Although attempts have been made to bridge the gap between ICD-10 and DSM-IV and move them closer, significant differences still persist concerning the definition, duration and subtypes of schizophrenia and the nomenclature of various other psychotic disorders classified with schizophrenia.  ICD-10 classifies schizotypal disorder,  persistent delusional disorder, acute and transient psychotic disorders,  induced delusional disorder and schizoaffective disorders together with schizophrenia (Table 1.1). DSM-IV does not include the category of schizotypal disorders with psychotic disorders but classifies it along with cluster A personality disorders.

Induced delusional disorder in ICD-10 is called shared psychotic disorder in DSM-IV;  persistent delusional disorder in ICD-10 is called delusional disorder in DSM-IV (Table 1.2). The major difference is in the category of acute and transient psychotic disorder of ICD-10,  which overlaps with brief psychotic disorder and schizophreniform disorder of DSM-IV.

The other major difference is in the classification of psychotic illness secondary to substance misuse and to general medical conditions, which are classified together with schizophrenia in DSM-IV but are classified with disorder due to psychoactive substance misuse (F10–F19)  and organic mental disorder (F00–F09), respectively, in ICD-10.

ICD-10 avoids criteria based on social and occupational dysfunction for the diagnosis of schizophrenia on the basis that it is difficult to equate these criteria between different cultures.

This is a major inclusion criterion in DSM-IV that is essential for the diagnosis of schizophrenia.

Diagnostic criteria for schizophrenia
ICD-10 requires either one of the Schneiderian first-rank symptoms,  or bizarre delusions,  or two or more symptoms including persistent hallucinations, thought disorder, catatonic behaviour,  negative symptoms or significant and persistent behavioural change. These features are required to be present for a 1-month duration or longer. ICD-10 recognizes that there may be a prodromal phase associated with schizophrenia, but as a prodrome typical of and specific to schizophrenia could not be described reliably it is not included in the diagnostic criteria. The 1-month duration of schizophrenia according to ICD-10 does not include the prodromal phase (Table 1.3).

ICD-10 requires exclusion of substance use or organic brain disease if they may be causing features of schizophrenia. As described   earlier,  the   presence   of   the   schizophrenia-like symptoms caused by either organic brain disease or substance use are classified along with organic mental disorder and substance misuse disorders, respectively, in ICD-10, not with schizophrenia.

DSM-IV requires,  for the diagnosis of schizophrenia,  1 month’s duration of characteristic symptoms with at least two of the symptoms of delusions,  hallucinations,  disorganized speech, grossly disorganized catatonic behaviour or negative symptoms (Table 1.4). However, only one of these is required if delusions are bizarre or third-person auditory hallucination or running commentary are present.  This criterion brings the DSM-IV diagnosis of schizophrenia closer to that of ICD-10.

In addition to this criterion, DSM-IV requires a total duration of at least 6 months, including 1 month of active symptoms and social and occupational disfunction during this time.

This criterion is significantly different from ICD-10 as the duration required is only 1 month in ICD-10 and social and occupational dysfunction is not required at all. DSM-IV recognizes the prodrome of schizophrenia and the duration of prodrome is included in the total 6-month duration required for its diagnosis. Specific exclusion criteria are similar to those of ICD-10, including those of schizoaffective and mood disorders and exclusion of disorders secondary to general medical condition and substance misuse. In the DSM-IV, schizophrenia-like illness secondary to a general medical condition or substance misuse is classified in the section on schizophrenia and related psychotic disorders. This is in contrast with ICD-10, as described above, and avoids hierarchical assumptions.

J.K. Wing and N. Agrawal

Edited by
Steven R. Hirsch
MD FRCP FRCPsych
Professor of Psychiatry Emeritus, Division of Neuroscience and Psychological Medicine Imperial College Faculty of Medicine and Director of Teaching Governance, West London Mental Health NHS Trust London, UK

Daniel R. Weinberger MD
Chief, Clinical Brain Disorders Branch Intramural Research Program National Institute of Mental Health Bethesda MD 20982, USA

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