DSM-IV-TR

DSM-IV stands for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. It is published by American Psychiatric Association. It became a standard method used by the physicians and health professionals both in US and other countries who are dealing with mental health problems.

In the DSM-IV-TR, the guidelines for schizophrenia are located in a chapter that also covers other psychotic disorders (e.g., schizophreniform, schizoaffective, and brief psychotic disorders), to help clinicians differentiate schizophrenia from these conditions.  Other psychiatric and medical conditions that may present with psychotic symptoms — such as Alzheimer’s disease and bipolar disorder are discussed in separate chapters. 

In addition to providing a general description of the symptoms associated with schizophrenia, the DSM-IV-TR provides specific criteria for diagnosing schizophrenia and classifying it into subtypes.  There are 6 criteria, as defined in the DSM-IV-TR, that people must meet to be diagnosed with schizophrenia.  Some criteria describe features that must be present, while others describe conditions that must be ruled out.  The first criterion (A, "characteristic symptoms") states that patients must have at least two of the following five symptoms: 

• delusions
• hallucinations
• disorganized speech
• grossly disorganized or catatonic behavior
• negative symptoms

Note that a person can be diagnosed with schizophrenia without having delusions and hallucinations.  The next two criteria state that the symptoms must seriously impact the person’s social or occupational functioning for a significant portion of time (Criterion B) and must persist for at least 6 months (Criterion C).  The remaining three criteria (D, E, and F) state that the symptoms cannot be due to another psychiatric disorder (e.g., schizoaffective disorder or mood disorder with psychotic features), medical condition (e.g., abuse of a drug or medication), or developmental disorder (e.g., autistic disorder).  The DSM-IV-TR also provides criteria for classifying the course of schizophrenia over time, but only after at least 1 year has elapsed since the initial onset of Criterion A symptoms:

• episodic, with interepisode residual symptoms (episodes are defined as a re-emergence of prominent psychotic symptoms)
• episodic, with no interepisode residual symptoms
• continuous (prominent psychotic symptoms are present throughout the period of observation)
• single episode in partial remission
• single episode in full remission
• other or unspecified pattern

Once a patient has been diagnosed with schizophrenia, clinicians can further refine the diagnosis by classifying the patient into subtypes based on the symptoms that were predominant during their evaluation (e.g., paranoid, disorganized, and catatonic).