Symptomatic manifestations of primary psychotic disorders

Specifier Scales for Symptomatic Manifestations of Primary Psychotic Disorders

ICD-11 includes the option of providing a specification of the level of severity for six symptom domains for the disorders included in Schizophrenia or Other Primary Psychotic Disorders. These domains are:

>6A25.0 Positive Symptoms

>6A25.1 Negative Symptoms

>6A25.2 Depressive Mood Symptoms

>6A25.3 Manic Mood Symptoms

>6A25.4 Psychomotor Symptoms

>6A25.5 Cognitive Symptoms

The contribution of each of these symptom domains can be recorded in the form of specifiers, which can be rated as not present (None), Mild, Moderate, or Severe, using the anchor points and descriptions provided in the table below. The ratings should be made based on the severity of the symptoms corresponding to that domain during the past week.

Each domain that contributes significantly to the individual clinical presentation should be rated. As many symptom specifiers should be applied as necessary to accurately describe the current clinical presentation. A symptom domain can also be recorded with unspecified severity, for example if symptoms corresponding to a particular domain are present but insufficient information is available in order to rate their severity.

In cases where multiple symptoms fall within a particular domain, the rating should reflect the most severe symptom within that domain. For example, hallucinations and delusions are both part of the Positive Symptoms domain. A person may experience hallucinations that result in minimal distress (indicative of Mild Positive Symptoms) and delusions that affect the person’s behaviour but not to the point of impairing their functioning (indicative of Moderate Positive Symptoms). In that case, the person’s positive symptoms should be rated as Moderate. Note that individuals with Primary Psychotic Disorders typically do not present with all of the symptoms that are part of a given specifier domain. For example, in the Positive Symptoms domain, a person may present with only hallucinations, only delusions, both, or neither. The descriptions corresponding to each rating in the table below are intended to convey examples of symptom presentations that would justify a rating at a particular level of severity; they are not intended to be used as required criteria.

Note that the Mild, Moderate, and Severe ratings for the Depressive Mood Symptoms specifier are not equivalent to the corresponding diagnostic requirements for a Mild, Moderate, or Severe Depressive Episode. In other words, a rating of mild for Depressive Mood Symptoms in the psychotic disorder specifiers does not indicate that the individual meets the requirements for a Mild Depressive Episode. The same is true of the Manic Mood Symptoms specifier. The rating of Depressive and Manic Mood Symptoms in these specifiers indicates the severity of depressed, elevated, or irritable mood, and does not include other symptoms (e.g., disrupted sleep, anhedonia, appetite change) that can occur as a part of Mood Episodes.

Symptom specifier ratings are intended to characterize the current clinical presentation among individuals diagnosed with Schizophrenia or Other Primary Psychotic Disorders, and should not be used in individuals without such a diagnosis. Symptoms attributable to the direct pathophysiological consequences of a comorbid medical condition or injury not classified under Mental, Behavioural or Neurodevelopmental Disorders (e.g., a brain tumour or traumatic brain injury), or to the direct physiological effects of substances or medications, including withdrawal effects, should not be included in the specifier ratings. However, in individuals with Schizophrenia or Other Primary Psychotic Disorders, the specific aetiology of symptoms is often unclear (e.g., whether a mood symptom is due to the psychotic disorder or a result of substance use). In these cases, the relevant symptom should be considered in making the specifier rating until it becomes clear that the pathogenesis of the symptom is unrelated to the Primary Psychotic Disorder.

Table 6.6: Symptomatic Manifestations of Primary Psychotic Disorders: Anchor Points and Descriptions for Specifier Severity Ratings

| | |

| - | - |

| Severity | Anchor points |

| None
XS8H | No significant symptoms from the respective domain have been present during the past week. |

| Mild
XS5W
| Symptoms in the domain have been present during the past week, but these are minimal in number or do not have a substantial degree of impact. Everyday functioning is not affected by these symptoms, or is affected only minimally. No significant negative social or personal consequences have occurred as a consequence of the symptoms. The symptoms may be intermittent and show fluctuations in severity, and there may be periods during which the symptoms are absent. Compared to other individuals with similar symptoms, the severity of symptoms in the domain is in the mildest third. |

| Moderate
XS0T | A greater number of symptoms in the domain have been present during the past week or a smaller number of symptoms that have a substantial degree of impact. Everyday functioning may be moderately affected by the symptoms. There are negative social or personal consequences of the symptoms, but these are not severe. Most of the symptoms are present the majority of the time. Compared to other individuals with similar symptoms, the severity of symptoms in the domain is in the middle third. |

| Severe
XS25 | Many symptoms in the domain have been present during the past week, or a smaller number that have a severe or pervasive degree of impact (i.e., they are intense and frequent or constant). Everyday functioning is persistently impaired due to the symptoms. There are serious negative social or personal consequences. Compared to other individuals with similar symptoms, the severity of symptoms in the domain is in the most severe third. |

| Severity Unspecified | Symptoms from the respective domain have been present during the past week, but it is not possible to make a severity rating based on the available information. |