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Most people have some level of vulnerability with specific mental disorders. How people stay resilient against them, and why others do not, becomes the focal point of the diathesis stress theory.

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Catatonia (marked psychomotor disturbance such as unresponsiveness to agitation) is now a specifier that can be used outside of schizophrenia spectrum and other psychotic disorders, such as with neurodevelopmental disorders, bipolar disorders, depressive disorders, neurocognitive disorders, medical disorders, and as a side effect of some psychotropic medications. For clients to receive this specifier, three of 12 symptoms must be present (without a specific time duration or frequency).

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Clients presenting with psychotic and schizophrenia spectrum disorders are challenging and diagnostically complex. To assist with these difficulties, the DSM-5 presents a new conceptualization to facilitate clinical utility and to streamline diagnostic formulations (Bruijnzeel & Tandon, 2011). Similar to autism, schizophrenia has been referenced as a spectrum disorder since 1995 (Kendler, Neale, & Walsh, 1995) and the DSM-5 marks the official recognition of this spectrum conceptualization by embedding the word in the diagnostic title. Essential to competent practice in this area is reading the on pages 87-88 of the DSM-5 (e.g., delusions, hallucinations, disorganized thinking, grossly disorganized or abnormal motor behavior, and negative symptoms). Further critical reading is the new on the DSM-5 pages 89-90. These pages describe the heterogeneity of psychotic disorders and the dimensional framework for the assessment of primary symptom severity within the psychotic disorders. This spectrum conceptualization differs from the DSM-IV-TR categorical and mutually exclusive diagnostic system that assumed “mental disorders are discrete entities, with relatively homogeneous populations that display similar symptoms and attributes of a disorder” (Jones, 2012, p. 481).

The diathesis–stress model is a psychological theory that ..

According to the DSM-5, proper use of the CRDPSS may include clinical neuropsychological assessment (especially of client cognitive functioning) to help guide diagnosis and treatment. Clinician “assessment of client cognition, depression and mania symptom domains can further assist with making critically important distinctions between the various schizophrenia spectrum and other psychotic disorders” (APA, 2013, p. 98). To track changes in client symptom severity over time, the CRDPSS may be completed at regular intervals as clinically indicated, depending on the stability of client symptoms and treatment status. Consistently high scores on a particular domain may indicate significant and problematic areas for the client that might warrant further assessment (mental status examination), treatment (counseling and pharmacological), and follow-up (case management).

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Although bipolar mood episodes may have an inherent episodic rhythm, all three disorders can be chronic, lifelong conditions that cause significant functional impairment. Yet the symptoms of bipolar disorder, but not schizophrenia, are often responsive to mood-stabilizing medications such as lithium and other anticonvulsants. Because of this “top-down” effect in which antipsychotic medications are used to treat both schizophrenia and bipolar disorders, the DSM-5 lists bipolar-related disorders in sequence after schizophrenia disorders. In addition, schizoaffective disorder is listed as the final psychotic disorder in the schizophrenia spectrum disorders chapter because it serves as a bridge to the bipolar-related disorders chapter in the DSM-5.