ICD Diagnosis
Symptoms should be present for most of the time lasting for at least one month at some time during most days:
(1) At least one of the following must be present:
(a) thought echo, thought insertion or withdrawal, or thought broadcasting;
(b) Delusions of control, influence, or passivity; delusional perceptions
(c) Hallucinatory voices: running commentary, discussion on patients, or coming from some other part of the body
(d) Persistent delusions of other kinds that are culturally inappropriate or impossible
(2) Or at least two of the following:
(a) Persistent hallucinations in any modality accompanied by half-formed delusions or overvalued ideas
(b) Neologisms, breaks, or interpolations in the train of thought, resulting in incoherence or irrelevant speech
(c) Catatonic behaviour
(d) Negative symptoms – apathy, paucity of speech, blunting or incongruity of emotional responses (it must be clear that these are not due to depression or to neuroleptic medication).
Exclusion clauses:
If showing manic or depressive episodes criteria must be met before the mood disturbance developed.
Not due to substances.
DSM Diagnosis
(A) Characteristic symptoms: Two or more of the following, each present for a significant portion of time during a 1-month period:
- Delusions
- Hallucinations
- Disorganised speech (e.g. frequent derailment or incoherence)
- Grossly disorganised or catatonic behaviour
- Negative symptoms, i.e. affective flattening, alogia or avolition
Only one Criterion A is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person’s behaviour or thoughts, or two or move voices conversing with each other.
(B) Social/ occupational dysfunction: For a significant portion of time since the onset of the disturbance, one or more areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset, or failure to achieve expected levels of achievement.
(C) Duration: Continuous signs of the disturbance persist for at least 6 months, which must include at least 1 month of symptoms that meet Criterion A and may include periods of prodromal or residual symptoms. During these periods, the signs of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in Criterion A present in an attenuated form.
(D) Exclusion of Schizoaffective and Mood Disorders.
(E) Exclusion of substance effects of a general medical condition.
(F) Relationship to a Pervasive Developmental Disorder: If there is a history of Autistic Disorder or another Pervasive Developmental Disorder, the additional diagnosis of Schizophrenia is made only id prominent delusions or hallucinations are also present for at least a month.
Type 1: Episodic, mainly positive
Type 2: Chronic, mainly negative
Positive symptoms- Positive symptoms reflect and excess or distortion of normal functions. They are an addition to the individuals behaviour.
Negative symptoms- Negative symptoms appear to reflect a diminution or loss of normal functions. They are associated with social withdrawal, apathy and indifference to personal welfare and hygiene.
Delusions- Bizarre beliefs that seem real to the person, but are not real. These can sometimes be paranoid in nature. They may involve inflated beliefs about the person’s power and importance. Delusions of reference involve the belief that the behaviour or comments of others are meant for them alone.
Experiences of control- They may believe they are under control of an alien force that has invaded their mind and/ or body. May be interpreted as the presence of spirits or implanted radio transmitters.
Hallucinations- Bizarre, unreal perceptions of the environment that are usually auditory, but may be visual, olfactory or tactile.
Disordered thinking- The feeling that thought have been inserted or withdrawn from the mind. They may believe their thoughts are being broadcast so that others can hear them. Tangential, incoherent or loosely associated speech is used as an indicator of disordered thinking.
Affective flattening- Reduction in the range and intensity of emotion expression including facial expression, voice tone, eye contact and body language.
Alogia- Poverty of speech, characterised by the lessening of speech fluency and productivity, thought to reflect slowing or blocked thoughts.
Avolition- Reduction of, or inability to initiate and persist in goal-directed behaviour, often mistaken for apparent disinterest.
Catatonic- Bizarre/ stiff movements and postures.