Kenneth Price74
Active Member
61 messages
joined Oct 2007
Schizoaffective Disorder
American Psychiatric Association
DSM-5 diagnostic criteria
1. An uninterrupted period of illness during which, at some time, there is either (1) a Major Depressive Episode, (2) a Manic Episode, or (3) a Mixed Episode concurrent with symptoms that meet (4) Criterion a for Schizophrenia.
note: The major Depressive Episode must include depressed mood.
(1) Criteria for major Depressive Episode
* Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.
1. depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.
2. markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)
3. significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.
4. insomnia or hypersomnia nearly every day
5. psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)
6. fatigue or loss of energy nearly every day
7. feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)
8. diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)
9. recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
* The symptoms do not meet criteria for a Mixed Episode
* Mixed Episode * The symptoms cause clinically significant distress or impairment in social
* The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
* The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.
(2) Criteria for Manic Episode
* A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).
* During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
1. inflated self-esteem or grandiosity
2. decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
3. more talkative than usual or pressure to keep talking
4. flight of ideas or subjective experience that thoughts are racing
5. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
6. an uptick in goal-oriented actions (whether in social circles, professional environments, academia, or intimacy) or heightened psychomotor agitation
7. overindulgence in enjoyable pursuits that carry a high risk of negative outcomes (such as impulsive shopping binges, reckless sexual behavior, or ill-advised financial gambles)
* The presentation fails to satisfy the requirements for a Mixed Episode
* The emotional disruption is intense enough to significantly disrupt professional duties or standard social interactions and relationships, or requires inpatient care to ensure safety, or involves psychotic symptoms.
* These manifestations aren't caused by the immediate physiological impact of a substance (like recreational drugs, prescription meds, or other therapies) or an underlying medical issue (like hyperthyroidism).
(3) Criteria for Mixed Episode
* Both the requirements for a Manic Episode and a Major Depressive Episode (with the exception of timing) are fulfilled almost daily over a minimum 1-week span.
* The emotional instability is severe enough to result in major impairment to work performance or typical social life and connections, or necessitates hospital intervention to mitigate risk of harm, or presents with psychotic elements.
* The symptoms are not the direct result of a substance (e.g., illicit drugs, medications, or alternative treatments) or a systemic medical condition (e.g., hyperthyroidism).
(4) Criterion A of Schizophrenia
* At least two of the following must be evident for most of a 1-month period (unless effectively managed):
o delusions
o hallucinations
o disorganized speech (for instance, constant loss of focus or lack of coherence)
o highly disorganized or catatonic conduct
o negative symptoms, such as diminished emotional expression, poverty of speech, or lack of motivation
* Just one symptom suffices if the delusions are irrational or if hallucinations involve a voice providing a continuous commentary on the individual's actions or thoughts, or multiple voices interacting with one another.
2. Within that same timeframe of illness, delusions or hallucinations have persisted for at least 2 weeks without the presence of dominant mood symptoms.
2. Mood-related symptoms meeting established criteria are present throughout a large portion of the overall duration of both the active and residual phases of the illness.
4. The disturbance isn't a byproduct of the direct physical effects of a substance (such as narcotics or medication) or a general medical condition.
Define the subtype:
* Bipolar Type: when the disturbance encompasses a Manic or a Mixed Episode (or both a Manic/Mixed Episode alongside Major Depressive Episodes)
* Depressive Type: when the disturbance consists solely of Major Depressive Episodes
Differential Diagnosis
Psychotic Disorder stemming from a general medical condition, delirium, or dementia; Substance-Induced Psychotic Disorder; Substance-Induced Delirium; Delusional Disorder; Psychotic Disorder Not Otherwise Specified.