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ICD-10 - Schizophrenia

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[From World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. Copyright, World Health Organization, Geneva, 1993.] ...

This overall category includes the common varieties of schizophrenia, together with some less common varieties and closely related disorders.
General criteria for paranoid, hebephrenic, catatonic, and undifferentiated schizophrenia
G1. Either at least one of the syndromes, symptoms, and signs listed under (1) below, or at least two of the symptoms and signs listed under (2) should be present for most of the time during an episode of psychotic illness lasting for at least 1 month (or at some time during most of the days).
  1. At least one of the following must be present:
    1. thought echo, thought insertion or withdrawal, or thought broadcasting;
    2. delusions of control, influence, or passivity, clearly referred to body or limb movements or specific thoughts, actions, or sensations; delusional perception;
    3. hallucinatory voices giving a running commentary on the patient's behavior, or discussing the patient among themselves, or other types of hallucinatory voices coming from some part of the body;
    4. persistent delusions of other kinds that are culturally inappropriate and completely impossible (e.g., being able to control the weather, or being in communication with aliens from another world).
  2. Or at least two of the following:
    1. persistent hallucinations in any modality, when occurring every day for at least 1 month, when accompanied by delusions (which may be fleeting or half-formed) without clear affective content, or when accompanied by persistent overvalued ideas;
    2. neologisms, breaks, or interpolations in the train of thought, resulting in incoherence or irrelevant speech;
    3. catatonic behavior, such as excitement, posturing or waxy flexibility, negativism, mutism, and stupor;
    4. “negative” symptoms, such as marked apathy, paucity of speech, and blunting or incongruity of emotional responses (it must be clear that these are not due to depression or to neuroleptic medication).
G2. Most commonly used exclusion clauses
  1. If the patient also meets criteria for manic episode or depressive episode, the criteria listed under G1(1) and GI(2) above must have been met before the disturbance of mood developed.
  2. The disorder is not attributable to organic brain disease or to alcohol- or drug-related intoxication, dependence, or withdrawal.
Comments
In evaluating the presence of these abnormal subjective experiences and behavior, special care should be taken to avoid false-positive assessments, especially where culturally or subculturally influenced modes of expression and behavior or a subnormal level of intelligence are involved.
Pattern of course
In view of the considerable variation of the course of schizophrenic disorders it may be desirable (especially for research) to specify the pattern of course by using a fifth character. Course should not usually be coded unless there has been a period of observation of at least 1 year.
Continuous
No remission of psychotic symptoms throughout the period of observation.
Episodic with progressive deficit
Progressive development of “negative” symptoms in the intervals between psychotic episodes.
Episodic with stable deficit
Persistent but nonprogressive “negative” symptoms in the intervals between psychotic episodes.
Episodic remittent
Complete or virtually complete remissions between psychotic episodes.
Incomplete remission
Complete remission
Other
Course uncertain, period of observation too short
Paranoid schizophrenia
  1. The general criteria for schizophrenia must be met.
  2. Delusions or hallucinations must be prominent (such as delusions of persecution, reference, exalted birth, special mission, bodily change, or jealousy; threatening or commanding voices, hallucinations of smell or taste, sexual or other bodily sensations).
  3. Flattening or incongruity of affect, catatonic symptoms, or incoherent speech must not dominate the clinical picture, although they may be present to a mild degree.
Hebephrenic schizophrenia
  1. The general criteria for schizophrenia must be met.
  2. Either of the following must be present:
    1. definite and sustained flattening or shallowness of affect;
    2. definite and sustained incongruity or inappropriateness of affect.
  3. Either of the following must be present:
    1. behavior that is aimless and disjointed rather than goal-directed;
    2. definite thought disorder, manifesting as speech that is disjointed, rambling, or incoherent.
  4. Hallucinations or delusions must not dominate the clinical picture, although they may be present to a mild degree.
Catatonic schizophrenia
  1. The general criteria for schizophrenia must eventually be met, although this may not be possible initially if the patient is uncommunicative.
  2. For a period of at least 2 weeks one or more of the following catatonic behaviors must be prominent:
    1. stupor (marked decrease in reactivity to the environment and reduction of spontaneous movements and activity) or mutism;
    2. excitement (apparently purposeless motor activity, not influenced by external stimuli);
    3. posturing (voluntary assumption and maintenance of inappropriate or bizarre postures);
    4. negativism (an apparently motiveless resistance to all instructions or attempts to be moved, or movement in the opposite direction);
    5. rigidity (maintenance of a rigid posture against efforts to be moved);
    6. waxy flexibility (maintenance of limbs and body in externally imposed positions);
    7. command automatism (automatic compliance with instruction).
Undifferentiated schizophrenia
  1. The general criteria for schizophrenia must be met. Either of the following must apply:
    1. insufficient symptoms to meet the criteria for any of the subtypes
    2. so many symptoms that the criteria for more than one of the subtypes listed above are met.
Postschizophrenic depression
  1. The general criteria for schizophrenia must have been met within the past 12 months but are not met at the present time.
  2. One of the conditions in Criterion G1(2) a, b, c, or d for general schizophrenia must still be present.
  3. The depressive symptoms must be sufficiently prolonged, severe, and extensive to meet criteria for at least a mild depressive episode.
Residual schizophrenia
  1. The general criteria for schizophrenia must have been met at some time in the past but are not met at the present time.
  2. At least four of the following “negative” symptoms have been present throughout the previous 12 months:
    1. psychomotor slowing or underactivity;
    2. definite blunting of affect;
    3. passivity and lack of initiative;
    4. poverty of either the quantity or the content of speech;
    5. poor nonverbal communication by facial expression, eye contact, voice modulation, or posture;
    6. poor social performance or self-care.
Simple schizophrenia
  1. There is slow but progressive development, over a period of at least 1 year, of all three of the following:
    1. a significant and consistent change in the overall quality of some aspects of personal behavior, manifest as loss of drive and interests, aimlessness, idleness, a selfabsorbed attitude, and social withdrawal;
    2. gradual appearance and deepening of “negative” symptoms such as marked apathy, paucity of speech, underactivity, blunting of affect, passivity and lack of initiative, and poor nonverbal communication (by facial expression, eye contact, voice modulation, and posture);
    3. marked decline in social, scholastic, or occupational performance.
  2. At no time are there any of the symptoms referred to in criterion G1 for general schizophrenia, nor are there hallucinations or well-formed delusions of any kind; i.e., the individual must never have met the criteria for any other type of schizophrenia or for any other psychotic disorder.
  3. There is no evidence of dementia or an
    [From World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. Copyright, World Health Organization, Geneva, 1993.] ...
    y other organic mental disorder.
Other schizophrenia
Schizophrenia, unspecified



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