Psychotic disorder symptoms that don’t clearly meet the full criteria used to be identified as Not Otherwise Specified. Now, doctors may use “unspecified” or “other specified.”
People who experience psychotic disorder symptoms that don’t seem to match the criteria for a psychotic or schizophrenia spectrum diagnosis may have what was previously called psychotic disorder not otherwise specified (PNOS).
Before 2013, the term “not otherwise specified” was used to describe any condition that didn’t quite meet the criteria for a definitive diagnosis.
The most recent version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) introduced new criteria for classifying these types of mental health conditions.
People who were once diagnosed with PNOS may be now diagnosed with other conditions that fall under the new criteria.
The DSM-5 is the guide relied upon by psychiatrists to make mental health diagnoses. It outlines all known potential diagnoses and the criteria for assigning those diagnoses.
According to the newest version of the DSM, psychotic disorder not otherwise specified (PNOS) has been recategorized as the following conditions:
- unspecified schizophrenia spectrum (USS) and other psychiatric disorder (ODD)
- other specified schizophrenia spectrum (OSSS) and other psychiatric disorder (ODD)
These categories refer to symptoms that are typical of a schizophrenia spectrum or other psychotic disorder diagnosis. Symptoms that may be present include:
- delusions
- hallucinations
- disorganized speech
- grossly disorganized or catatonic behavior
- flat affect
When these symptoms are present and responsible for significant issues at home and at work, without the additional required criteria for another diagnosis, PNOS may be diagnosed.
Much is still being learned about psychotic disorders, so a more encompassing diagnosis for those conditions that didn’t fully fit into any other diagnostic criteria was created.
And with approximately
In 2013, the fifth edition of the DSM was published based on 10 years of research and psychiatric experience.
Many changes were made
The reasons for this change were not clearly outlined. Still, the new classification system offers a more accurate and precise diagnosis for symptoms that do not meet the full criteria for a specific disorder but may still apply.
The PNOS diagnosis is no longer used, according to the latest version of the DSM.
However, in cases of psychotic or schizophrenia spectrum disorders, the person would have symptoms that cause significant problems in key areas of their life, such as at work, home, and with family and friends.
- persistent non-bizarre delusions with overlapping mood episodes that were not present during the delusion
- hallucinations without other psychotic features
- disorganized speech
- grossly disorganized or catatonic behavior
negative symptoms such as lack of emotional expression, complete lack of speech, or total lack of motivation
It’s possible that a person may receive this diagnosis if it’s their first psychotic break, as determined by their doctor.
Typically, symptoms intensify over time and unfold over months. If at an evaluation the symptoms aren’t fully present to meet a specific diagnostic criteria, this diagnosis will be used.
A person may receive the “unspecified” diagnosis when a doctor either chooses not to, or is unable to, say why the person’s symptoms don’t match any other diagnostic criteria. For example, in an emergency room setting where the clinician has limited information.
Clinicians may also use the “unspecified” diagnosis if the individual has a mix of symptoms that don’t quite reflect a full diagnosis of schizophrenia or “other specified” psychotic disorder.
On the other hand, a diagnosis of “other specified” may be assigned when a clinician has spent plenty of time with an individual and can clearly see their symptoms don’t meet the full criteria.
You may be diagnosed with one of the following conditions, if your symptoms do not quite fit the criteria for a psychotic or schizophrenia spectrum disorder diagnosis:
- unspecified schizophrenia spectrum (USS) and other psychiatric disorder (ODD)
- other specified schizophrenia spectrum (OSSS) and other psychiatric disorder (ODD)
In each of these conditions, the person shows some symptoms that may cause distress or significant problems in their day-to-day life.
The diagnosing physician must be skilled at recognizing the subtle variations in the delusional and hallucinatory symptoms to make a diagnosis that’s accurate.
They must also be able to distinguish whether the psychotic symptoms are a result of another condition.
Other conditions that may be caused by these symptoms include:
- schizophrenia
- manic state of bipolar disorder
- psychedelic intoxication
- ETOH (ethanol) withdrawal
- brief psychotic disorder
- post-traumatic stress disorder (PTSD)
- long-term alcohol or cocaine/methamphetamine use
- traumatic brain injury (TBI)
Before treatment can began, the doctor will have to examine the person’s history and conduct a neurological exam and toxicology screening.
If you think you may have a psychotic or schizophrenia spectrum disorder, but your symptoms are not as severe to warrant a full diagnosis, consider reaching out to a licensed psychotherapist who has experience treating these types of conditions.
You could ask your doctor to recommend a therapist, or you could search for an expert online. You can try the American Psychology Association’s Find a Therapist Tool.
If you’re experiencing these symptoms yourself or you’re a mental healthcare professional, you may be looking for more information on PNOS.
While PNOS is no longer used, there are still criteria your doctor will look at to make an accurate diagnosis.