Short description of changes in DSM 5 in Schizophrenia Categories.

1. DSM-5 Changes:
Schizophrenia
&
Psychotic Disorders
Diagnostic and Statistical Manual of Mental Disorders,
5th Edition (DSM-5) has a number of changes to
schizophrenia and other psychotic disorders.
Asit Kumar Maurya
Banaras Hindu University
Varanasi, India

2. Schizophrenia
Two changes were made to the primary symptom criteria for
schizophrenia.
1. The first change is the elimination of the special
attribution of bizarre delusions and Schneiderian first-
rank auditory hallucinations (e.g., two or more voices
conversing). In DSM-IV, only one such symptom was
needed to meet the diagnostic requirement for Criterion
A, instead of two of the other listed symptoms.

3. This special attribution was removed due to the
nonspecificity of Schneiderian symptoms and the poor
reliability in distinguishing bizarre from nonbizarre
delusions.
“Therefore, in DSM-5, two Criterion A symptoms
are required for any diagnosis of schizophrenia.”

4. 2. The second change was the requirement for a person to
now have at least one of three “positive” symptoms of
schizophrenia:
• Hallucinatios
• Delusions
• Disorganized speech
The APA believes this helps increase the reliability of a
schizophrenia diagnosis.

5. Schizophrenia subtypes
• Schizophrenia subtypes have been dumped in the DSM-5 because
of their “limited diagnostic stability, low reliability, and poor
validity,” according to the APA. (The old DSM-IV had specified
the following schizophrenia subtypes: paranoid, disorganized,
catatonic, undifferentiated, and residual type.)
• The APA also justified the removal of schizophrenia subtypes
from the DSM-5 because they didn’t appear to help with
providing better targeted treatment, or predicting treatment
response.

6. • The APA proposes that clinicians instead use a “dimensional
approach to rating severity for the core symptoms of
schizophrenia is included in Section III to capture the
important heterogeneity in symptom type and severity
expressed across individuals with psychotic disorders.” Section
III is the new section in the DSM-5 that includes assessments,
as well as diagnoses needing further research.

7. Schizoaffective Disorder
• The biggest change to schizoaffective disorder is that a
major mood episode must be present for a majority of the
time the disorder has been present in the person.
• The APA says this change was made on “both conceptual
and psychometric grounds.
• It makes schizoaffective disorder a longitudinal instead of a
cross-sectional diagnosis — more comparable to
schizophrenia, bipolar disorder, and major depresive
disorder, which are bridged by this condition.

8. • The change was also made to improve the reliability,
diagnostic stability, and validity of this disorder, while
recognizing that the characterization of patients with both
psychotic and mood symptoms, either concurrently or at
different points in their illness, has been a clinical
challenge.”

9. Delusional Disorder
• Mirroring the change in the schizophrenia diagnostic
criteria, delusions in delusion disorder are no longer
required to be of the “non-bizarre” type. A person can
now be diagnosed with delusional disorder with bizarre
delusions, via a new specifier in the DSM-5.
• Delusional disorder is no longer separated from shared
delusional disorder.

10. Catatonia
• In DSM-IV, two out of five symptom clusters were
required if the context was a psychotic or mood disorder,
whereas only one symptom cluster was needed if the
context was a general medical condition. In DSM-5, all
contexts require three catatonic symptoms (from a total of
12 characteristic symptoms).
• In DSM-5, all contexts require three catatonic symptoms
(from a total of 12 characteristic symptoms).

11. • In DSM-5, catatonia may be diagnosed as a specifier for
depressive, bipolar, and psychotic disorders; as a separate
diagnosis in the context of another medical condition; or
as another specified diagnosis.

12. Reference:
• Grohol, J. (2014). DSM-5 Changes: Schizophrenia &
Psychotic Disorders. Psych Central. Retrieved on August 19,
2015, from http://pro.psychcentral.com/dsm-5-changes-
schizophrenia-psychotic-disorders/004336.html
• American Psychiatric Association. (2013). Diagnostic and
statistical manual of mental disorders (5th ed.). Washington,
DC: Author