Table 3.

Revised criteria for psychosis in major or mild neurocognitive disorder.

A. Characteristic Symptoms

Presence of one (or more) of the following symptoms:

1. Visual or auditory hallucinations (e.g., seeing silent individuals standing in the room, seeing children in the yard, or seeing animals in the house)

2. Delusions (fixed false beliefs that the patient believes to be true, e.g. that the spouse is unfaithful, that possessions are being stolen, or that one is not who one claims to be)

B. Primary Diagnosis

All the criteria for any major and mild neurocognitive disorder are met, with the etiologic diagnoses specified (e.g., major neurocognitive disorder (Alzheimer’s disease)). Specific diagnoses include Alzheimer’s disease, dementia with Lewy bodies, vascular dementia, Parkinson disease dementia, frontotemporal dementia, progressive supranuclear palsy, mild cognitive impairment, traumatic brain injury, and corticobasal degeneration. Other rarer causes of major and mild neurocognitive disorder are also appropriate when diagnosed as a cause of psychosis.

C. Chronology of the onset of symptoms of psychosis vs. onset of symptoms of

cognitive impairment

There is evidence from the history that the symptoms in Criterion A have not been present continuously since prior to the onset of the symptoms of dementia

D. Duration

The symptom(s) in Criterion A have been present, at least intermittently, for 1 month or longer.

E. Severity

Symptoms are severe enough to cause some disruption in patients’ and/or others’ functioning or pose a threat to the safety of self or others. “Disruption” is defined as interfering with the

patient’s or others’ ability to accomplish activities of daily living or interact as usual socially; “patient’s functioning” is defined as being able to interact with family members and others, not being preoccupied with hallucinations, etc.; “other’s functioning” is defined as interfering with the ability of others to care for or interact with the patient or causing distress to the partner.

F. Exclusionary Criteria

A diagnosis of psychosis in major or mild neurocognitive disorder should be excluded in the following patients:

1. Patients who have met the criteria for Schizophrenia, Schizoaffective Disorder, Delusional Disorder, Mood Disorder with Psychotic Features, or Depression with Psychotic Features.

2. When the psychosis occurs exclusively during the course of a delirium.

3. When the psychosis is solely attributable to another general-medical condition (e.g., hypothyroidism) or direct physiological effects of a substance (e.g., a drug of abuse, a medication).

4. When the symptoms are culturally appropriate (e.g., ancestor hallucinations in some cultures).

5. When the hallucinations are more readily attributable to conditions known to cause hallucinations such as epilepsy, migraine, disease of the sensory organs, or stroke.

G. Associated features: (Specify if associated)

With Agitation: when there is evidence, from history or examination, of prominent agitation with or without physical or verbal aggression.

With Depression: when prominent depressive symptoms, such as depressed mood, insomnia or hypersomnia, feelings of worthlessness or excessive or inappropriate guilt, or recurrent thoughts of death are present (note that Mood Disorder with Psychotic Features is an exclusion for the diagnosis of psychosis with major or mild neurocognitive disorders (see F.1 above)