Positive symptoms in primary psychotic disorders

This specifier may be used together with a diagnosis from the grouping of Schizophrenia or Other Primary Psychotic Disorders to indicate the degree to which positive psychotic symptoms are a prominent part of the current clinical presentation. Positive symptoms include delusions, hallucinations (most commonly verbal auditory hallucinations), disorganized thinking (formal thought disorder such as loose associations, thought derailment, or incoherence), disorganized behaviour (behaviour that appears bizarre, purposeless and not goal-directed) and experiences of passivity and control (the experience that one's feelings, impulses, or thoughts are under the control of an external force). Abnormal psychomotor behaviour (e.g., catatonic restlessness or agitation, waxy flexibility, negativism) is not included in this domain but instead would be rated in the Psychomotor Symptoms domain below.

The rating should be made based on the severity of positive symptoms during the past week.

Table 6.7: Rating Scale for Positive Symptoms in Primary Psychotic Disorders

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| None
6A25.0&XS8H
| No significant positive symptoms have been present during the past week. |

| Mild
6A25.0&XS5W
| Example symptoms (not all are required):
Delusions: The person believes the delusion (lack of reality testing), but does not feel pressure to act upon it and the delusion leads to minimal distress.
Hallucinations: Hallucinations are recurrent but relatively infrequent, and the person expresses only minimal distress regarding their content.
Experiences of Passivity and Control: Some distortions of self-experience, such as feeling that one’s thoughts are not one’s own, but these are relatively infrequent and there is only minimal associated distress.
Disorganized Thinking: Some circumstantial or tangential thought process, but for the most part the individual is able to convey the point of the intended communication.
Disorganized Behaviour: Infrequent episodes of purposeless behaviour that is not goal-directed and causes only minimal impairment in functioning.
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| Moderate
6A25.0&XS0T
| Example symptoms (not all are required):
Delusions: The person’s behaviour is clearly affected by the delusional beliefs but the person’s behavioural response does not significantly impair functioning (e.g., a person with persecutory delusions is watchful of his surroundings but continues to venture outside).
Hallucinations: Hallucinations are relatively frequent and may be distressing at times but are tolerated at other times, and do not persistently |

| Severe
6A25.0&XS25
| Example symptoms (not all are required):
Delusions: The person is preoccupied with delusional beliefs that dictate many of the person’s actions and significantly impair functioning (e.g., a person with persecutory delusions refuses to eat most food because of a conviction that food has been poisoned).
Hallucinations: The person is markedly distressed or preoccupied by frequent hallucinations or there are recurrent hallucinations that prompt potentially harmful behaviour to which the person feels compelled to respond.
Experiences of Passivity and Control: Distortions of self-experience are markedly distressing, and significantly impact the individual’s behaviour (e.g., wearing a hat made of aluminium foil to prevent thought broadcasting).
Disorganized Thinking: Loose associations in thought processes that are so severe that speech is mostly incoherent.
Disorganized Behaviour: Purposeless behaviour that is not goal-directed dominates the individual’s behavioural repertoire and causes severe impairment in functioning. |

| Severity Unspecified
6A25.0
| Positive symptoms have been present during the past week, but it is not possible to make a severity rating based on the available information. |