Psychotic Disorders in DSM-5: Clinical Implications of Revisions From DSM-IV

1. Inadequate presentation of the heterogeneity of clinical syndromes 2. Treatment of schizoaffective disorder as an episode diagnosis with unclear separation from schizophrenia 3. Poor reliability and low diagnostic stability of schizoaffective disorder 4. Variable definitions and discrepant treatment of catatonia across disorders in DSM-IV 5. The limited role and validity of schizophrenia subtypes 6. Inadequate classification for early detection of potential psychoses Relevant revisions in DSM-5 eliminate the classic subtypes of schizophrenia and add unique psychopathological dimensions, as well as a scale to measure each of these dimensions across all psychotic disorders; provide a more precise definition of the boundary between schizophrenia and schizoaffective disorder; and add a new category—attenuated psychosis syndrome. The latter is a condition for further study in Section 3. In this article, we discuss the implications of these changes for clinical practice.