Is Crazy the same as Insane, or Lunatic?
III. PSYCHOSES NOT ATTRIBUTED TO PHYSICAL CONDI-
TIONS LISTED PREVIOUSLY (295—298)
This major category is for patients whose psychosis is not caused by
physically. Nevertheless, some of these pa-
tients may show additional signs of an organic condition.
- 295 Schizophrenia
This large category includes a group of disorders manifested by char-
acteristic disturbances of thinking, mood and behavior. Disturbances in
thinking are marked by alterations of concept formation which may
lead to misinterpretation of reality and sometimes to delusions and hal
lucinations, which frequently appear psychologically self-protective.
Corollary mood changes include ambivalent, constricted and inappro-
priate emotional responsiveness and loss of empathy with others. Be-
havior may be withdrawn, regressive and bizarre. The schizophrenias, in
which the mental status is attributable primarily to a thought disorder,
are to be distinguished from the Major affective illnesses (q.v.) which
are dominated by a mood disorder. The Paranoid states (q.v.) are dis-
tinguished from schizophrenia by the narrowness of their distortions of
reality and by the absence of other psychotic symptoms.
295.0 Schizophrenia, simple type
This psychosis is characterized chiefly by a slow and insidious re-
duction of external attachments and interests and by apathy and in-
difference leading to impoverishment of interpersonal relations, mental
deterioration, and adjustment on a lower level of functioning. In gen-
eral, the condition is less dramatically psychotic than are the hebe-
phrenic, catatonic, and paranoid types of schizophrenia. Also, it
contrasts with schizoid personality, in which there is little or no
progression of the disorder.
295.1 Schizophrenia, hebephrenic type
This psychosis is characterized by disorganized thinking, shallow and
inappropriate affect, unpredictable giggling, silly and regressive be-
havior and mannerisms, and frequent hypochondriacal complaints.
Delusions and hallucinations, if present, are transient and not well
organized.
- 295.2 Schizophrenia, catatonic type
- 295.23* Schizophrenia, catatonic type, excited*
- 295.24* Schizophrenia, catatonic type, withdrawn*
It is frequently possible and useful to distinguish two subtypes of
catatonic schizophrenia. One is marked by excessive and sometimes
violent motor activity and excitement and the other by generalized
inhibition manifested by stupor, mutism, negativism, or waxy flex-
ibility. In time, some cases deteriorate to a vegetative state.
- 295.3 Schizophrenia, paranoid type
This type of schizophrenia is characterized primarily by the pres-
ence of persecutory or grandiose delusions, often associated with hal-
lucinations. Excessive religiosity is sometimes seen. The patient's at-
titude is frequently hostile and aggressive, and his behavior tends
to be consistent with his delusions. In general the disorder does
not manifest the gross personality disorganization of the hebephrenic
and catatonic types, perhaps because the patient uses the mech-
anism of projection, which ascribes to others characteristics he can-
not accept in himself. Three subtypes of the disorder may sometimes
be differentiated, depending on the predominant symptoms: hostile,
grandiose, and hallucinatory.
- 295.4 Acute schizophrenic episode
This diagnosis does not apply to acute episodes of schizophrenic
disorders described elsewhere. This condition is distinguished by
the acute onset of schizophrenic symptoms, often associated with
confusion, perplexity, ideas of reference, emotional turmoil, dream-
like dissociation, and excitement, depression, or fear. The acute
onset distinguishes this condition from simple schizophrenia. In time
these patients may take on the characteristics of catatonic, hebe-
phrenic or paranoid schizophrenia, in which case their diagnosis
should be changed accordingly. In many cases the patient recovers
within weeks, but sometimes his disorganization becomes progres-
sive. More frequently remission is followed by recurrence. (In DSM-I
this condition was listed as "Schizophrenia, acute undifferentiated
type.")
- 295.5 Schizophrenia, latent type
This category is for patients having clear symptoms of schizophrenia
but no history of a psychotic schizophrenic episode. Disorders some-
times designated as incipient, pre-psychotic, pseudoneurotic, pseudo-
psychopathic, or borderline schizophrenia are categorized here. (This
category includes some patients who were diagnosed in DSM-I under
"Schizophrenic reaction, chronic undifferentiated type." Others for-
merly included in that DSM-I category are now classified under
Schizophrenia, other [and unspecified] types (q.v.).)
- 295.6 Schizophrenia, residual type
This category is for patients showing signs of schizophrenia but
who, following a psychotic schizophrenic episode, are no longer psy-
chotic.
- 295.7 Schizophrenia, schizo-affective type
This category is for patients showing a mixture of schizophrenic
symptoms and pronounced elation or depression. Within this category
it may be useful to distinguish excited from depressed types as
follows:
295.73* Schizophrenia, schizo-affective type, excited*
295.74* Schizophrenia, schizo-affective type, depressed*
295.8* Schizophrenia, childhood type*
This category is for cases in which schizophrenic symptoms appear
before puberty. The condition may be manifested by autistic, atypical,
and withdrawn behavior; failure to develop identity separate from
the mother's; and general unevenness, gross immaturity and inade-
quacy in development. These developmental defects may result in
mental retardation, which should also be diagnosed. (This category
is for use in the United States and does not appear in ICD-8. It is
equivalent to "Schizophrenic reaction, childhood type" in DSM-I.)
- 295.90* Schizophrenia, chronic undifferentiated type*
This category is for patients who show mixed schizophrenic symp-
toms and who present definite schizophrenic thought, affect and be-
havior not classifiable under the other types of schizophrenia. It is
distinguished from Schizoid personality (q.v.). (This category is
equivalent to "Schizophrenic reaction, chronic undifferentiated type"
in DSM-I except that it does not include cases now diagnosed as
Schizophrenia, latent type and Schizophrenia, other [and unspecified]
types.)
- 295.99* Schizophrenia, other [and unspecified] types*
This category is for any type of schizophrenia not previously de-
scribed. (In DSM-I "Schizophrenic reaction, chronic undifferentiated
type" included this category and also what is now called Schizo-
phrenia, latent type and Schizophrenia, chronic undifferentiated type.)
- 296 Major affective disorders ((Affective psychoses))
This group of psychoses is characterized by a single disorder of mood,
either extreme depression or elation, that dominates the mental life
of the patient and is responsible for whatever loss of contact he has
with his environment. The onset of the mood does not seem to be
related directly to a precipitating life experience and therefore is dis-
tinguishable from Psychotic depressive reaction and Depressive neurosis.
(This category is not equivalent to the DSM-I heading "Affective reac-
tions," which included "Psychotic depressive reaction.")
- 296.0 Involutional melancholia
This is a disorder occurring in the involutional period and character-
ized by worry, anxiety, agitation, and severe insomnia. Feelings of
guilt and somatic preoccupations are frequently present and may be
of delusional proportions. This disorder is distinguishable from Manic-
depressive illness (q.v.) by the absence of previous episodes; it is
distinguished from Schizophrenia (q.v.) in that impaired reality
testing is due to a disorder of mood; and it is distinguished from
Psychotic depressive reaction (q.v.) in that the depression is not
due to some life experience. Opinion is divided as to whether this
psychosis can be distinguished from the other affective disorders. It
is, therefore, recommended that involutional patients not be given this
diagnosis unless all other affective disorders have been ruled out. (In
DSM-I this disorder was included under "Disorders due to dis-
turbances of metabolism, growth, nutrition or endocrine function.")
Manic-depressive illnesses (Manic-depressive psychoses)
These disorders are marked by severe mood swings and a tendency
to remission and recurrence. Patients may be given this diagnosis in
the absence of a previous history of affective psychosis if there is no
obvious precipitating event. This disorder is divided into three
major subtypes: manic type, depressed type, and circular type.
- 296.1
- Manic-depressive illness, manic type ((Manic-depres-
- sive psychosis, manic type))
This disorder consists exclusively of manic episodes. These episodes
are characterized by excessive elation, irritability, talkativeness, flight
of ideas, and accelerated speech and motor activity. Brief periods of
depression sometimes occur, but they are never true depressive epi-
sodes.
- 296.2 Manic-depressive illness, depressed type ((Manic-depres-
sive psychosis, depressed type))
This disorder consists exclusively of depressive episodes. These
episodes are characterized by severely depressed mood and by mental
and motor retardation progressing occasionally to stupor. Uneasi-
ness, apprehension, perplexity and agitation may also be present.
When illusions, hallucinations, and delusions (usually of guilt or of
hypochondriacal or paranoid ideas) occur, they are attributable to
the dominant mood disorder. Because it is a primary mood dis-
order, this psychosis differs from the Psychotic depressive reaction,
which is more easily attributable to precipitating stress. Cases in-
completely labelled as "psychotic depression" should be classified
here rather than under Psychotic depressive reaction.
- 296.3 Manic-depressive illness, circular type ((Manic-depressive
- psychosis, circular type))
This disorder is distinguished by at least one attack of both a de-
pressive episode and a manic episode. This phenomenon makes
clear why manic and depressed types are combined into a single cate-
gory. (In DSM-I these cases were diagnosed under "Manic depres-
sive reaction, other.") The current episode should be specified and
coded as one of the following:
296.33* Manic-depressive illness, circular type, manic*
296.34* Manic-depressive illness, circular type, depressed*
296.8 Other major affective disorder ((Affective psychosis,
other))
Major affective disorders for which a more specific diagnosis has not
been made are included here. It is also for "mixed" manic-depres-
sive illness, in which manic and depressive symptoms appear almost
simultaneously. It does not include Psychotic depressive reaction
(q.v.) or Depressive neurosis (q.v.). (In DSM-I this category was
included under "Manic depressive reaction, other.")
These are psychotic disorders in which a delusion, generally persecu-
tory or grandiose, is the essential abnormality. Disturbances in mood,
behavior and thinking (including hallucinations) are derived from this
delusion. This distinguishes paranoid states from the affective psy-
choses and schizophrenias, in which mood and thought disorders, re-
spectively, are the central abnormalities. Most authorities, however,
question whether disorders in this group are distinct clinical entities
and not merely variants of schizophrenia or paranoid personality.
This extremely rare condition is characterized by gradual de-
velopment of an intricate, complex, and elaborate paranoid system based on and often proceeding logically from misinterpretation of an actual event. Frequently the patient considers himself endowed with unique and superior ability. In spite of a chronic course the condi-tion does not seem to interfere with the rest of the patient's thinking
and personality.
297.1 Involutional paranoid state ((Involutional paraphrenia))
This paranoid psychosis is characterized by delusion formation with
onset in the involutional period. Formerly it was classified as a para-
noid variety of involutional psychotic reaction. The absence of con-
spicuous thought disorders typical of schizophrenia distinguishes it
from that group.
297.9 Other paranoid state
This is a residual category for paranoid psychotic reactions not
classified earlier.
- 298.0 Psychotic depressive reaction ((Reactive depressive psy-
- chosis))
This psychosis is distinguished by a depressive mood attributable to
some experience. Ordinarily the individual has no history of re-
peated depressions or cyclothymic mood swings. The differentiation
between this condition and Depressive neurosis (q.v.) depends on
whether the reaction impairs reality testing or functional adequacy
enough to be considered a psychosis. (In DSM-I this condition was
included with the affective psychoses.)
[Dementia, insanity or psychosis not otherwise specified]
This is not a diagnosis but is listed here for librarians and statis-
ticians to use in coding incomplete diagnoses.
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