenia (F20.-), persistent delusional disorders (F22.-), acute and transient psychotic disorders (F23.-), psychotic types of manic episode (F30.2), or severe depressive episode (F32.3).

Incl.:

Chronic hallucinatory psychosis

F29Unspecified nonorganic psychosis

Incl.:

Psychosis NOS

Excl.:

mental disorder NOS (F99)

organic or symptomatic psychosis NOS (F09)

The Brain A User's Guide to Emotion