Friday, September 23, 2016

Into the DSM - Schizophrenia

Schizophrenia will doubtless come up for social workers employed in clinic settings. That means it's one of the diagnoses that you may find appear on the social work licensing exam. Here are the criteria:

A. At least two of the following for a significant portion of the time during a one-month period:

1. Delusions
2. Hallucinations
3. Disorganized speech
4. Grossly disorganized or catatonic behavior
5. Negative symptoms (e.g., flat affect)

B. Level of functioning is markedly below level at onset of symptoms.

C. Disturbance persists at least six months.

D. Schizoaffective, depressive, and bipolar disorder ruled out.

E. Symptoms not attributable to the effects of a substance.

F. If there is a history of autism spectrum disorder or a communication disorder of childhood onset, a schizophrenia diagnosis is made only if prominent delusions or hallucinations are present for at least one month.

Specifiers include:
  • First episode, currently in acute episode
  • First episode, currently in partial remission
  • First episode, currently in full remission
  • Multiple episodes (acute, partial, or full remission)
  • Continuous
  • With catatonia
DSM-5 also includes a severity rating for schizophrenia--each symptom can receive its own rating ranging from 0 (not present) to 4 (present and severe).

For further reading, including risk factors and treatment, take a look at

Friday, September 09, 2016

Into the DSM - Autism Spectrum Disorder

New in DSM-5, autism spectrum disorder covers a wide array of symptoms. It's wise to review them ahead of sitting for the social work licensing exam. Here we go...

A. Persistent deficits in social communication and social interaction across multiple contexts, for example:

  • Deficits in social-emotional reciprocity (back-and-forth conversation, sharing of interests)
  • Deficits in nonverbal communication (eye contact, body language)
  • Deficits in developing, maintaining, and understanding relationships (adjusting behavior to context, making friends)
B. Restricted, repetitive patterns of behavior, interests, or activities, including at least two of the following:
  • Stereotyped or repetitive motor movements (lining up toys, echolalia, idiosyncratic phrases)
  • Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior 
  • Highly restricted, fixated interests that are abnormal in intensity or focus
  • Hyper- or hyporeactivity to sensory input (indifference to pain/temperature, adverse response to specific sounds...)
C. Symptoms present in early development.

D. Symptoms cause clinically significant impairment.

E. Disturbances not better explained by an intellectual development disorder or global developmental delay.

Specifiers include:
  • With or without intellectual impairment
  • With or without language impairment
  • Associated with a medical or genetic condition or environmental factor
  • Associated with another neurodevelopmental, mental, or behavioral disorder
  • With catatonia
Since ASD encompasses old (DSM-IV-TR) diagnoses of autistic disorder, Asperger's disorder, and pervasive developmental disorder, severity levels play an important part in the diagnosis. More about those in a future post!

For further reading try NIMH and/or the CDC.