Schizophrenia Symptoms

The formal diagnosis of schizophrenia rests on these symptoms, which can be evaluated by psychiatrists and other mental health professionals.

Symptoms of Schizophrenia

The following specific diagnostic criteria are reproduced verbatim (except for codings and page references) from the DSM-IV, the immediate predessor of the current DSM-IV TR (where ‘IV TR’ indicates fourth edition, text revision).

Diagnostic Criteria for Schizophrenia

A. Characteristic symptoms: Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated):

• delusions
• hallucinations
• disorganized speech (e.g., frequent derailment or incoherence)
• grossly disorganized or catatonic behavior
• negative symptoms, i.e., affective flattening, alogia, or avolition

Note: Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person’s behavior or thoughts, or two or more voices conversing with each other.

B. Social/occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement).

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C. Duration: Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual 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 (e.g., odd beliefs, unusual perceptual experiences).

D. Schizoaffective and Mood Disorder exclusion: Schizoaffective Disorder and Mood Disorder With Psychotic Features have been ruled out because either (1) no Major Depressive Episode, Manic Episode, or Mixed Episode have occurred concurrently with the active-phase symptoms; or (2) if mood episodes have occurred during active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods.

E. Substance/general medical condition exclusion: The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or 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 if prominent delusions or hallucinations are also present for at least a month (or less if successfully treated).

Subtypes

1. Paranoid Type

A type of Schizophrenia in which the following criteria are met:

• Preoccupation with one or more delusions or frequent auditory hallucinations.
• None of the following is prominent: disorganized speech, disorganized or catatonic behavior, or flat or inappropriate affect.

2. Catatonic Type

A type of Schizophrenia in which the clinical picture is dominated by at least two of the following:

• motoric immobility as evidenced by catalepsy (including waxy flexibility) or stupor
• excessive motor activity (that is apparently purposeless and not influenced by external stimuli)
• extreme negativism (an apparently motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved) or mutism
• peculiarities of voluntary movement as evidenced by posturing (voluntary assumption of inappropriate or bizarre postures),
• stereotyped movements, prominent mannerisms, or prominent grimacing
• echolalia or echopraxia

3. Disorganized Type

A type of Schizophrenia in which the following criteria are met:

• All of the following are prominent:
  • disorganized speech
  • disorganized behavior
  • flat or inappropriate affect
• The criteria are not met for Catatonic Type.

4. Undifferentiated Type

A type of Schizophrenia in which symptoms that meet Criterion A are present, but the criteria are not met for the Paranoid, Disorganized, or Catatonic Type.

5. Residual Type

A type of Schizophrenia in which the following criteria are met:

• Absence of prominent delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior.
• There is continuing evidence of the disturbance, as indicated by the presence of negative symptoms or two or more symptoms listed in Criterion A for Schizophrenia, present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

Associated features

• Learning Problem
• Hypoactivity
• Psychosis
• Euphoric Mood
• Depressed Mood
• Somatic or Sexual Dysfunction
• Hyperactivity
• Guilt or Obsession
• Sexually Deviant Behavior
• Odd/Eccentric or Suspicious Personality
• Anxious or Fearful or Dependent Personality
• Dramatic or Erratic or Antisocial Personality