Schizophrenia Spectrum and Other Psychotic Disorders

Delusional disorder- criterion A

The presence of one (or more) delusions with a duration of 1 month or longer.

Brief Psychotic Disorder – Criterion A (Core Symptoms)

At least one psychotic symptom, and at least one must be 1, 2, or 3:

1. Delusions

2. Hallucinations

3. Disorganized speech (e.g., frequent derailment, incoherence)

4. Grossly disorganized or catatonic behavior

Brief Psychotic Disorder – Criterion B (Duration & Recovery)

• Episode lasts ≥ 1 day but < 1 month

• Disturbance resolves with full return to premorbid level of functioning

Schizophreniform Disorder – Criterion A (Core Symptoms)

Two or more symptoms for a significant part of 1 month (or less if treated), and at least one is 1, 2, or 3:

1. Delusions

2. Hallucinations

3. Disorganized speech (e.g., derailment, incoherence)

4. Grossly disorganized or catatonic behavior

5. Negative symptoms (e.g., diminished emotional expression, avolition)

Schizophreniform Disorder – Criterion B (Duration)

• Episode lasts ≥ 1 month but < 6 months

• If diagnosis is made before recovery or full duration is known, label as “provisional.”

Schizophrenia – Criterion A (Core Symptoms)

Two or more symptoms for a significant part of 1 month (or less if treated), and at least one is 1, 2, or 3:

1. Delusions

2. Hallucinations

3. Disorganized speech (e.g., derailment, incoherence)

4. Grossly disorganized or catatonic behavior

5. Negative symptoms (e.g., diminished emotional expression, avolition)

Schizophrenia – Criterion B (Functional Decline)

For a significant portion of time since onset:

• Functioning in one or more major areas (work, relationships, self-care) is markedly below prior level

• Or, if onset in childhood/adolescence: failure to reach expected interpersonal, academic, or occupational level

Schizophrenia – Criterion C (Duration & Course)

• Continuous disturbance ≥ 6 months

• Includes ≥ 1 month of active-phase symptoms meeting Criterion A (or less if treated)

• Remaining time can be prodromal or residual periods, shown by:

  • Only negative symptoms, or

  • Two or more Criterion A symptoms in attenuated form (e.g., odd beliefs, unusual perceptual experiences)

Schizoaffective Disorder – Criterion A (Core Requirement)

• Uninterrupted period of illness with:

  • A major mood episode (major depressive or manic)
    and

  • Concurrent symptoms meeting Criterion A for schizophrenia

• If major depressive episode is present, it must include depressed mood (Criterion A1)

Schizoaffective Disorder – Criterion B (Psychosis Without Mood)

• There are delusions or hallucinations for ≥ 2 weeks

• Occur without any major mood episode (no depressive or manic episode)

• This must happen at some point during the illness

Schizoaffective Disorder – Criterion C (Mood Episode Proportion)

• Symptoms meeting criteria for a major mood episode (depressive or manic) are present for the majority of the total duration of the active + residual phases of the illness.

HiTOP – Psychotic Disorders & Schizoaffective Disorder

• Psychotic disorders (e.g., schizophrenia, schizophreniform, brief psychotic disorder)

  • Load primarily on the Thought Disorder spectrum in HiTOP

  • Core features: delusions, hallucinations, disorganization, and related cognitive/perceptual abnormalities

• Schizoaffective disorder

  • Also loads on Thought Disorder, plus a mood component

  • Mood component: Mania (and/or depression), reflecting overlap with the Bipolar/Mania subfactor

  • Thus combines Thought Disorder + Mania (and/or depressive) dimensions