DSM-IV Codes for Schizophrenia & Other Psychotic Disorders

Psychotic symptoms have many causes. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) provides specific diagnostic criteria for mental disorders to help clinicians arrive at a correct diagnosis. Schizophrenia and related disorders include various types of psychotic symptoms, as well as other symptoms. A careful evaluation over many sessions helps create a full picture. Determining the cause of psychotic symptoms is vital in developing a treatment plan and predicting outcome.

Definitions

• The term psychosis indicates a loss of touch with reality that usually takes the form of hallucinations and/or delusions. A hallucination is a false sensory impression--i.e., sensing something that doesn't exist. A person with hallucinations might hear voices speaking to him when he is alone in a room. A delusion is a false belief that cannot be explained in a cultural or other context. A person with a delusion might believe aliens are putting thoughts into her head. Many other symptoms are present in psychotic disorders as well.

Symptoms of Schizophrenia

• Patients with schizophrenia have had symptoms for at least six months, with at least a month of two of the following symptoms: delusions, hallucinations, disorganized behavior, disorganized speech and negative symptoms. Disorganized behavior refers to actions that do not appear to be goal-directed or are bizarre, such as reciting the same poem over and over again. Disorganized speech is hard to follow; one thought does not logically follow the next. Negative symptoms are symptoms that take away from the person--lack of speech, lack of emotion and the lack of a will to do anything.

Schizophrenia Subtypes

• Patients with Schizophrenia, Paranoid Type (DSM-IV code 295.30) primarily have persecutory delusions and hallucinations. Delusions and hallucinations are less prominent in patients with Schizophrenia, Disorganized Type (295.10), who instead show negative symptoms and disorganized speech and/or behavior. Patients with Schizophrenia, Catatonic Type (295.20) may show greatly reduced or amplified speech and/or behavior. With Schizophrenia, Undifferentiated Type (295.90), symptoms are present in roughly equal amounts. If psychosis is gone but patients still appear odd, withdrawn or peculiar, Schizophrenia, Residual Type (295.60) may be the diagnosis.

Schizophrenia-Like Disorders

• Three disorders resemble schizophrenia in various ways but differ in severity, duration of illness and presence of mood symptoms. Schizophreniform Disorder (DSM-IV code 295.40) is diagnosed for patients who seem to have schizophrenia but later recover completely; it indicates that a cause for psychosis has not yet been found. Schizoaffective Disorder (295.70) can be seen as a combination of mood disorder and psychosis. Patients with Brief Psychotic Disorder (298.8) have psychotic symptoms for at least a day but return to normal within one month.

Other Psychotic Disorders

• Patients with Delusional Disorder (297.1) have a false belief that is not bizarre, such as the conviction a spouse is cheating. Shared Psychotic Disorder (297.3) is extremely rare; also known as folie à deux, it can be diagnosed when two or more people share a delusion. For people with Psychotic Disorder Due to a Medical Condition (293.8x, where the x will be a 1 if the patient mostly has delusions or a 2 if the patient experiences hallucinations), symptoms are a direct result of the medical problem. The diagnosis Psychotic Disorder Not Otherwise Specified (298.9) is used for other syndromes that do not fit into above categories. Substance-Induced Psychotic Disorder is coded specifically by prominent psychotic symptom, then by substance as follows: 291.5, Delusions, alcohol-related; 292.11, Delusions, other substances; 291.3, Hallucinations, alcohol-related; and 292.12, Hallucinations, other substances.