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Schizophrenia Information > Diagnosis of Schizophrenia

Diagnosis of Schizophrenia

Table of Contents - Schizophrenia Symptoms and Diagnosis

The First Steps Towards Proper Diagnosis

The first step in getting treatment for schizophrenia is getting a correct diagnosis. This can be a more difficult than it might seem because the symptoms of schizophrenia can be similar at times to other major brain disorders such as bipolar disorder (Manic/Depression) or even major depression, or because a person with schizophrenia may be paranoid or believe that nothing is wrong and may not want to go to see a doctor.  Because many regular family doctors may not be very familiar with schizophrenia it is important to see a good psychiatrist that is experienced in the diagnosis and treatment of schizophrenia.  One way to do this is to contact a local support group that deals with brain disorders such as schizophrenia and talk to the other members that already have experience with the local psychiatrists. If that is not convenient, we recommend you join in our discussion areas (see "parents" area or "Main Area" listed on home page) and ask there if anyone can recommend a good psychiatrist in your area. Local members may be able to recommend a good psychiatrist experienced in schizophenia that they have worked with. As with most serious illnesses, its important to get diagnosis and treatment as quickly as possible. 

The Common Symptoms of Schizophrenia

  • The First Signs of Schizophrenia - Personal Stories
  • The Importance of Keeping a Journal - For best diagnosis and recovery of person with schizophrenia

  • Symptoms of Schizophrenia

    Schizophrenia is characterized by profound disruption in cognition and emotion, affecting the most fundamental human attributes: language, thought, perception, affect, and sense of self. The array of symptoms, while wide ranging, frequently includes psychotic manifestations, such as hearing internal voices or experiencing other sensations not connected to an obvious source (hallucinations) and assigning unusual significance or meaning to normal events or holding fixed false personal beliefs (delusions). No single symptom is definitive for diagnosis; rather, the diagnosis encompasses a pattern of signs and symptoms, in conjunction with impaired occupational or social functioning (Source: DSM-IV -available on Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR).

    Symptoms are typically divided into positive and negative symptoms because of their impact on diagnosis and treatment. Positive symptoms are those that appear to reflect an excess or distortion of normal functions. The diagnosis of schizophrenia, according to DSM-IV, requires at least 1-month duration of two or more positive symptoms, unless hallucinations or delusions are especially bizarre, in which case one alone suffices for diagnosis. Negative symptoms are those that appear to reflect a diminution or loss of normal functions. These often persist in the lives of people with schizophrenia during periods of low (or absent) positive symptoms. Negative symptoms are difficult to evaluate because they are not as grossly abnormal as positives ones and may be caused by a variety of other factors as well (e.g., as an adaptation to a persecutory delusion). However, advancements in diagnostic assessment tools are being made.

    Diagnosis is complicated by early treatment of schizophrenia’s positive symptoms. Antipsychotic medications, particularly the traditional ones, often produce side effects that closely resemble the negative symptoms of affective flattening and avolition. In addition, other negative symptoms are sometimes present in schizophrenia but not often enough to satisfy diagnostic criteria (DSM-IV): loss of usual interests or pleasures (anhedonia); disturbances of sleep and eating; dysphoric mood (depressed, anxious, irritable, or angry mood); and difficulty concentrating or focusing attention.

    Currently, discussion is ongoing within the field regarding the need for a third category of symptoms for diagnosis: disorganized symptoms. Disorganized symptoms include thought disorder, confusion, disorientation, and memory problems. While they are listed by DSM-IV as common in schizophrenia—especially during exacerbations of positive or negative symptoms (DSM-IV)—they do not yet constitute a formal new category of symptoms. Some researchers think that a new category is not warranted because disorganized symptoms may instead reflect an underlying dysfunction common to several psychotic disorders, rather than being unique to schizophrenia.

    Diagnostic criteria for schizophrenia (USA criteria)

    1. Characteristic symptoms: Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated):

      1. Delusions - false beliefs strongly held in spite of invalidating evidence, especially as a symptom of mental illness: for example,
        1. Paranoid delusions, or delusions of persecution, for example believing that people are "out to get" you, or the thought that people are doing things when there is no external evidence that such things are taking place.
        2. Delusions of reference - when things in the environment seem to be directly related to you even though they are not. For example it may seem as if people are talking about you or special personal messages are being communicated to you through the TV, radio, or other media.
        3. Somatic Delusions are false beliefs about your body - for example that a terrible physical illness exists or that something foreign is inside or passing through your body.
        4. Delusions of grandeur - for example when you believe that you are very special or have special powers or abilities. An example of a grandiouse delusion is thinking you are a famous rock star.
      2. Hallucinations - Hallucinations can take a number of different forms - they can be:
        1. Visual (seeing things that are not there or that other people cannot see),
        2. Auditory (hearing voices that other people can't hear,
        3. Tactile (feeling things that other people don't feel or something touching your skin that isn't there.)
        4. Olfactory (smelling things that other people cannot smell, or not smelling the same thing that other people do smell)
        5. Gustatory experiences (tasting things that isn't there)
      3. Disorganized speech (e.g., frequent derailment or incoherence) - these are also called "word salads".
      4. Grossly disorganized or catatonic behavior (An abnormal condition variously characterized by stupor/innactivity, mania, and either rigidity or extreme flexibility of the limbs).
      5. Negative symptoms, these are the lack of important abilities. Some of these include:
        1. lack of emotion - the inability to enjoy acitivities as much as before
        2. Low energy - the person sits around and sleeps much more than normal
        3. lack of interest in life, low motivation
        4. Affective flattening - a blank, blunted facial experession or less lively facial movements or physical movements.
        5. Alogia (difficulty or inability to speak)
        6. Inappropriate social skills or lack of interest or ability to socialize with other people
        7. Inability to make friends or keep friends, or not caring to have friends
        8. Social isolation - person spends most of the day alone or only with close family

          Note: Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person’s behavior or thoughts, or two or more voices conversing with each other.

      Cognitive Symptoms of Schizophrenia
      Cognitive symptoms refer to the difficulties with concentration and memory. These can include:
      1. disorganized thinking
      2. slow thinking
      3. difficulty understanding
      4. poor concentration
      5. poor memory
      6. difficulty expressing thoughts
      7. difficulty integrating thoughts, feelings and behavior

    2. Social/occupational dysfunction: For a significant portion of the time s+ince the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement).

    3. Duration: Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

    4. Schizoaffective and mood disorder exclusion: Schizoaffective disorder and mood disorder with psychotic features have been ruled out because either (1) no major depressive, manic, or mixed episodes have occurred concurrently with the active-phase symptoms; or (2) if mood episodes have occurred during active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods.

    5. Substance/general medical condition exclusion: The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

    6. Relationship to a pervasive developmental disorder: If there is a history of autistic disorder or another pervasive developmental disorder, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations are also present for at least a month (or less if successfully treated).

  • Positive Symptoms of Schizophrenia

    Delusions are firmly held erroneous beliefs due to distortions or exaggerations of reasoning and/or misinterpretations of perceptions or experiences. Delusions of being followed or watched are common, as are beliefs that comments, radio or TV programs, etc., are directing special messages directly to him/her.

    Hallucinations are distortions or exaggerations of perception in any of the senses, although auditory hallucinations (“hearing voices” within, distinct from one’s own thoughts) are the most common, followed by visual hallucinations.

    Disorganized speech/thinking, also described as “thought disorder” or “loosening of associations,” is a key aspect of schizophrenia. Disorganized thinking is usually assessed primarily based on the person’s speech. Therefore, tangential, loosely associated, or incoherent speech severe enough to substantially impair effective communication is used as an indicator of thought disorder by the DSM-IV.

    Grossly disorganized behavior includes difficulty in goal-directed behavior (leading to difficulties in activities in daily living), unpredictable agitation or silliness, social disinhibition, or behaviors that are bizarre to onlookers. Their purposelessness distinguishes them from unusual behavior prompted by delusional beliefs.

    Catatonic behaviors are characterized by a marked decrease in reaction to the immediate surrounding environment, sometimes taking the form of motionless and apparent unawareness, rigid or bizarre postures, or aimless excess motor activity.

    Other symptoms sometimes present in schizophrenia but not often enough to be definitional alone include affect inappropriate to the situation or stimuli, unusual motor behavior (pacing, rocking), depersonalization, derealization, and somatic preoccupations.

    Negative Symptoms of Schizophrenia

    Affective flattening is the reduction in the range and intensity of emotional expression, including facial expression, voice tone, eye contact, and body language.

    Alogia, or poverty of speech, is the lessening of speech fluency and productivity, thought to reflect slowing or blocked thoughts, and often manifested as short, empty replies to questions.

    Avolition is the reduction, difficulty, or inability to initiate and persist in goal-directed behavior; it is often mistaken for apparent disinterest. (examples of avolition include: no longer interested in going out and meeting with friends, no longer interested in activities that the person used to show enthusiasm for, no longer interested in much of anything, sitting in the house for many hours a day doing nothing.)





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