Diagnostic Categories of Psychotic Disorders

Catatonia is just one of many key features listed in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) that help to define a psychotic disorder. The psychotic disorders, as listed in the DSM-5, fall under the section entitled “Schizophrenia and Other Psychotic Disorders,” as schizophrenia is the illness that most lay people refer to when the word psychotic or crazy is mentioned.

Patients that present to an emergency department with psychotic symptoms for psychiatric help may present with a diagnostic picture that fits any of the following disorders. It is important to note, with regard to diagnosis, that not all individuals will neatly fall into any given diagnostic picture perfectly. The majority of diagnostic attempts on a person may appear to be akin to trying to fit an octagon into a circular space or sometimes even a square.

The art of diagnosis can be described as or give the feeling of pigeonholing especially when you look at the multiple diagnostic criteria that the clinician attempts to sort through and match up with the symptoms that the patient presents with. In some cases, you may be able to have five different clinicians diagnose the same patient at the same time and develop five different diagnoses based on their clinical opinions (Spurious Precision: Procedural Validity of Diagnostic Assessment in Psychotic Disorders 1995). The main point to remember is that diagnosis is not a perfect, flawless skill. When you take into account the limited time and resources that many emergency department clinicians are presented with on the job, the rates of accurate assessment and diagnosis may decline in this clinical environment.