What Criteria Have to Be Met, for the Diagnosis of Psychosis?

Question

Thanks, Dee, I was Begining to Wonder if Anyone Would Respond.

SAMI, So Much of What you Stated is Subjective, So One Can Be Imprisoned On the Basis of Hearsay, a Lack of Due Process, Sounds Like Guantanomo (Sp?) Bay or the Soviet Union, I Think their Should Unequivical Supportive Hard Evidence, Before One is Imprisoned, Not Just Hearsay.

Thanks, K, So Very Far From Being Hard and Fast, Like a Physical Diagnosis.

Dr. Jon, Would you Be Willing to Say that at Least one Symptom has to Be Present, Delusion?

Answer 1

This is a diagnosis made upon meeting specified criteria within the DSM-IV. One would think that its creation entailed a reliance on empirical work. You may already know, but, from what I remember it was devised using a clinical panel.

Furthermore, clinicians relying on these constellations of symptoms aren't forced into keeing abreast of current literature. These criteria are also merely guidelines. I assume though that all organic or physical explanations for symptoms should be ruled out before the label is attached to a person (....although, I KNOW that this is not the current practise of non-psychiatrists who attempt to make the diagnosis of other "emotional disorder" labels--particularly, anxiety and depression).

Sorry I could not be of more help. I will try and see if I can find the DSM-IV later on for you. I will check back...

EDIT:: Can't access it on-line here, but attaching some citations with summaries that might help:

1.Diagnostic and statistical manual of mental disorders : DSM-IV
American Psychiatric Association. Task Force on DSM-IV.

Summary
The product of a Task Force and 13 Work Groups of the American Psychiatric Association, DSM-IV represents the first complete change in DSM in 13 years. In addition to increased clarity, specificity, and clinical utility, it features increased emphasis on the influence of culture and ethnicity on psychiatric assessment and diagnosis; increased emphasis on the role of substance use and general medical conditions in the development of psychiatric disorders; and increased emphasis on how development across the life span influences the presentation and assessment of psychiatric disorders.

Title: Diagnostic and statistical manual of mental disorders : DSM-IV.
Edition: 4th ed.
Publication info: Washington, D.C. : American Psychiatric Association, c1994.
Physical descrip: xxvii, 886 p. ; 26 cm.

2. DSM-IV guidebook
Frances, Allen, 1942-
American Psychiatric Press, c1995. x, 501 p.

Summary
Provides a comprehensive tour through DSM-IV "TM" by the acknowledged experts who were most involved in its development. Covers how and why DSM-IV "TM" developed the way it did and presents a clear road map of the intricacies of the organization of the DSM "TM" diagnostic system.

3. DSM-IV handbook of differential diagnosis
First, Michael B., 1956-
American Psychiatric Press, c1995. xv, 247 p.

Summary
An invaluable addition to DSM-IV Library, this book is a succinct reference to ensure that you consider all the important diagnoses that need to be ruled out during a clinical evaluation. It is a great convenience for busy practitioners and a valuable overview for trainees.

EDIT:: Yeah, I don’t really get it. There has been some study into neurotransmitters and other brain-based explanations for “psychiatric labels” (some of these studies obviously not causal), but even so, diagnosis is typically made through psychological assessment and (in some cases) through the elimination of possible physical conditions. Without “proof” that (for example) one’s neurotransmitters are out of wack though, is there really evidence that the disorder exists?? I don’t know. I have seen docs (GP's, anyhow) diagnose and treat a said disorder whether one exists or not by justifying either ‘diagnosis by treatment’, ‘symptom treatment until underlying cause is determined’, or ‘treat symptoms in order to get to the root of a physical problem (as a moderating approach)’. I don’t have all the answers and I don't know if this is the way we need to go about it for now. I can totally see the flip side of things. But, I don't understand how doctors can actually *diagnose* a disorder then if they are found to be wrong, take it back, but also justify the label as part of the diagnostic process...all the while, without evidence to support that the symptoms were a manifested disorder. How is that fair to a person?? They are taking drugs that may have just masked an underlying problem (or made it worse) and are led to believe they have a psychological disorder. I can see this wrecking people's lives.

EDIT:: DR. JON: Thanx for your answer. The focal abnormality finding is interesting as heck!!

Answer 2

According to the DSM IV Diagnostic Criteria for Psychosis NOS (not otherwise specified) which is kind of a catch all when someone has a psychotic break and initially until further observation or hospitalizations and history can be obtained. There are a few other categories of psychosis like due to a medical condition, substance abuse to name a couple.
The criteria to Dx someone with "Psychosis NOS 298.9
This catergory includes psychotic symptomology I.e., delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior) about which there is inadequate information to make a specific diagnosis or about which there is contradictory information, or disorders with psychotic symptoms that do not meet the criteria for any specific psychotic disorder.
Examples include
1. postpartum psychosis that does not meet criteria for mood disorder with psychotic features, brief psychotic disorder, psychotic disorder due to a general medical condition, or substance-induced psychotic disorder
2. psychotic symptoms taht have lasted for less than one month, but that have not yet remitted, so that the criteria for brief psychotic disorder are not met
3. persistent auditory hallucinations in the absence of any other features
4. persistent nonbizarre delusions with periods of overlapping mood episodes that have been present for a substantial portion of the delusional disturbance
5. situations in which the clinician has concluded that a psychotic disorder is present, but is unable to determine whether it is primary, due to a general medical condition, or substance induced."

Hope this helps!

FYI schizophrenia and all it's varieties fall under it's own diagnostic code and criteria. Pyschosis nos sometimes is used until a more specific diagnosis such as schizophrenia or Bipolar Disorder with psychotic features or numerous other more specific psychotic disorders can be ruled out or pin pointed.

Answer 3

I think you would first have to ask yourself, to be technically correct, what psychosis? The psychotic disorders are numerous and include:
Schizophrenia (and the various types:Paranoid,Disorganized, Catatonic, Undifferentiated, Residual), Schizophreniform Disorder, Schizoaffective Disorder, Delusional Disorder, Brief Psychotic Disorder, Shared Psychotic Disorder, Psychotic Disorder Due to a General Medical Condition, Substance-Induced Psychotic Disorder and my favorite Psychosis NOS.

Strictly speaking: psychosis=A severe mental disorder, with or without organic damage, characterized by derangement of personality and loss of contact with reality and causing deterioration of normal social functioning. (Stedman's)

There is an ICD-9 code for "Uspecified psychosis" but
in general I would give tend to give the diagnosis of brief psychotic disorder, or schizophreniform until >6 months, the diagnostic criteria for schizophrenia could be met.

• At least one positive symptom of psychosis, from the following symptoms: delusions; hallucinations; disorganized speech which is strange, peculiar, difficult to comprehend; disorganized (bizarre or child-like) behavior; or catatonic behavior.

• Limited duration. The psychotic symptoms have occurred for at least one day but less than one month. There is an eventual return to normal level of functioning.

• The symptoms are not biologically influenced or attributable to another disorder. In other words, the symptoms cannot be occurring as part of a mood disorder, schizoaffective disorder, or schizophrenia, and they cannot be due to intoxication with drugs or alcohol. Further, the symptoms cannot be an adverse reaction to a medication, and they cannot be caused by a physical injury or medical illness.

Edit: Sources for some emerging "hard" criteria from the nascent field of neuropsychiatry, including:

"Whole-Brain Morphometric Study of Schizophrenia Revealing a Spatially Complex Set of Focal Abnormalities"

Conclusions This study confirms previous findings of reduced frontotemporal volumes and suggests new hypotheses, especially involving occipital association and speech production areas. It also suggests finer localization of volume reduction in the hippocampus and other limbic structures and in the frontal lobe. Pattern classification showed high sensitivity and specificity for the diagnosis of schizophrenia, suggesting the potential utility of magnetic resonance imaging as a diagnostic aid.

EDIT-2: That gets into semantics, the difference between illusion and hallucination. If you have a true hallucination, not only are you seeing/hearing something, you actually believe it, and are therefore, delusional. So it is hard to separate at the end of the day.

Answer 4

Psychotic does not know he is abnormal and has some or all of the following features
1)Loss of touch with reality
2)Hallucinations
3)Disorganized thought and disassociated speech
4)Emotion is exhibited in an abnormal manner
5)Mania
6)Confusion
7)Depression and sometimes suicidal thoughts
8)Unfounded fears andsuspicion
9)Illusions.
10)Delusions

Answer 5

While I agree with the criteria given by Sami, there was one more category of schizophrenia recognized viz. uncategorized, because in this condition the patient had an insight that he/she has an insight into the problem and knows something is wrong with their mind and seeks medical help.

Answer 6

that's all very close and complicated to inform in certain circumstances for the professionals like you're saying usually they provide the effect of being at length (of psychotic episode attack), and extremity of it even as it grow to be present day.. yet even this isn't sufficient so usually they in simple terms opt for to attend, till they certain, or till more advantageous warning signs present day.. tho for sure they gained't admit this to you (that they are waiting), yet they are going to say to you that they are uncertain... because they do no longer want to later be proved incorrect. that is an same for bipolar, perchance dissociative is way less complicated to diagnose.. because it has somewhat diverse warning signs, in simple terms about more advantageous at possibility of rigidity-like severe state usually a good looking good element of the time they don't look to make sure

Answer 7

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