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Assessment Measures
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A growing body of scientific evidence favors dimensional concepts in the diagnosis of mental
disorders. The limitations of a categorical approach to diagnosis include the failure to find zones of
rarity between diagnoses (i.e., delineation of mental disorders from one another by natural
boundaries), the need for intermediate categories like schizoaffective disorder, high rates of
comorbidity, frequent not-otherwise-specified (NOS) diagnoses, relative lack of utility in furthering
the identification of unique antecedent validators for most mental disorders, and lack of treatment
specificity for the various diagnostic categories.
From both clinical and research perspectives, there is a need for a more dimensional approach that
can be combined with DSM’s set of categorical diagnoses. Such an approach incorporates variations
of features within an individual (e.g., differential severity of individual symptoms both within and
outside of a disorder’s diagnostic criteria as measured by intensity, duration, or number of
symptoms, along with other features such as type and severity of disabilities) rather than relying on a
simple yes-or-no approach. For diagnoses for which all symptoms are needed for a diagnosis (a
monothetic criteria set), different severity levels of the constituent symptoms may be noted. If a
threshold endorsement of multiple symptoms is needed, such as at least five of nine symptoms for
major depressive disorder (a polythetic criteria set), both severity levels and different combinations
of the criteria may identify more homogeneous diagnostic groups.
A dimensional approach depending primarily on an individual’s subjective reports of symptom
experiences along with the clinician’s interpretation is consistent with current diagnostic practice. It
is expected that as our understanding of basic disease mechanisms based on pathophysiology,
neurocircuitry, gene-environment interactions, and laboratory tests increases, approaches that
integrate both objective and subjective patient data will be developed to supplement and enhance the
accuracy of the diagnostic process.
Cross-cutting symptom measures modeled on general medicine’s review of systems can serve as an
approach for reviewing critical psychopathological domains. The general medical review of systems
is crucial to detecting subtle changes in different organ systems that can facilitate diagnosis and
treatment. A similar review of various mental functions can aid in a more comprehensive mental
status assessment by drawing attention to symptoms that may not fit neatly into the diagnostic
criteria suggested by the individual’s presenting symptoms, but may nonetheless be important to the
individual’s care. The cross-cutting measures have two levels: Level 1 questions are a brief survey of
13 symptom domains for adult patients and 12 domains for child and adolescent patients. Level 2
questions provide a more in-depth assessment of certain domains. These measures were developed
to be administered both at initial interview and over time to track the patient’s symptom status and
response to treatment.
Severity measures are disorder-specific, corresponding closely to the criteria that constitute the
disorder definition. They may be administered to individuals who have received a diagnosis or who
have a clinically significant syndrome that falls short of meeting full criteria for a diagnosis. Some of
the assessments are self-completed by the individual, while others require a clinician to complete. As
with the cross-cutting symptom measures, these measures were developed to be administered both
at initial interview and over time to track the severity of the individual’s disorder and response to
treatment.
The World Health Organization Disability Assessment Schedule, Version 2.0 (WHODAS 2.0) was
developed to assess a patient’s ability to perform activities in six areas: understanding and
communicating; getting around; self-care; getting along with people; life activities (e.g., household,
work/school); and participation in society. The scale is self-administered and was developed to be
used in patients with any medical disorder. It corresponds to concepts contained in the WHO
International Classification of Functioning, Disability and Health. This assessment can also be used
over time to track changes in a patient’s disabilities.
This chapter focuses on the DSM-5 Level 1 Cross-Cutting Symptom Measure (adult self-rated and
parent/guardian versions); the Clinician-Rated Dimensions of Psychosis Symptom Severity; and the
WHODAS 2.0. Clinician instructions, scoring information, and interpretation guidelines are
included for each. These measures and additional dimensional assessments, including those for
diagnostic severity, can be found online at www.psychiatry.org/dsm5.
Cross-Cutting Symptom Measures
The DSM-5 Level 1 Cross-Cutting Symptom Measure is a patient- or informant-rated measure that
assesses mental health domains that are important across psychiatric diagnoses. It is intended to
help clinicians identify additional areas of inquiry that may have significant impact on the
individual’s treatment and prognosis. In addition, the measure may be used to track changes in the
individual’s symptom presentation over time.
The adult version of the measure consists of 23 questions that assess 13 psychiatric domains,
including depression, anger, mania, anxiety, somatic symptoms, suicidal ideation, psychosis, sleep
problems, memory, repetitive thoughts and behaviors, dissociation, personality functioning, and
substance use (Table). Each domain consists of one to three questions. Each item inquires about how
much (or how often) the individual has been bothered by the specific symptom during the past 2
weeks. If the individual is of impaired capacity and unable to complete the form (e.g., an individual
with dementia), a knowledgeable adult informant may complete this measure. The measure was
found to be clinically useful and to have good reliability in the DSM-5 field trials that were conducted
in adult clinical samples across the United States and in Canada(Clarke et al. 2013; Narrow et al.
2013).
Level 1 Cross-Cutting Symptom Measure Adult DSM-5 Self-Rated Level 1
Cross-Cutting Symptom Measure: 13 domains, thresholds for further inquiry,
and associated DSM-5 Level 2 measures
Enlarge table
The parent/guardian-rated version of the measure (for children ages 6–17) consists of 25 questions
that assess 12 psychiatric domains, including depression, anger, irritability, mania, anxiety, somatic
symptoms, inattention, suicidal ideation/attempt, psychosis, sleep disturbance, repetitive thoughts
and behaviors, and substance use (Table). Each item asks the parent or guardian to rate how much
(or how often) his or her child has been bothered by the specific psychiatric symptom during the past
2 weeks. The measure was also found to be clinically useful and to have good reliability in the DSM-5
field trials that were conducted in pediatric clinical samples across the United States(Narrow et al.
2013). For children ages 11–17, along with the parent/guardian rating of the child’s symptoms, the
clinician may consider having the child complete the child-rated version of the measure. The childrated version of the measure can be found online at www.psychiatry.org/dsm5.
On the adult self-rated version of the measure, each item is rated on a 5-point scale (0=none or not
at all; 1=slight or rare, less than a day or two; 2=mild or several days; 3=moderate or more than half
the days; and 4=severe or nearly every day). The score on each item within a domain should be
reviewed. However, a rating of mild (i.e., 2) or greater on any item within a domain, except for
substance use, suicidal ideation, and psychosis, may serve as a guide for additional inquiry and
follow-up to determine if a more detailed assessment is necessary, which may include the Level 2
cross-cutting symptom assessment for the domain (see ). For substance use, suicidal ideation, and
psychosis, a rating of slight (i.e., 1) or greater on any item within the domain may serve as a guide for
additional inquiry and follow-up to determine if a more detailed assessment is needed. As such,
indicate the highest score within a domain in the “Highest domain score” column. Table outlines
threshold scores that may guide further inquiry for the remaining domains.
Scoring and interpretation Parent/guardian-rated DSM-5 Level 1 CrossCutting Symptom Measure for child age 6–17: 12 domains, thresholds for
further inquiry, and associated Level 2 measures
Enlarge table
On the parent/guardian-rated version of the measure (for children ages 6–17), 19 of the 25 items are
each rated on a 5-point scale (0=none or not at all; 1=slight or rare, less than a day or two; 2=mild or
several days; 3=moderate or more than half the days; and 4=severe or nearly every day). The suicidal
ideation, suicide attempt, and substance abuse items are each rated on a “Yes, No, or Don’t Know”
scale. The score on each item within a domain should be reviewed. However, with the exception of
inattention and psychosis, a rating of mild (i.e., 2) or greater on any item within a domain that is
scored on the 5-point scale may serve as a guide for additional inquiry and follow-up to determine if
a more detailed assessment is necessary, which may include the Level 2 cross-cutting symptom
assessment for the domain (see Table). For inattention or psychosis, a rating of slight or greater (i.e.,
1 or greater) may be used as an indicator for additional inquiry. A parent or guardian’s rating of
“Don’t Know” on the suicidal ideation, suicide attempt, and any of the substance use items, especially
for children ages 11–17 years, may result in additional probing of the issues with the child, including
using the child-rated Level 2 Cross-Cutting Symptom Measure for the relevant domain. Because
additional inquiry is made on the basis of the highest score on any item within a domain, clinicians
should indicate that score in the “Highest Domain Score” column. Tableoutlines threshold scores
that may guide further inquiry for the remaining domains.
Level 2 Cross-Cutting Symptom Measures
Any threshold scores on the Level 1 Cross-Cutting Symptom Measure (as noted in Tables 1 and 2 and
described in “Scoring and Interpretation” indicate a possible need for detailed clinical inquiry. Level
2 Cross-Cutting Symptom Measures provide one method of obtaining more in-depth information on
potentially significant symptoms to inform diagnosis, treatment planning, and follow-up. They are
available online at www.psychiatry.org/dsm5. Tables 1 and 2 outline each Level 1 domain and
identify the domains for which DSM-5 Level 2 Cross-Cutting Symptom Measures are available for
more detailed assessments. Adult and pediatric (parent and child) versions are available online for
most Level 1 symptom domains at www.psychiatry.org/dsm5.
Frequency of Use of the Cross-Cutting Symptom Measures
To track change in the individual’s symptom presentation over time, the Level 1 and relevant Level 2
cross-cutting symptom measures may be completed at regular intervals as clinically indicated,
depending on the stability of the individual’s symptoms and treatment status. For individuals with
impaired capacity and for children ages 6–17 years, it is preferable for the measures to be completed
at follow-up appointments by the same knowledgeable informant and by the same parent or
guardian. Consistently high scores on a particular domain may indicate significant and problematic
symptoms for the individual that might warrant further assessment, treatment, and follow-up.
Clinical judgment should guide decision making.
References: Frequency of Use of the Cross-Cutting Symptom Measures
• Clarke DE , Narrow WE , Regier DA , et al: DSM-5 field trials in the United States and
Canada, Part I: study design, sampling strategy, implementation, and analytic
approaches. Am J Psychiatry 170(1):43–
58, 2013 10.1176/appi.ajp.2012.12071000 [Abstract]
• Narrow WE , Clarke DE , Kuramoto SJ , et al: DSM-5 field trials in the United States and
Canada, Part III: development and reliability testing of a cross-cutting symptom
assessment for DSM-5. Am J Psychiatry 170(1):71–
82, 2013 10.1176/appi.ajp.2012.12071000
• Regier DA , Narrow WE , Clarke DE , et al: DSM-5 field trials in the United States and
Canada, Part II: test-retest reliability of selected categorical diagnoses. Am J
Psychiatry 170(1):59–70, 2013 10.1176/appi.ajp.2012.12071000 (Epub ahead of
print)[Abstract]
DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure—Adult
Parent/Guardian-Rated DSM-5 Level 1 Cross-Cutting Symptom
Measure—Child Age 6–17
Clinician-Rated Dimensions of Psychosis Symptom
Severity
As described in the chapter “Schizophrenia Spectrum and Other Psychotic Disorders,” psychotic
disorders are heterogeneous, and symptom severity can predict important aspects of the illness, such
as the degree of cognitive and/or neurobiological deficits(Barch et al. 2003). Dimensional
assessments capture meaningful variation in the severity of symptoms, which may help with
treatment planning, prognostic decision-making, and research on pathophysiological mechanisms.
The Clinician-Rated Dimensions of Psychosis Symptom Severity provides scales for the dimensional
assessment of the primary symptoms of psychosis, including hallucinations, delusions, disorganized
speech, abnormal psychomotor behavior, and negative symptoms. A scale for the dimensional
assessment of cognitive impairment is also included. Many individuals with psychotic disorders have
impairments in a range of cognitive domains(Reichenberg et al. 2009), which predict functional
abilities(Green et al. 2004). In addition, scales for dimensional assessment of depression and mania
are provided, which may alert clinicians to mood pathology. The severity of mood symptoms in
psychosis has prognostic value (Bowie et al. 2006)and guides treatment(Peralta and Cuesta 2009).
The Clinician-Rated Dimensions of Psychosis Symptom Severity is an 8-item measure that may be
completed by the clinician at the time of the clinical assessment. Each item asks the clinician to rate
the severity of each symptom as experienced by the individual during the past 7 days.
Scoring and Interpretation
Each item on the measure is rated on a 5-point scale (0=none; 1=equivocal; 2=present, but mild;
3=present and moderate; and 4=present and severe) with a symptom-specific definition of each
rating level. The clinician may review all of the individual’s available information and, based on
clinical judgment, select (with checkmark) the level that most accurately describes the severity of the
individual’s condition. The clinician then indicates the score for each item in the “Score” column
provided.
Frequency of Use
To track changes in the individual’s symptom severity over time, the measure may be completed at
regular intervals as clinically indicated, depending on the stability of the individual’s symptoms and
treatment status. Consistently high scores on a particular domain may indicate significant and
problematic areas for the individual that might warrant further assessment, treatment, and followup. Clinical judgment should guide decision making.
References: Frequency of Use
• Barch DM , Carter CS , MacDonald AW 3rd , et al: Context-processing deficit in
schizophrenia: diagnostic specificity, 4-week course, and relationships to clinical
symptoms. J Abnorm Psychol 112(1):132–143, 2003
• Bowie CR , Reichenberg A , Patterson TL , et al: Determinants of real-world functional
performance in schizophrenia subjects: correlations with cognition, functional capacity,
and symptoms. Am J Psychiatry 163(3):418–425, 2006
• Green MF , Kern RS , Heaton RK : Longitudinal studies of cognition and functional outcome
in schizophrenia: implications for MATRICS. Schizophr Res 72(1):41–51, 2004
• Peralta V , Cuesta MJ : Exploring the borders of the schizoaffective spectrum: a categorical
and dimensional approach. J Affect Disord108(1–2):71–86, 2009
• Reichenberg A , Harvey PD , Bowie CR , et al: Neuropsychological function and dysfunction
in schizophrenia and psychotic affective disorders. Schizophr Bull 35(5):1022–1029, 2009
Clinician-Rated Dimensions of Psychosis Symptom Severity
World Health Organization Disability Assessment
Schedule 2.0
The adult self-administered version of the World Health Organization Disability Assessment
Schedule 2.0 (WHODAS 2.0) is a 36-item measure that assesses disability in adults age 18 years and
older. It assesses disability across six domains, including understanding and communicating, getting
around, self-care, getting along with people, life activities (i.e., household, work, and/or school
activities), and participation in society. If the adult individual is of impaired capacity and unable to
complete the form (e.g., a patient with dementia), a knowledgeable informant may complete the
proxy-administered version of the measure, which is available at www.psychiatry.org/dsm5. Each
item on the self-administered version of the WHODAS 2.0 asks the individual to rate how much
difficulty he or she has had in specific areas of functioning during the past 30 days.
WHODAS 2.0 Scoring Instructions Provided by WHO
WHODAS 2.0 summary scores
There are two basic options for computing the summary scores for the WHODAS 2.0 36-item full
version.
Simple: The scores assigned to each of the items—“none” (1), “mild” (2), “moderate” (3), “severe”
(4), and “extreme” (5)—are summed. This method is referred to as simple scoring because the scores
from each of the items are simply added up without recoding or collapsing of response categories;
thus, there is no weighting of individual items. This approach is practical to use as a hand-scoring
approach, and may be the method of choice in busy clinical settings or in paper-and-pencil interview
situations. As a result, the simple sum of the scores of the items across all domains constitutes a
statistic that is sufficient to describe the degree of functional limitations.
Complex: The more complex method of scoring is called “item-response-theory” (IRT)–based
scoring. It takes into account multiple levels of difficulty for each WHODAS 2.0 item. It takes the
coding for each item response as “none,” “mild,” “moderate,” “severe,” and “extreme” separately, and
then uses a computer to determine the summary score by differentially weighting the items and the
levels of severity. The computer program is available from the WHO Web site. The scoring has three
steps:
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Step 1—Summing of recoded item scores within each domain.
Step 2—Summing of all six domain scores.
Step 3—Converting the summary score into a metric ranging from 0 to 100 (where 0 = no
disability; 100 = full disability).
WHODAS 2.0 domain scores
WHODAS 2.0 produces domain-specific scores for six different functioning domains: cognition,
mobility, self-care, getting along, life activities (household and work/school), and participation.
WHODAS 2.0 population norms
For the population norms for IRT-based scoring of the WHODAS 2.0 and for the population
distribution of IRT-based scores for WHODAS 2.0, please see
www.who.int/classifications/icf/Pop_norms_distrib_IRT_scores.pdf.
Additional Scoring and Interpretation Guidance for DSM-5 Users
The clinician is asked to review the individual’s response on each item on the measure during the
clinical interview and to indicate the self-reported score for each item in the section provided for
“Clinician Use Only.” However, if the clinician determines that the score on an item should be
different based on the clinical interview and other information available, he or she may indicate a
corrected score in the raw item score box. Based on findings from the DSM-5 Field Trials in adult
patient samples across six sites in the United States and one in Canada, DSM-5 recommends
calculation and use of average scores for each domain and for general disability. The average
scores are comparable to the WHODAS 5-point scale, which allows the clinician to think of the
individual’s disability in terms of none (1), mild (2), moderate (3), severe (4), or extreme (5). The
average domain and general disability scores were found to be reliable, easy to use, and clinically
useful to the clinicians in the DSM-5 Field Trials. The average domain score is calculated by dividing
the raw domain score by the number of items in the domain (e.g., if all the items within the
“understanding and communicating” domain are rated as being moderate, then the average domain
score would be 18/6 = 3, indicating moderate disability). The average general disability score is
calculated by dividing the raw overall score by number of items in the measure (i.e., 36). The
individual should be encouraged to complete all of the items on the WHODAS 2.0. If no response is
given on 10 or more items of the measure (i.e., more than 25% of the 36 total items), calculation of
the simple and average general disability scores may not be helpful. If 10 or more of the total items
on the measure are missing but the items for some of the domains are 75%–100% complete, the
simple or average domain scores may be used for those domains.
Frequency of use
To track change in the individual’s level of disability over time, the measure may be completed at
regular intervals as clinically indicated, depending on the stability of the individual’s symptoms and
treatment status. Consistently high scores on a particular domain may indicate significant and
problematic areas for the individual that might warrant further assessment and intervention.
Schizophrenia Spectrum and
Other Psychotic Disorders
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Schizophrenia spectrum and other psychotic disorders include schizophrenia, other
psychotic disorders, and schizotypal (personality) disorder. They are defined by
abnormalities in one or more of the following five domains: delusions, hallucinations,
disorganized thinking (speech), grossly disorganized or abnormal motor behavior
(including catatonia), and negative symptoms.
Key Features That Define the Psychotic Disorders
Delusions
Delusions are fixed beliefs that are not amenable to change in light of conflicting
evidence. Their content may include a variety of themes (e.g., persecutory, referential,
somatic, religious, grandiose). Persecutory delusions (i.e., belief that one is going to be
harmed, harassed, and so forth by an individual, organization, or other group) are most
common. Referential delusions (i.e., belief that certain gestures, comments,
environmental cues, and so forth are directed at oneself) are also common. Grandiose
delusions (i.e., when an individual believes that he or she has exceptional abilities,
wealth, or fame) and erotomanic delusions (i.e., when an individual believes falsely that
another person is in love with him or her) are also seen. Nihilistic delusions involve the
conviction that a major catastrophe will occur, and somatic delusions focus on
preoccupations regarding health and organ function.
Delusions are deemed bizarre if they are clearly implausible and not understandable to
same-culture peers and do not derive from ordinary life experiences. An example of a
bizarre delusion is the belief that an outside force has removed his or her internal organs
and replaced them with someone else’s organs without leaving any wounds or scars. An
example of a nonbizarre delusion is the belief that one is under surveillance by the
police, despite a lack of convincing evidence. Delusions that express a loss of control
over mind or body are generally considered to be bizarre; these include the belief that
one’s thoughts have been “removed” by some outside force (thought withdrawal), that
alien thoughts have been put into one’s mind (thought insertion), or that one’s body or
actions are being acted on or manipulated by some outside force (delusions of control).
The distinction between a delusion and a strongly held idea is sometimes difficult to
make and depends in part on the degree of conviction with which the belief is held
despite clear or reasonable contradictory evidence regarding its veracity.
Hallucinations
Hallucinations are perception-like experiences that occur without an external stimulus.
They are vivid and clear, with the full force and impact of normal perceptions, and not
under voluntary control. They may occur in any sensory modality, but auditory
hallucinations are the most common in schizophrenia and related disorders. Auditory
hallucinations are usually experienced as voices, whether familiar or unfamiliar, that are
perceived as distinct from the individual’s own thoughts. The hallucinations must occur
in the context of a clear sensorium; those that occur while falling asleep (hypnagogic) or
waking up (hypnopompic) are considered to be within the range of normal experience.
Hallucinations may be a normal part of religious experience in certain cultural contexts.
Disorganized Thinking (Speech)
Disorganized thinking (formal thought disorder) is typically inferred from the
individual’s speech. The individual may switch from one topic to another (derailment or
loose associations). Answers to questions may be obliquely related or completely
unrelated (tangentiality). Rarely, speech may be so severely disorganized that it is
nearly incomprehensible and resembles receptive aphasia in its linguistic
disorganization (incoherence or “word salad”). Because mildly disorganized speech is
common and nonspecific, the symptom must be severe enough to substantially impair
effective communication. The severity of the impairment may be difficult to evaluate if
the person making the diagnosis comes from a different linguistic background than that
of the person being examined. Less severe disorganized thinking or speech may occur
during the prodromal and residual periods of schizophrenia.
Grossly Disorganized or Abnormal Motor Behavior (Including Catatonia)
Grossly disorganized or abnormal motor behavior may manifest itself in a variety of
ways, ranging from childlike “silliness” to unpredictable agitation. Problems may be
noted in any form of goal-directed behavior, leading to difficulties in performing
activities of daily living.
Catatonic behavior is a marked decrease in reactivity to the environment. This ranges
from resistance to instructions (negativism); to maintaining a rigid, inappropriate or
bizarre posture; to a complete lack of verbal and motor responses (mutism and stupor).
It can also include purposeless and excessive motor activity without obvious cause
(catatonic excitement). Other features are repeated stereotyped movements, staring,
grimacing, mutism, and the echoing of speech. Although catatonia has historically been
associated with schizophrenia, catatonic symptoms are nonspecific and may occur in
other mental disorders (e.g., bipolar or depressive disorders with catatonia) and in
medical conditions (catatonic disorder due to another medical condition).
Negative Symptoms
Negative symptoms account for a substantial portion of the morbidity associated with
schizophrenia but are less prominent in other psychotic disorders. Two negative
symptoms are particularly prominent in schizophrenia: diminished emotional
expression and avolition. Diminished emotional expression includes reductions in the
expression of emotions in the face, eye contact, intonation of speech (prosody), and
movements of the hand, head, and face that normally give an emotional emphasis to
speech. Avolition is a decrease in motivated self-initiated purposeful activities. The
individual may sit for long periods of time and show little interest in participating in
work or social activities. Other negative symptoms include alogia, anhedonia, and
asociality. Alogia is manifested by diminished speech output. Anhedonia is the
decreased ability to experience pleasure from positive stimuli or a degradation in the
recollection of pleasure previously experienced(Kring and Moran
2008). Asociality refers to the apparent lack of interest in social interactions and may be
associated with avolition, but it can also be a manifestation of limited opportunities for
social interactions.
Disorders in This Chapter
This chapter is organized along a gradient of psychopathology. Clinicians should first
consider conditions that do not reach full criteria for a psychotic disorder or are limited
to one domain of psychopathology. Then they should consider time-limited conditions.
Finally, the diagnosis of a schizophrenia spectrum disorder requires the exclusion of
another condition that may give rise to psychosis.
Schizotypal personality disorder is noted within this chapter as it is considered within
the schizophrenia spectrum, although its full description is found in the chapter
“Personality Disorders.” The diagnosis schizotypal personality disorder captures a
pervasive pattern of social and interpersonal deficits, including reduced capacity for
close relationships; cognitive or perceptual distortions; and eccentricities of behavior,
usually beginning by early adulthood but in some cases first becoming apparent in
childhood and adolescence. Abnormalities of beliefs, thinking, and perception are below
the threshold for the diagnosis of a psychotic disorder.
Two conditions are defined by abnormalities limited to one domain of psychosis:
delusions or catatonia. Delusional disorder is characterized by at least 1 month of
delusions but no other psychotic symptoms. Catatonia is described later in the chapter
and further in this discussion.
Brief psychotic disorder lasts more than 1 day and remits by 1 month. Schizophreniform
disorder is characterized by a symptomatic presentation equivalent to that of
schizophrenia except for its duration (less than 6 months) and the absence of a
requirement for a decline in functioning.
Schizophrenia lasts for at least 6 months and includes at least 1 month of active-phase
symptoms. In schizoaffective disorder, a mood episode and the active-phase symptoms
of schizophrenia occur together and were preceded or are followed by at least 2 weeks of
delusions or hallucinations without prominent mood symptoms.
Psychotic disorders may be induced by another condition. In substance/medicationinduced psychotic disorder, the psychotic symptoms are judged to be a physiological
consequence of a drug of abuse, a medication, or toxin exposure and cease after removal
of the agent. In psychotic disorder due to another medical condition, the psychotic
symptoms are judged to be a direct physiological consequence of another medical
condition.
Catatonia can occur in several disorders, including neurodevelopmental, psychotic,
bipolar, depressive, and other mental disorders. This chapter also includes the
diagnoses catatonia associated with another mental disorder (catatonia specifier),
catatonic disorder due to another medical condition, and unspecified catatonia, and the
diagnostic criteria for all three conditions are described together.
Other specified and unspecified schizophrenia spectrum and other psychotic disorders
are included for classifying psychotic presentations that do not meet the criteria for any
of the specific psychotic disorders, or psychotic symptomatology about which there is
inadequate or contradictory information.
Clinician-Rated Assessment of Symptoms and
Related Clinical Phenomena in Psychosis
Psychotic disorders are heterogeneous, and the severity of symptoms can predict
important aspects of the illness, such as the degree of cognitive or neurobiological
deficits(Barch et al. 2003). To move the field forward, a detailed framework for the
assessment of severity is included in Section III “Assessment Measures,” which may
help with treatment planning, prognostic decision making, and research on
pathophysiological mechanisms. Section III “Assessment Measures” also contains
dimensional assessments of the primary symptoms of psychosis, including
hallucinations, delusions, disorganized speech (except for substance/medicationinduced psychotic disorder and psychotic disorder due to another medical condition),
abnormal psychomotor behavior, and negative symptoms, as well as dimensional
assessments of depression and mania. The severity of mood symptoms in psychosis has
prognostic value and guides treatment(Peralta and Cuesta 2009). There is growing
evidence that schizoaffective disorder is not a distinct nosological category(e.g.,Owen et
al