DSM Morrison Study Guide

1. Arnold Wilson — Schizophreniform Disorder

Key decision: Psychotic disorder, but not schizophrenia

Core findings

• Auditory hallucinations + delusional beliefs → Criterion A met

• Symptoms present >1 month but <6 months

• No substance use or medical cause

• Functioning not clearly impaired (not required)

Why NOT schizophrenia

• Duration too short

• Functional decline not required for SphD

Why NOT brief psychotic disorder

• Symptoms lasted longer than 1 month

Prognosis reasoning

Good prognosis indicators:

• Abrupt onset

• Good premorbid functioning

• Intact affect

Elisabeth Jacks — Bipolar I Disorder, Manic Episode

Key decision: Mood disorder with psychotic features

Core findings

• ≥1 week of elevated mood

• Reduced sleep, pressured speech, flight of ideas

• Severe impairment → hospitalization

• Grandiose delusion (“I am becoming God”)

Why NOT hypomania

• Severity and impairment, not symptom type

Why NOT psychotic disorder

• Psychotic content occurred within mood episode

• Mood symptoms dominated course

Why NOT cyclothymic disorder

• Presence of full manic episode

Specifiers

• Severe with mood-congruent psychotic features

• With peripartum onset

Final diagnosis

Bipolar I disorder, currently manic

Morrison principle:

Mood course organizes diagnosis

Leighton Prescott — Obsessive–Compulsive Disorder

Key decision: OCD with good insight

Core findings

• Intrusive contamination obsessions

• Repetitive handwashing compulsions

• Hours per day → major impairment

• Recognizes thoughts as unreasonable

Why NOT delusional disorder

• Insight preserved

Why NOT generalized anxiety disorder

• Concerns not about real-life problems

Why NOT OCPD

• Ego-dystonic, resisted behaviors

Specifier

• With good insight

Final diagnosis

Obsessive–compulsive disorder

Morrison principle:

Insight distinguishes obsessions from delusions

5. Rodney Partridge — Alcohol Withdrawal Delirium

Key decision: Delirium, not psychosis

Core findings

• Poor orientation + impaired attention → Criterion A

• Acute onset after heavy alcohol cessation

• Visual hallucinations, agitation, tremor

Why NOT schizophrenia

• Cognitive impairment + acute course

Why no separate psychotic diagnosis

• Psychosis occurred only during delirium

Why delirium supersedes withdrawal

• DSM hierarchy: delirium absorbs withdrawal

Additional diagnosis

• Severe alcohol use disorder

Final diagnosis

Alcohol withdrawal delirium, hyperactive

Morrison principle:

Delirium absorbs psychosis

 Eddie Ortway — Personality Change Due to Head Trauma

Key decision: Personality change due to another medical condition

Core findings

• Abrupt personality shift after gunshot wound

• Apathy, passivity, loss of initiative

• MRI shows brain tissue loss

• Occupational + social impairment

Why NOT personality disorder

• Not lifelong; clear premorbid contrast

Why NOT delirium or dementia

• Normal attention and cognition

Subtype

• Apathetic type

Final diagnosis

Personality change due to head trauma, apathetic type

Morrison principle:

Abrupt change after brain injury overrides personality labels

4. Francine Parfit — Depersonalization/Derealization Disorder

Key decision: Dissociative disorder with intact reality testing

Core findings

• Recurrent depersonalization episodes

• Describes experience “as if” unreal

• No hallucinations or delusions

• Significant distress → help-seeking

Why NOT psychotic disorder

• Reality testing intact

Why NOT panic disorder

• Depersonalization is primary, not secondary to panic

DSM-5 update

• Derealization alone is sufficient

Final diagnosis

Depersonalization/derealization disorder

Morrison principle:

“As if” = intact reality testing