What is Schizophrenia
Schizophrenia is a chronic brain disorder that alters the way an individual feels, thinks, and perceives.
The immense detachment between fact and fiction causes the individual with the disorder to endure a massive withdrawal from reality and personal relationships.
Additionally, the constant disconnection leads the individual to act out inappropriately and experience delusions that catapult them into a fantasy world, creating further separation.
The psychotic disorder has an array of behavioral, emotional, and cognitive symptoms. The range of these symptoms in conjunction with the fact that there’s not a simple lab test to conclude if an individual has schizophrenia makes the disorder difficult to diagnose.
The trademark characteristic of schizophrenia is psychosis.
Psychosis is a mental disorder in which the thoughts of individuals are impaired such a degree that they have lost contact with their external reality. Individuals with psychosis or experiencing a psychosis episode often find it impossible to distinguish what is real from what is fake.
In this case, individuals with schizophrenia often experience psychosis in the form of auditory hallucinations, such as voices in their heads, and delusions, such as false beliefs under the perception that they are true.
Symptoms of Schizophrenia – 4 Domains
Furthermore, four domains can classify schizophrenia symptoms.
Hallucinations, primarily auditory, delusions, and disorganized speech and behavior are among the psychotic manifestations that fall under the domain of positive symptoms.
Negative symptoms involve a significant decrease in emotional range and an extreme loss of interest or initiative for things the individual may have once found fulfilling. Additionally, the negative symptoms may involve a lack of communication.
Cognitive symptoms involve neurocognitive deficits. For example, a deficit in memory function or the ability to pay attention or organize. Additionally, cognitive symptoms include trouble in distinguishing nuances and social and interpersonal cues.
An individual showing mood symptoms may be incredibly happy or sad without explanation as to why. For this reason, patients with mood symptoms often suffer from depression.
What is the DSM
Published by the American Psychiatric Association, the DMS is the abbreviation for the Diagnostic and Statistical Manual of Mental Disorders.
The Diagnostic and Statistical Manual of Mental Disorders is a source for the common language and standard criteria for categorizing mental disorders. Therefore, it is widely used by psychiatrists in the United States to aid in diagnosing patients.
The Diagnostic and Statistical Manual of Mental Disorders exists in order to make sure that each diagnosis given by a psychiatric professional was scientifically valid.
For decades there was serious concern that psychiatric diagnosis was solely at the whims of the medical professional. For this reason, a patient may receive two very different diagnoses from two different practitioners. Therefore, the varying diagnoses would ultimately result in varying medication and treatment plans.
The DSM aimed to eliminate this issue as well as prevent future misdiagnoses.
DSM 5 Schizophrenia Changes
The DSM was originally published in 1952 with data from psychiatric hospitals and mental health clinicians. Luckily (and obviously necessary), there have been multiple revisions to the DSM since its first publication.
The latest incarnation of the DSM is the DSM-5. Finalized in December 2012, the DSM-5 was released in May 2013. While the DSM-5 has approximately the same number of conditions as DSM-4, several major changes have been made.
Elimination of Schizophrenia Subtypes
Perhaps the most substantial change in the DSM-5 in regards to schizophrenia is the removal of schizophrenia subtypes.
The American Psychiatric Association (APA) eliminated the following subtypes of schizophrenia:
The elimination of the subtypes is due to the fact that they have not proved to be helpful for treatment or added to scientific validity or reliability.
Catatonic Specifiers and New Catatonic Categories
Catatonia is defined as an abnormal neuropsychiatric condition. It affects behavioral and motor function. For this reason, catatonia results in a total unresponsiveness in an individual who appears awake.
While the catatonia subtype has been eliminated, a catatonic specifier has been added. Practitioners use this specifier with depressive disorder, bipolar disorder, and psychotic disorders.
In DSM-5, catatonia is a separate diagnostic feature. The change stems from the realization that catatonia may exist without necessarily indicating psychosis because it cuts across several broad categories disorders.
Furthermore, there are now three types of catatonia. These types include catatonia disorder that is linked to a mental disorder, and the two new categories: Catatonic Disorder due to Another Medical Condition and Other Unspecified Catatonia Disorder.
The Other Unspecified Catatonia Disorder is used when the medical professional does not know whether the catatonia is linked to depression, bipolar, psychotic, or medical conditions.
The DSM-5 manual requires 3 of the 12 symptoms of catatonia for all four of the conditions (depression, bipolar, psychotic, and medical) in order to make a diagnosis.
Conversely, in the DSM-4 manual, medical conditions only required 1 of 5 symptom sets and psychotic disorders and mood disorders only required 2 out of 5 symptom sets.
Schizophrenia Symptom Criteria Changes
There were several issues with the lack of specificity in DSM-4. Therefore, the criteria changes involve adding clarity to words like “substantial” and reducing cultural biases and confusion by eliminating words such as “bizarre.”
There are five key symptoms of psychotic disorders:
3) Disorganized speech
4) Disorganized or catatonic behavior
5) Negative symptoms
In DSM-5, two of the five symptoms are required and one of them has to be from the first three symptoms (delusions, hallucinations, disorganized speech).
Whereas in DSM-4, only one of the five symptoms was required if the symptom was “bizarre.” Eliminating this phrasing was necessary as it’s difficult to decipher exactly what constitutes as “bizarre.”
Schizoaffective disorder links mood and psychosis.
The DSM-5 manual changes the mood episode from having to occur for a “substantial duration” of the illness to needing to occur the majority of the illness.
This change eliminates the vagueness of “substantial.”
Comparable to the changes in the schizophrenia diagnostic criteria, in DSM-5 the “non-bizarre” requirement no longer exists.
In the DSM-5 there is a new exclusion criterion that states the individual’s symptoms “must not be better explained by conditions such as obsessive-compulsive or body dysmorphic disorder with absent insight/delusional beliefs.”
Obsessive-Compulsive and Related Disorders
The DSM-5 includes an additional category of disorders known as Obsessive-Compulsive and Related Disorders.
DSM-5 now groups the following disorders together as one known as Obsessive-Compulsive and Related Disorders:
- Body Dysmorphic Disorder
- Trichotillomania (a disorder in which ones pulls out their hair)
Additionally, it adds new diagnoses for hoarding disorder and excoriation (skin picking) disorder.
In grouping these disorders together, the APA hopes that physicians will be able to design better treatment plans and make proper diagnoses.
Additional Changes in the DSM-5
Changes in the Major Sections Outlined
There are three major sections of the DSM-5:
I. Introduction and a clear, thorough guide on how to use the DSM manual.
II. Information on categorical diagnoses.
III. Self-assessment information as well as categories that necessitate further research.
Changes to Section II – Disorders
The entirety of the diagnostic and statistical manual frames the disorders by age, gender, and developmental characteristics.
Additionally, the DSM-5 eliminates the use of the multi-axial system.
The system entailed diagnosing an individual on five different domains known as “axes.”
In the DSM-IV-TR criteria these axes were:
- I: Clinical disorders
- II: Personality disorders or mental retardation
- III: Medical and/or physical symptoms
- IV: Contributing environmental or psychosocial factors
- V: Global assessment of function
After reaching a major clinical disorder diagnosis, the multi-axial system was used in efforts to provide further details. However, it instead created confusion and negatively affected research.
The DSM-5 combines the first three axes. This eliminates specific distinctions between diagnoses which creates a streamline information source for practitioners, researchers, and insurance companies.
While practitioners continue to use the last two axes, they use different tools to reach a proper diagnosis.
Changes in Specific Disorders
In the DSM-4 there were four separate disorders: autistic disorder, Asperger’s disorder, childhood disintegrative disorder, and pervasive developmental disorder.
Whereas the DSM-5 combines these four disorders into one known as Autism Spectrum Disorder (ASD).
Disruptive Mood Dysregulation Disorder
The DSM-5 now refers to childhood bipolar disorder as disruptive mood dysregulation disorder. The disorder can diagnose individuals up to the age of 18.
Attention Deficit Hyperactivity Disorder (ADHD)
The DSM-5 modifies the diagnosis of attention-deficit hyperactivity disorder to indicate that the disorder can remain into adulthood. Furthermore, it states that an individual can have an ADHD diagnosis for the first time once they reach adulthood.
Bereavement Exclusion Removal
Oddly enough, the DSM-4 states that an individual grieving the loss of a loved one cannot be diagnosed with Major Depressive Disorder in the first two months. While it is unclear where this two-month time frame came from, it no longer exists in the DSM-5.
Post-traumatic Stress Disorder (PTSD)
Also, the DSM-5 now includes four major behavioral symptoms of post-traumatic stress disorder.
These four systems are:
- Persistent negative changes in thought process and mood
Additionally, DSM-5 lowers diagnostic thresholds for diagnosing children and adolescents with post-traumatic stress disorder. Also, children under the age of six with the disorder now have separate criteria for diagnosis.
Major and Mild Neurocognitive Disorder
In DSM-5, Major Neurocognitive Disorder includes dementia and the amnestic disorder.
Furthermore, Mild Neurocognitive Disorder now exists. The disorder allows for early detection as well as an early efficient treatment plan.
Other Additions to the DSM-5
While physicians were previously diagnosing patients with the following disorders, they are now “real” diagnoses:
- Binge Eating Disorder
- Premenstrual Dysphoric Disorder
- Hoarding Disorder (now separate from OCD)
Changing for the Better
By and large, the need for consistent revisions is paramount as the world of science and medicine continue to grow, progress, and change.
The fifth edition of the Diagnostic and Statistical Manual aims to aid physicians in reaching accurate, specific diagnoses and improve treatment plans for the individuals needing it most.