Report of the DSM-V Psychotic Disorders Work Group
November 2008
William T. Carpenter, Jr., M.D.
Key issues presently under consideration by the work group are:
Will the disorders assigned to the work group be kept as categories in DSM-V?
What might a psychotic disorder grouping look like in DSM-V? For example, evidence is being reviewed to determine the relationship of schizophrenia to other disorders with psychotic symptoms, and to disorders that share other features (such as familiality). These disorders, not currently classified as psychotic disorders in DSM-IV, include schizotypal personality disorder and bipolar disorder.
How should the prodromal phase or early detection syndrome be handled in DSM-V?
Which diagnostic criteria are problematic and how can these problems be addressed? For example, the A criterion for schizoaffective disorder has low reliability. The diagnostic criteria for this disorder might be improved with dimensional assessments. The work group is also considering a separate category for catatonia with a subheading for associated condition, i.e., associated with schizophrenia, or mood disorder, or delirium, or general medical condition. Under this scenario, the term psychomotor would anchor the criterion for schizophrenia and the term catatonia would be removed.
Are the traditional subtypes useful for clinical or research purposes? Might dimensional assessments be more valuable?
How can dimensional assessments be combined with categorical classification? Questions include: Will dimensions be functional or psychopathological? Which dimensions that are relevant to the assessment of psychotic disorders cut across other disorders, and which are specific to this diagnostic cluster? Dimensions that are based on psychopathology include such domains as reality distortion, disorganization of thought, negative symptoms, cognition impairment, depression, mania, obsessive symptoms, psychomotor, and suicidality.