DSM-5 added a requirement that the patient must have at least one of the following symptoms: delusions, hallucinations, or disorganized speech.

DSM-5 added a requirement that the patient must have at least one of the following symptoms: delusions, hallucinations, or disorganized speech.

• A. Removal of any role for first-rank symptoms
• B. Addition of a requirement to have at least one of delusions, hallucinations, or disorganized speech
• C. Extension of duration requirement to 18 months
• D. Introduction of a new category for catatonia

Answer: (B)

DSM-5 defines schizophrenia with Criterion A: two or more symptoms must be present during a 1‑month period, and at least one of these symptoms must be delusions, hallucinations, or disorganized speech. This makes psychotic features central to the diagnosis and improves specificity, ensuring the label reflects clear psychotic phenomena rather than other symptom clusters. In practice, if someone shows two symptoms that are purely negative (for example, avolition and diminished emotional expression) without any delusions, hallucinations, or disorganized speech, they would not meet the threshold for schizophrenia. That’s precisely the change captured by this addition: it prevents the diagnosis from being assigned when the core psychotic experiences aren’t present, even if other symptoms are. The other proposed changes do not reflect what DSM-5 added. There was no removal of first-rank symptoms, no extension of a duration requirement to 18 months, and no introduction of a new category for catatonia.

DSM-5 defines schizophrenia with Criterion A: two or more symptoms must be present during a 1‑month period, and at least one of these symptoms must be delusions, hallucinations, or disorganized speech. This makes psychotic features central to the diagnosis and improves specificity, ensuring the label reflects clear psychotic phenomena rather than other symptom clusters.

In practice, if someone shows two symptoms that are purely negative (for example, avolition and diminished emotional expression) without any delusions, hallucinations, or disorganized speech, they would not meet the threshold for schizophrenia. That’s precisely the change captured by this addition: it prevents the diagnosis from being assigned when the core psychotic experiences aren’t present, even if other symptoms are.

The other proposed changes do not reflect what DSM-5 added. There was no removal of first-rank symptoms, no extension of a duration requirement to 18 months, and no introduction of a new category for catatonia.