ICD-10 Classification of Mental and Behavioural Disorders, World Health Organization, Geneva, 1992
F20.0 Paranoid Schizophrenia
Definition | Diagnostic Guidelines | DCR-10 Criteria
This is the commonest type of schizophrenia in most parts of the world. The clinical picture is dominated by relatively stable, often paranoid, delusions, usually accompanied by hallucinations, particularly of the auditory variety, and perceptual disturbances. Disturbances of affect, volition, and speech, and catatonic symptoms, are not prominent.Examples of the most common paranoid symptoms are:
(a) delusions of persecution, reference, exalted birth, special mission, bodily
change, or jealousy;
(b) hallucinatory voices that threaten the patient or give commands, or auditory
hallucinations without verbal form, such as whistling, humming, or laughing;
(c) hallucinations of smell or taste, or of sexual or other bodily sensations;
visual hallucinations may occur but are rarely predominant.
Thought disorder may be obvious in acute states, but if so it does not prevent the typical delusions or hallulcinations from being described clearly. Affect is usually less blunted than in other varieties of schizophrenia, but a minor degree of incongruity is common, as are mood disturbances such as irritability, sudden anger, fearfulness, and suspicion. "Negative" symptoms such as blunting of affect and impaired volition are often present but do not dominate the clinical picture.
The course of paranoid schizophrenia may be episodic, with partial or complete remissions, or chronic. In chronic cases, the florid symptoms persist over years and it is difficult to distinguish discrete episodes. The onset tends to be later than in the hebephrenic and catatonic forms.
The general criteria for a diagnosis of schizophrenia (see introduction to F20 above) must be satisfied. In addition, hallucinations and/or delusions must be prominent, and disturbances of affect, volition and speech, and catatonic symptoms must be relatively inconspicuous. The hallucinations will usually be of the kind described in (b) and (c) above. Delusions can be of almost any kind of delusions of control, influence, or passivity, and persecutory beliefs of various kinds are the most characteristic.Includes:
* paraphrenic schizophrenia
Differential diagnosis.
It is important to exclude epileptic and drug-induced psychoses, and to remember that persecutory delusions might carry little diagnostic weight in people from certain countries or cultures.
Excludes:
* involutional paranoid state (F22.8)
* paranoia (F22.0)
G1. Either at least one of the syndromes, symptoms and signs listed under (1) below or at least two of the symptoms and signs listed under (2) should be present for most of the time during an episode of psychotic illness lasting for at least 1 month (or at some time during most of the days)
(1) At least one of the following must be present:
a) thought echo, thought insertion or withdrawal, or thought broadcasting;
b) delusions of control, influence or passivity, clearly referred to body or limb movements or specific thoughts, actions or sensations; delusional perception
c) hallucinatory voices giving a running commentary on the patient's behaviour, or discussing the patient between themselves, or other types of hallucinatory voices coming from some part of the body
d) persistent delusions of other kinds that are culturally inappropriate and completely impossible (e.g. being able to control the weather, or being in communication with beings from another world)
(2) Or at least two of the following:
a) persistent hallucinations in any modality, when occurring every day for at least 1 month, when accompanied by delusions (which may be fleeting or half-formed) without clear affective content, or when accompanied by persistent overvalued ideas
b) neologisms, breaks or interpolations in the train of thought, resulting in incoherence or irrelevant speech
c) catatonic behaviour, such as excitement, posturing or waxy flexibility, negativism, mutism and stupor
d) 'negative' symptoms, such as marked apathy, paucity of speech and blunting or incongruity of emotional response
ICD-10 copyright © 1992 by World Health Organization.