Department of Psychiatry, New York University, New York, NY, USA; Creedmoor Psychiatric Center, New York State Office of Mental Health, USA.
Schizophr Res. 2013 Oct;150(1):21-5. doi: 10.1016/j.schres.2013.04.026. Epub 2013 May 23.
Characterization of patients with both psychotic and mood symptoms, either concurrently or at different points during their illness, has always posed a nosological challenge and this is reflected in the poor reliability, low diagnostic stability, and questionable validity of DSM-IV Schizoaffective Disorder. The clinical reality of the frequent co-occurrence of psychosis and Mood Episodes has also resulted in over-utilization of a diagnostic category that was originally intended to only rarely be needed. In the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, an effort is made to improve reliability of this condition by providing more specific criteria and the concept of Schizoaffective Disorder shifts from an episode diagnosis in DSM-IV to a life-course of the illness in DSM-5. When psychotic symptoms occur exclusively during a Mood Episode, DSM-5 indicates that the diagnosis is the appropriate Mood Disorder with Psychotic Features, but when such a psychotic condition includes at least a two-week period of psychosis without prominent mood symptoms, the diagnosis may be either Schizoaffective Disorder or Schizophrenia. In the DSM-5, the diagnosis of Schizoaffective Disorder can be made only if full Mood Disorder episodes have been present for the majority of the total active and residual course of illness, from the onset of psychotic symptoms up until the current diagnosis. In earlier DSM versions the boundary between Schizophrenia and Schizoaffective Disorder was only qualitatively defined, leading to poor reliability. This change will provide a clearer separation between Schizophrenia with mood symptoms from Schizoaffective Disorder and will also likely reduce rates of diagnosis of Schizoaffective Disorder while increasing the stability of this diagnosis once made.
同时或在疾病不同阶段出现精神病和心境症状的患者的特征，一直以来都是一个分类挑战，这反映在 DSM-IV 分裂情感障碍可靠性差、诊断稳定性低和有效性值得怀疑上。精神病和心境发作频繁同时发生的临床现实也导致了过度使用原本很少需要的诊断类别。在《精神障碍诊断与统计手册》第五版中，通过提供更具体的标准和将分裂情感障碍的概念从 DSM-IV 的发作诊断转变为 DSM-5 的疾病病程，努力提高了这种情况的可靠性。当精神病症状仅在心境发作期间发生时，DSM-5 指出，诊断为伴有精神病特征的适当心境障碍，但如果这种精神病状态包括至少两周没有明显心境症状的精神病期，则诊断可能是分裂情感障碍或精神分裂症。在 DSM-5 中，只有在精神病症状出现后的整个活跃和残留病程中，大多数时间都存在完整的心境障碍发作，才能做出分裂情感障碍的诊断，直到目前的诊断。在早期的 DSM 版本中，精神分裂症和分裂情感障碍之间的界限只是定性定义的，导致可靠性差。这种变化将更清楚地区分伴有心境症状的精神分裂症与分裂情感障碍，同时可能降低分裂情感障碍的诊断率，增加一旦做出诊断的稳定性。
