Schizophrenia Spectrum and Other Psychotic Disorders
Schizophrenia
ICD-10-CM: F20.9
1. Criteria
DSM Criteria
Criterion A
- Two or more characteristic symptoms are present for a significant part of 1 month, or less if successfully treated.
- At least one symptom is delusions, hallucinations, or disorganized speech.
- The characteristic symptoms are delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms such as diminished emotional expression or avolition.
DSM Criteria
Criterion B
- For a significant portion of the time since onset, level of functioning in work, interpersonal relations, or self-care is markedly below the prior level.
DSM Criteria
Criterion C
- Continuous signs of disturbance persist for at least 6 months.
DSM Criteria
Criterion D
- Schizoaffective disorder and mood disorders with psychotic features have been ruled out appropriately.
DSM Criteria
Criterion E
- The disturbance is not attributable to a substance or another medical condition.
DSM Criteria
Criterion F
- Functioning in work, interpersonal relations, or self-care is markedly below prior level.
- If there is a history of autism spectrum disorder or communication disorder of childhood onset, prominent delusions or hallucinations must also be present for at least 1 month.
2. Context
- Schizophrenia is a chronic psychotic illness in which delusions, hallucinations, disorganization, and negative symptoms begin to reshape how a person functions over time. The diagnosis becomes clearer when the psychotic symptoms persist, functioning drops, and shorter or mood-driven explanations stop fitting well.
- Timeline: The timing matters. You need at least 1 month of active symptoms within a broader disturbance that lasts 6 months or longer.
- Mandatory symptom mix: Not every symptom combination qualifies. You need at least two core psychotic symptoms, and one of them must be delusions, hallucinations, or disorganized speech.
- Functional anchor: A real drop in work, relationships, school performance, or self-care helps separate schizophrenia from briefer or less entrenched psychotic syndromes.
- Clinical focus: Broad clinician-rated severity measure across positive, negative, and general psychopathology.
3. Validated scales
PANSS
Broad clinician-rated severity measure across positive, negative, and general psychopathology.
BPRS
Shorter psychosis severity instrument for inpatient or consultation settings.
CGI-S
Fast global severity check when full psychosis scales are not practical.
AIMS
Essential when monitoring tardive dyskinesia during antipsychotic treatment.
4. FDA approved treatments
Treatment of schizophrenia
FDA-approved antipsychotics for schizophrenia vary by age bracket and formulation; verify product-specific labeling.
Common treatment side effects
Check drugs.com/sfx for common side effects. Direct side-effect links for the medications in this section are below when available.
- Haloperidol side effects
- Perphenazine side effects
- Loxapine side effects
- Chlorpromazine side effects
- Fluphenazine side effects
- Risperidone side effects
- Olanzapine side effects
- Quetiapine side effects
- Ziprasidone side effects
- Aripiprazole side effects
- Paliperidone side effects
- Asenapine side effects
- Lurasidone side effects
- Brexpiprazole side effects
- Cariprazine side effects
- Lumateperone side effects
- Iloperidone side effects
Treatment-resistant schizophrenia and suicidality
Clozapine carries distinct FDA labeling for treatment-resistant schizophrenia and for reducing recurrent suicidal behavior in schizophrenia or schizoaffective disorder.
Common treatment side effects
Check drugs.com/sfx for common side effects. Direct side-effect links for the medications in this section are below when available.
Long-acting injectable options
These are useful when adherence is a major driver of relapse risk; check each product for oral overlap and maintenance requirements.
Common treatment side effects
Check drugs.com/sfx for common side effects. Direct side-effect links for the medications in this section are below when available.
Common off-label medications
Interventional psychiatry modalities
- ECT is used in catatonia, severe psychosis, or clozapine-resistant cases.
- TMS is under investigation for hallucinations and negative symptoms.
- Ketamine is not a standard schizophrenia treatment and is mainly research-limited here.
Related Guides
5. Top management articles
- Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia The Lancet, 2013
- Clozapine for the treatment-resistant schizophrenic Archives of General Psychiatry, 1988
- The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia APA guideline
When to seek professional help
- Seek urgent help if there are thoughts of suicide, self-harm, or feeling unable to stay safe.3
- Seek urgent help if there are thoughts of harming someone else, escalating violent urges, or loss of behavioral control.3
- Take hopelessness seriously, especially if the person feels trapped, cannot imagine staying safe, or is withdrawing from support.4
- Use emergency services if there is immediate danger, severe agitation, psychosis, intoxication, or inability to care for basic needs. In the United States, call or text 988 for crisis support and call 911 for immediate danger. Use emergency services in your region if you are outside the U.S.3