Malingering and factitious disorders. An episode of factitious disorder, with predomi- nantly psychological signs and symptoms, may have the appearance of brief psychotic disorder, but in such cases there is evidence that the symptoms are intentionally produced.
When malingering involves apparently psychotic symptoms, there is usually evidence that the illness is being feigned for an understandable goal.
Personality disorders. In certain individuals with personality disorders, psychosocial stressors may precipitate brief periods of psychotic symptoms. These symptoms are usu- ally transient and do not warrant a separate diagnosis. If psychotic symptoms persist for at least 1 day, an additional diagnosis of brief psychotic disorder may be appropriate.
Diagnostic Criteria 295.40 (F20.81)
A. Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less it successfully treated). At least one of these must be (1 ). (2), or (3): 1. Delusions.
2. Hallucinations.
3. Disorganized speech (e.g., frequent derailment or incoherence).
4. Grossly disorganized or catatonic behavior.
5. Negative symptoms (i.e., diminished emotional expression or avolition).
B. An episode of the disorder lasts at least 1 month but less than 6 months. When the diagnosis must be made without waiting for recovery, it should be qualified as “provi- sional."
C. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either 1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or 2) if mood episodes have occurred dur- ing active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.
D. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.
Specify it:
With good prognostic features: This specifier requires the presence of at least two of the following features: onset of prominent psychotic symptoms within 4 weeks of the premorbid social and occupational functioning; and absence of blunted or flat affect.
Without good prognostic features: This specifier is applied if two or more of the above features have not been present.
Specify if:
With catatonia (refer to the criteria for catatonia associated with another mental disor- der, pp. 119—120, for definition).
Coding note: Use additional code 293.89 (F06.1) catatonia associated with schizo- phreniform disorder to indicate the presence of the comorbid catatonia.
Specify current severity:
Severity is rated by a quantitative assessment of the primary symptoms of psychosis, including delusions, hallucinations, disorganized speech, abnormal psychomotor be- havior, and negative symptoms. Each of these symptoms may be rated for its current severity (most severe in the last 7 days) on a 5-point scale ranging from 0 (not present) to 4 (present and severe). (See CIinician-Rated Dimensions of Psychosis Symptom
Severity in the chapter “Assessment Measures")
Note: Diagnosis of schizophreniform disorder can be made without using this severity specifier.
Note: For additional information on Associated Features Supporting Diagnosis, Develop- ment and Course (age-related factors), Culture-Related Diagnostic Issues, Gender-Related
Diagnostic Issues, Differential Diagnosis, and Comorbidity, see the corresponding sec- tions in schizophrenia.