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Primary Psychotic Disorders. ICD-10 Schizophrenia, Schizotypal and Delusional Disorders. Schizophrenia. Schizophrenia. Schizoaffective Disorder.
Typology: Schemes and Mind Maps
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ORIGINS OF THE CONCEPT OF SCHIZOPHRENIA ‘Dementia praecox’ (1893) ‘Group of Schizophrenias’ (1911)
The Evolution of the Schizophrenia Concept Tandon et al., Schizophrenia, “just the facts” 4. Clinical features and conceptualization Schiz Res 2009;110:1- 23
Status Report on ICD-11 Psychotic Disorders
ICD-11 Schizophrenia or Other Primary Psychotic Disorders ICD-10 Schizophrenia, Schizotypal and Delusional Disorders Schizophrenia Schizophrenia Schizoaffective Disorder Schizoaffective Disorder Acute and Transient Psychotic Disorder Acute and Transient Psychotic Disorder: 1 Acute Polymorphic Psychotic Disorder without Symptoms of Schizophrenia 2,3,4 see below Schizotypal Disorder Schizotypal Disorder Delusional Disorder Persistent Delusional Disorder Induced Delusional Disorder 4 Other Acute Predominantly Delusional Psychotic Disorder Other Primary Psychotic Disorder 3 Acute Schizophrenia-like Psychotic Disorder 2 Acute Polymorphic Psychotic Disorder with Symptoms of Schizophrenia
INTERNATIONAL ICD-11/10 VIGNETTE-BASED FIELD TRIAL
INTERNATIONAL ICD-11/10 VIGNETTE-BASED FIELD TRIAL DIAGNOSTIC ACCURACY Vignette n ICD- 11 % correct ICD- 10 % correct p Overall 928 71.9 53.2 <0. Schizophrenia 94 74.4 78.4 0. Schizoaffective Disorder 95 63.5 44.2 0. Bipolar Disorder Type II 90 68.4 9.6 <0. Recurrent Depressive Disorder 97 81.6 66.7 0. Moderate Personality Disorder 89 57.4 73.8 0. Adjustment Disorder 92 34.6 55.0 0. Complex PTSD 95 71.1 32.0 <0. Binge Eating Disorder 92 86.5 87.5 0. Bodily Distress Disorder 89 95.5 37.8 <0. Compulsive Sexual Behaviour Disorder 95 89.3 48.7 <0. Gaebel et al.,Eur Arch Psychiatry Clin Neurosci 2019.
ICD-10/11 PSYCHOTIC DISORDERS: OVERARCHING CHANGES ICD-10 term ‘nonorganic’ psychotic disorders has been changed to ‘primary’ psychotic disorders to avoid suggesting these disorders are not brain-based Acute and Transient Psychotic Disorder and Delusional Disorder substantially simplified Course Qualifiers Symptom Qualifiers and Severity Ratings
ICD-11 Schizophrenia - What is new?
Rationale: Cluster analytic and other approaches to identify taxonic schizophrenia subtypes consistently fail to identify the DSM-IV subtypes. Picardi et al., Psychiatry Res. 2012;198, 386–394. A review of 24 publications describing 38 analyses of 28 participant cohorts found no support for classic schizophrenia subtypes. Linscott et al., Schizophr Bull 2010; 36: 811- 829 Subtypes continue to be found to exhibit poor diagnostic stability over time, do not cluster in families, and have limited prognostic value. Tandon et al., Schizophr Res 2009, 110: 1- 23 Except for the paranoid and undifferentiated subtypes, the other subtypes are rarely utilized in most mental health care settings across the world. Tandon et al., Schizophrenia Research 2013;150 :3– 10
Green et al., Schizophr Res 2004;72:41-51; Milev et al., Am J Psychiatr 2005;162:495- 506 Neurocognitive factors predict 52% of the variance in return to work or school in schizophrenia Nuechterlein et al., Schizophr Bull 2011; 37 (Suppl. 2):S33-S Cognitive remediation and cognitive behavioral therapy are effective in reducing negative symptoms in schizophrenia Klingberg et al., Schizophr Bull 2011; 37 (Suppl. 2):S98-S Cognitive training improves the outcome of vocational rehabilitation therapy in schizophrenia McGurk et al., Schizophr Bull 2009;35:319-335; Tan & King, Austr N Z J Psychiatr 2013;47:1068- 1080 Rationale:
Replace subtypes Rate each individual with any primary psychotic disorder on all six domains: Positive Symptoms Negative Symptoms Depressive Mood Symptoms Manic Mood Symptoms Psychomotor Symptoms Cognitive Symptoms
QUALIFIER SCALES (GENERIC SEVERITY OPERATIONALIZATIONS) FOR SYMPTOMATIC MANIFESTATIONS OF PRIMARY PSYCHOTIC DISORDERS
Present and mild Symptoms in the domain have been present during the past week, but these are minimal in number or do not have a substantial degree of impact. Everyday functioning is not affected by these symptoms, or is affected only minimally. No significant negative social or personal consequences have occurred as a consequence of the symptoms. The symptoms may be intermittent and show fluctuations in severity, and there may be periods during which the symptoms are absent. Compared to other individuals with similar symptoms, the severity of symptoms in the domain is in the mildest third. Present and moderate A greater number of symptoms in the domain have been present during the past week or a smaller number of symptoms that have a substantial degree of impact. Everyday functioning may be moderately affected by the symptoms. There are negative social or personal consequences of the symptoms, but these are not severe. Most of the symptoms are present the majority of the time. Compared to other individuals with similar symptoms, the severity of symptoms in the domain is in the middle third. Present and severe Many symptoms in the domain have been present during the past week, or a smaller number that have a severe or pervasive degree of impact (i.e., they are intense and frequent or constant). Everyday functioning is persistently impaired due to the symptoms. There are serious negative social or personal consequences. Compared to other individuals with similar symptoms, the severity of symptoms in the domain is in the most severe third. Unspecified For example, unable to make a current severity rating based on the available information.