in which psychotic symptoms are prominent features of the clinical picture. The grouping of disorders in DSM-5 under this heading includes schizotypal personality disorder, which is not a psychotic disorder but that sometimes precedes full-blown schizophrenia.
Schizophrenia.
Schizophrenia is a chronic disorder in which prominent hallucinations or delusions are usually present. The individual must be ill for at least 6 months, although he or she need not be actively psychotic during all of that time. Three phases of the disorder are recognized by clinicians, although they are not included in DSM-5 as discrete phases. The prodrome phase refers to deterioration in function before the onset of the active psychotic phase. The active phase symptoms (delusions, hallucinations, disorganized speech, grossly disorganized behavior, or negative symptoms such as flat affect, avolition, and alogia) must be present for at least 1 month. The residual phase follows the active phase. The features of the residual and prodromal phases include functional impairment and abnormalities of affect, cognition, and communication. In DSM-IV, schizophrenia was sub typed according to the most prominent symptoms present at the time of the evaluation (paranoid, disorganized, catatonic, undifferentiated, and residual types); however, those subtypes are no longer part of the official DSM-5 nomenclature. Nevertheless, they are phenomenologically accurate, and the authors of Synopsis believe they remain useful descriptions that clinicians will still find helpful when communicating with one another.
Delusional Disorder.
Delusional disorder is characterized by persistent delusions (e.g., erotomanic, grandiose, jealous, persecutory,somatic, mixed, unspecified). In general, the delusions are about situations that could occur in real life such as infidelity, being followed, or having an illness, which are categorized as nonbizarre beliefs. Within this category one finds what was termed in DSM-IV, Shared Delusional Disorder (also known as folie a deux) but which has been renamed delusional symptoms in partner with delusional disorder in DSM-5 and is characterized by a delusional belief that develops in a person who has a close relationship with another person with the delusion, the content of which is similar. Paranoia (a term not included in DSM-5) is a rare condition characterized by the gradual development of an elaborate delusional system, usually with grandiose ideas; it has a chronic course, and the rest of the personality remains intact.
Brief Psychotic Disorder.
Brief psychotic disorder requires the presence of delusions, hallucinations, disorganized speech, grossly disorganized behavior, or catatonic behavior for at least 1 day but less than 1 month. It may be precipitated by an external life stress. After the episodes, the individual returns to his or her usual level of functioning.
Schizophreniform Disorder.
Schizophreniform disorder is characterized by the same active phase symptoms of schizophrenia (delusions, hallucinations, disorganized speech, grossly disorganized behavior, or negative symptoms), but it lasts between 1 and 6 months and has no prodromal or residual phase features of social or occupational impairment.
Schizoaffective Disorder.
Schizoaffective disorder is also characterized by the same active phase symptoms of schizophrenia (delusions, hallucinations, disorganized speech, grossly disorganized behavior, or negative symptoms), as well as the presence of a manic or depressive syndrome that is not brief relative to the duration of the psychosis. Individuals with schizoaffective disorder, in contrast to a mood disorder with psychotic features, have delusions or hallucinations for at least 2 weeks without coexisting prominent mood symptoms.
Substance/Medication-Induced Psychotic Disorder.
These are disorders with symptoms of psychosis caused by psychoactive or other substances (e.g., hallucinogens, cocaine).
Psychotic Disorder Due to Another Medical Condition.
This disorder is characterized by hallucinations or delusions that result from a medical illness (e.g., temporal lobe epilepsy, avitaminosis, meningitis).
Catatonia.
Catatonia is characterized by motor abnormalities such as catalepsy (waxy flexibility), mutism, posturing, and negativism. It can be associated with another mental disorder (e.g., schizophrenia or bipolar disorder) or due to another medical condition (e.g., neoplasm, head trauma, hepatic encephalopathy).
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