Dec 6, 2010

Schizophrenia Symptoms and Diagnosis

Corpus Curare Spiritumque

There is currently no physical or lab test that can absolutely diagnose schizophrenia - a psychiatrist usually comes to the diagnosis based on clinical symptoms. 
What physical testing can do is rule out a lot of other conditions (seizure disorders, metabolic disorders, thyroid disfunction, brain tumor, street drug use, etc) that sometimes have similar symptoms.

Current research is evaluating possible physical diagnostic tests (such as a blood test for schizophrenia, special IQ tests for identifying schizophrenia, eye-tracking, brain imaging, 'smell tests', etc), but these are still in trial stages at only a few universities and companies and are not yet widely used. It will likely be a few years before these on the market, and adopted by hospitals, etc.
People diagnosed with schizophrenia usually experience a combination of positive (i.e. hallucinations, delusions, racing thoughts), negative (i.e. apathy, lack of emotion, poor or nonexistant social functioning), and cognitive (disorganized thoughts, difficulty concentrating and/or following instructions, difficulty completing tasks, memory problems). Please refer to the information available on this page (see below) for common signs and symptoms, as well as consumer/family stories of how they identified schizophrenia in their own experiences. However, only a psychiatrist can make a diagnosis and start a treatment program. If you are experiencing symptoms are bothersome, debilitating, or harmful, please we recommend you try the on-line Screening test for identification of early schizophrenia symptoms (click here to go to the test) that we offer on this web site. The on-line test is also available in an "off-line version" for print-out (valuable for testing a family member who is not on-line, or who may not like the site of a schizophrenia-focused web site) - and the responses can then be entered into the on-line version of the test for scoring. If you test positive you may want to go to to an early psychosis diagnosis and treatment center or make an appointment with your doctor and/or a psychiatrist.

The First Steps Towards Proper Diagnosis
The first step in getting treatment for schizophrenia is getting a correct diagnosis. This is important to do quickly because research has shown that the sooner you get diagnosed and treated, the better the long-term outcome (which is the same for all serious illnesses). 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-epression) or even major depression. Another issue is that a person with schizophrenia may be paranoid or believe that nothing is wrong with them, and therefore 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. 
The best place for proper diagnosis of psychosis (hallucinations & delusions) and schizophrenia - are at the increasing number of centers focused on early diagnosis and treatment of psychosis and schizophrenia. See the following list to find out if there is one in your area: Worldwide list of early psychosis/schizophrenia diagnosis and treatment clinics.
Another way to do find a good psychiatrist 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.
See our FAQ guide, with sections on finding and working with a good psychiatrist. This is a vital part of the treatment and recovery process, as research and anecdotal evidence both confirm that a good patient-doctor relationship can be important for enhancing treament compliance.
If you have a family history of schizophrenia, psychiatric illness, or other serious conditions in your family, it can be a great help to the doctor if you create a Health Family Tree that tracks such diseases through family generations. Having a family health history in front of them can help providers decide which diagnostic and screening tests are most appropriate for you or your loved one. Create your own Health Family Tree with this free, web-based software (provided by the Health and Human Services Dept).
As with most serious illnesses, its important to get diagnosis and treatment as quickly as possible. Getting treatment early can significantly improve an individual's chances at a partial or complete recovery by preventing further brain damage or other damage caused by the disease symptoms. More information on the importance of early diagnosis and treatment

The Common Symptoms of Schizophrenia
  • The First Signs of Schizophrenia - Personal Stories
    • A comprehensive list of early signs - compiled by a schizophrenia.com member. Note: please use as a reference only, not as a diagnostic tool. Only a doctor can diagnose schizophrenia, or any other psychiatric disorder. Many of the common signs/symptoms are also present in healthy people, usually to a lesser degree.
  • The Importance of Keeping a Journal - For best diagnosis and recovery of person with schizophrenia
  • Early Predictions of Schizophrenia are Possible (BBC News, January 05)

  • 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 for purchase on Amazon.com 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 Schizophrenia 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". Ongoing disjointed or rambling monologues - in which a person seems to talking to himself/herself or imagined people or voices.
             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 of Schizophrenia , these symptoms are the lack of important abilities. Some of these include:

                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.

                Affective flattening is the reduction in the range and intensity of emotional expression, including facial expression, voice tone, eye contact (person seems to stare, doesn't maintain eye contact in a normal process), and is not able to interpret body language nor use appropriate body language.

                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.)

     A short summary of a list of negative symptoms are:
     1. lack of emotion - the inability to enjoy regular activities (visiting with friends, etc.) as much as before
    2. Low energy - the person tends to sit around and sleep much more than normal
    3. lack of interest in life, low motivation
    4. Affective flattening - a blank, blunted facial expression or less lively facial movements, flat voice (lack of normal intonations and variance) 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 since 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).

    Source: US Surgeon General


    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.)
  • Types of Schizophrenia
    • Paranoid schizophrenia - These persons are very suspicious of others and often have grand schemes of persecution at the root of their behavior. Halluciations, and more frequently delusions, are a prominent and common part of the illness.
    • Disorganized schizophrenia (Hebephrenic Schizophrenia) - In this case the person is verbally incoherent and may have moods and emotions that are not appropriate to the situation. Hallucinations are not usually present.
    • Catatonic schizophrenia - In this case, the person is extremely withdrawn, negative and isolated, and has marked psychomotor disturbances.
    • Residual schizophrenia - In this case the person is not currently suffering from delusions, hallucinations, or disorganized speech and behavior, but lacks motivation and interest in day-to-day living.
    • Schizoaffective disorder - These people have symptoms of schizophrenia as well as mood disorder such as major depression, bipolar mania, or mixed mania.
    • Undifferentiated Schizophrenia - Conditions meeting the general diagnostic criteria for schizophrenia but not conforming to any of the above subtypes, or exhibiting the features of more than one of them without a clear predominance of a particular set of diagnostic characteristics.
    • Additional Information on Types of Schizophrenia
Misdiagnosis Issues

Because there is currently no physical test that confirms the presence of schizophrenia, and because schizophrenia often shares a significant number symptoms with other disorders, misdiagnosis is a common problem. According to one study surveying members of the National Depression and Bipolar Support Alliance, there is an average delay of 10 years from the first onset of symptoms to correct diagnosis and treatment of psychiatric disorders.
However, getting a correct diagnosis is necessary for finding a treatment program that works for you.
Being aware of the potential for misdiagnosis, and knowing what other disorders may appear like schizophrenia or vice-versa, will hopefully help you get started on the right treatment as soon as possible.
  • Disorders Related to (or sometimes with similar symptoms to)Schizophrenia:

    Knowing the symptoms of these disorders, and how they can be similar and different from schizophrenia, can help prevent a possible misdiagnosis.
  • Schizophrenia and Psychosis - What's the Difference?
    • It is valuable to understand the difference between psychosis and schizophreia. Psychosis is a general term used to describe psychotic symptoms. Schizophrenia is a kind of psychosis. Several different brain disorders can lead to psychotic symptoms, including lesions in the brain resulting from head traumas, strokes, tumors, infections or the use of illegal drugs. If a serious depression goes untreated for a long time, psychotic symptoms may develop. These examples demonstrate that not all psychosis is schizophrenia. If is for this reason that doctors may take quite some time (6 months or more) to diagnose someone, because while the symptoms of schizophrenia are quite obvious - the fact that the symptoms are not being caused by some other brain disorder is frequently not obvious.

    • Schizophrenia - Hypothetical Examples
Articles on Diagnosing Schizophrenia and Advances in the Science
Before a psychiatrist or doctor will arrive at a diagnosis of schizophrenia they must make a thorough psychiatric evaluation. This includes a medical evaluation, a physical exam, a mental status exam and appropriate laboratory tests. Also a full history of the illness should be conveyed to the doctor (see "The Importance of a Journal for the person with schizophrenia") that includes any changes in thinking, behavior, movement, mood, etc. - as seen by the family or patient. Increasingly doctors are also using Magnetic Resonance Imaging (MRIs) to create images of the brain and compare them with known abnormalities in the brain that are frequently caused by, or associated with, schizophrenia.
  • Early Detection and Treatment for Schizophrenia - Articles and Recent Research/Tests
    • Early Diagnosis of Schizophrenia Improves Results of Treatment (Yale University, Feb. 2004)
    • The Importance of Early Detection and Treatment in Schizophrenia (8/96)
    • The Importance and The Rationale for Early Detection and Intervention
    • Early Detection and Intervention for Initial Episodes of Schizophrenia
    • Detection as a Baby - Early Detection of Schizophrenia via Movement Analysis (12/96) Note: this technique would seem to be valuable in families with a history of mental illness.
  • Dual Diagnosis (Schizophrenia and Drug Addiction/Alcoholism)
    • Dual Diagnosis Program in Australia (3/97)
    • Livengrin Foundation Announces Dual Diagnosis Program (7/96)
    • Dual Diagnosis - Drugs and Mental Illness
    • What to do if some one is mentally ill and has a chemical dependency

Posted by D 7070 CH at 7:47 PM
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