Revisions and Refinements of the Diagnosis of Schizophrenia in DSM-5

The DSM-5 changes to the diagnostic criteria for schizophrenia reflect modest incremental changes. The two most substantial changes, the elimination of subtypes and de-emphasis of Schneiderian First-Rank Symptoms, are a significant departure from long-standing approaches to conceptualizing and defining schizophrenia, but are unlikely to have an appreciable impact on caseness or clinical management. Several minor modifications to the diagnosis are generally useful additions that will likely enhance diagnostic precision. The two most controversial changes that were considered, the addition of dimensional ratings and attenuated psychosis syndrome, were ultimately placed in the third section of DSM-5 for further research and consideration. In sum, the changes demonstrate increased precision of diagnosis, with minimal changes in caseness.