What is Schizophrenia according to the DSM- V?

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Dsm 5 Schizophrenia (A Comprehensive Guide)

In this guide, DSM 5 Schizophrenia , symptoms of depression along with the diagnostic criteria, causes, and treatment options for depression will be discussed.

What is Schizophrenia according to the DSM- V?

Schizophrenia is the name given to a complex and often long term/lifelong mental disorder that can impact the ability of a person to think clearly, be in touch or be connected to reality, manage their emotions and their relationship with people, as well as functioning well in society as a contributing member to the economy.

Schizophrenia is just one of several conditions that fall under the spectrum of psychotic disorders and share similar symptoms  with other psychotic disorders. 

The symptoms of schizophrenia fall into three main categories.

Positive Symptoms 

Positive Symptoms which involve things that are present which should not be. These includes

  • Hallucinations: Seeing, hearing, smelling, tasting, or feeling (through touch) things that are not there
  • Delusions: False beliefs that don’t change even when the person is presented with evidence that they are false- which lead to paranoia or irrational fears.
  • Unusual thinking or disorganised speech

Negative Symptoms

Negative symptoms refer to behaviours, thoughts, and feelings that should be present but are not. These might include:

  • Loss of motivation
  • Disinterest or lack of enjoyment in daily life
  • Social withdrawal and reduced speaking
  • Difficulty showing emotions
  • Difficulty planning, beginning, and sustaining activities
  • Difficulty expressing emotions using facial expression or voice tone

Cognitive Symptoms

These symptoms include problems and deficits in processing information to make decisions, using information immediately after learning it, problems focusing or paying attention

The Diagnosis of schizophrenia spectrum disorders is based on the outlining criteria that must be met for a diagnosis of a specific condition as prescribed by the DSM 5.

Schizophrenia is one of the disorders of the schizophrenia spectrum that also includes other psychotic disorders according to the DSM V.These disorders share similarities in symptoms however they are classified differently based on certain factors, such as:

  • Duration of psychotic symptoms 
  • The presence of mood disorder characteristics.

Psychotic disorders on the schizophrenia spectrum include:

  • Schizophrenia
  • Schizoaffective disorder
  • Schizophreniform disorder
  • Brief psychotic disorder
  • Delusional disorder

What is the DSM criteria for Schizophrenia diagnosis?

The Diagnostic and statistical manual of Mental Disorders (5th ed) DSM-V outlines the following criterion to make a diagnosis of Schizophrenia. 

For someone to be diagnosed with schizophrenia they should experience at least two (or more) of the following for a 1-month period:

  • Delusions.
  • Hallucinations.
  • Disorganized speech
  • Grossly disorganized or catatonic behavior.
  • Negative symptoms 

They should also be observed to experience disturbance in functioning in major areas such as work, relationships, self care since the time of onset. 

They also experience setbacks and their functioning is markedly below the level achieved prior to the onset in terms of interpersonal, academic,

or occupational functioning.

These symptoms are continuous and persist for at least 6 months along with a 1 month of symptoms experienced actively- positive and negative or cognitive symptoms. 

During these six months they might also be observed to experience signs of the disturbance manifested by only negative symptoms or by two or more symptoms presented above.

What are the prevalence rates of Schizophrenia according to the DSM-V?

According to the DSM V, the lifetime prevalence of schizophrenia appears to be approximately 0.3%–0.7% as of 2013. In the United States, it is believed to affect around 0.25% to 0.64% of people, according to the National Institute of Mental Health (NIMH). 

There is reported variation in prevalence rates based on race/ethnicity, across countries, and by geographic origin for immigrants and children of immigrants. Research finds that people who are part of minorities tend to have higher risk.

Prevalence rate differences in terms fo sex ration differes across populations. Negative symptoms and longer enduring conditions are observed more in men than women.

While schizophrenia comorbid with mood symptoms and brief presentations

Is observed in both sexs at the same rates. The general incidence of schizophrenia and late onset tends to be slightly more in males in the clinical population. 

What are the Risk factors and comorbidity risks?

According to the DSM 5, some of the risk factors that has been linked with schizophrenia includes:

Environmental factors such as urban versus rural areas where there are higher risks for children who are growing up in urban communities as well as for people who are part of minority ethnic groups. 

Season of birth is also thought to be one of the risk factors where children who are born in late winter or early spring have been linked to the incidence of schizophrenia.

Genetic factors related to the development of schizophrenia are strongly implicated. People who have an immediate relative with schizophrenia such as parents and siblings have about a 10-12% risk of developing the disorder, compared with a 1% risk among people who do not have such family history. 

According to the research reviewed for the DSM 5, vulnerability to the disorder has been found to be linked to a spectrum of risk alleles, common and rare.

However, research till date has found that there is only a small fraction of percentage to which each allele contributes to the development of this disorder. 

Research has also found that the risk alleles identified to date are also associated with other

mental disorders, including bipolar disorder, depression, and autism spectrum disorder.

Prenatal factors such as Pregnancy and birth complications with hypoxia and greater paternal age- where parents are older at the time of conceiving- are associated

with a higher risk of schizophrenia for the foetus. 

Stress, infection, malnutrition, maternal diabetes, and other medical conditions during the prenatal stage have also been found to be linked to schizophrenia. 

Commorbites related to schizophrenia include depressive symptoms or feelings of hopelessness due to functional deficits causing unemployment and social exclusion etc. All of which contributes to high risk of suicide. 

According to the DSM-5, approximately 5%–6% of individuals with schizophrenia die by suicide, about 20% attempt suicide on one or more occasions.

Most of the suicidal behvaiors tend to be a response to hallucinations and sucide ideation tend to remain higher over one’s entire lifespan with higher risk for younger men with comorbid substance use disorders. 

What are the functional consequences of Schizophrenia?

Schizophrenia has a major impact on the function of an individual in terms of their social life as well as their professional or occupational life. 

People who are affected by this condition tend to experience impairment related to their ability to go about their day to day life and symptoms impact their ability to maintain their relationships as well as affect their occupational performance and progress. 

According to the DSM 5, people with schizophrenia tend to struggle with their educational and learning progress and their ability to maintain their jobs is another common consequence of schizophrenia.

This dysfunction is due to the symptomatic manifestation of their disorder such as deficits in cognition, psychotic symptoms, as well as the negative symptoms of schizophrenia all of which impact their ability to meet the demands of their day to day life. 

The DSM also notes that, off the population that has been studied and observed, data notes that people who schizophrenia tend to be employed in lower occupational levels than their parents, tend to have limited social contacts, and tend to not marry. 

What are the treatments available for schizophrenia?

Some of the treatments available for schizophrenia spectrum disorders include:

Antipsychotic drugs

Antipsychotic drugs for the treatment of schizophrenia are divided into conventional antipsychotics and 2nd-generation antipsychotics (SGAs).

SGAs may offer some advantages as they have been clinically observed to have greater efficacy and reduced likelihood of an involuntary movement disorder and related adverse effects. 

However, this class of drugs have some risks in terms of developing metabolic syndrome causing excess abdominal fat, insulin resistance, dyslipidemia, and hypertension as compared to conventional antipsychotics. 

Rehabilitation Services

Interventions that include training and programs aimed to help individuals rehabilitate include skill training and vocational programs to help many patients work and care for themselves.

This training is to help them be able to manage a household; socialise, work with mental health care practitioners, as well as ease their way into the work through supported employment. 

In terms of supported employment, they usually work with job coaches where they are mostly engaged in on-site adaptation and skill training to help them in porblemsolving as well as communicate with their employers.

Community support services

Support services include supervision for patients with schizophrenia that can help them to reside in the community. 

Most people with schizophrenia in treatment can live independently however some might require supervision to ensure safety and adherence to treatment. 

These support services promote patient autonomy while providing sufficient care to minimise the likelihood of relapse and need for inpatient hospitalisation.

In some cases, hospitalisation may be required during severe relapses, and involuntary hospitalisation may be necessary if patients pose a danger to themselves or others.

Psychotherapy

Treatment for schizophrenia along with pharmacological treatment also includes psychotherapy where the goal of psychotherapy in schizophrenia is to develop strategies to help patients manage their symptoms to form routines of care including reducing stress and taking their drugs efficiently and on time. 

These strategies are usually created through a collaborative relationship between the patients, family members, and physician/therapist.

Treatment includes addressing the needs of the patient, providing education and support for the family of the patient, promoting adaptiveness and management skills of their condition. 

This approach involves empathy and understanding of the condition- for both family and patient along with support to adapt to what is often a lifelong illness which is substantially limiting.

Conclusion

In this guide we have discussed the DSM-V criteria for depression and the various risk factors and treatment strategies to help cope with schizophrenia. 

Frequently asked questions related to “DSM 5 Schizophrenia”

What are the 5 major psychiatric disorders?

Five major mental illnesses include autism, attention deficit-hyperactivity disorder, bipolar disorder, major depressive disorder and schizophrenia 

What is brief psychotic disorder?

A person is diagnosed with Brief psychotic disorder when they experience an episode of psychotic behaviour with a sudden onset- meaning that it is not gradual- and the episode  lasts less than a month and is followed by complete remission. 

What is Schizophreniform disorder?

In this disorder, the person exhibits the same symptoms as schizophrenia however unlike schizophrenia, this diagnosis is given to people whose condition lasts less than six months. 

People with thai disorder are further diagnosed with schizophrenia if the symptoms reach the six-month mark even after treatments and interventions.

References

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association, 2013.

Jones.H. What Is the Schizophrenia Spectrum? Verywellmind. Retrieved on 18th March 2022.https://www.verywellhealth.com/schizophrenia-spectrum-and-types-5193053#toc-what-is-schizophrenia

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