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Schizophrenia E006

Last amended 
10 November 2016

In this section

Current RMA Instruments
Reasonable Hypothesis SOP
83 of 2016
Balance of Probabilities SOP
84 of 2016
Changes from previous Instruments

SOP bulletin 193

ICD Coding
  • ICD-9-CM Codes: 295.1-295.3, 295.6, 295.9
  • ICD-10-AM Codes: F20.0-F20.3, F20.5, F20.9
Brief description

Schizophrenia is a disorder of mental health involving chronic or recurrent psychosis.  Psychosis means a loss of contact with reality in the form of hallucinations and delusions, as well as disorganised thoughts and behaviour.

Confirming the diagnosis

A report from a specialist psychiatrist that conforms with the Repatriation Commission Guidelines for Psychiatric Compensation Claims is required for diagnosis.

Additional diagnoses covered by SOP
  • catatonic schizophrenia
  • hebephrenic schizophrenia
  • paranoid schizophrenia
  • residual schizophrenia
Conditions not covered by SOP
  • acute schizophrenic (like) episode, ICD code 295.4
  • latent schizophrenia, ICD code 295.5
  • mood disorders with psychotic features, ICD code 296.99
  • psychosis due to the direct physiological effects of a substance, ICD code 292.89
  • schizoaffective disorder, ICD code 295.7
  • schizoid personality disorder, ICD code 301.2
  • simple schizophrenia, ICD code 295.0

(all non-SOP conditions)

Clinical onset

Symptoms meeting the diagnostic criteria need to be present for 6 months before the diagnosis can be confirmed, but clinical onset can then be backdated to when those relevant symptoms began.

Clinical worsening

The course of schizophrenia is variable.  There may be periods of remission and long term recovery to a good level of functioning or symptoms may be continuous and impairment may be severe.