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Table of Contents - Symptoms of Schizophrenia and Schizophrenia Diagnosis
Potential Problems
What to do Next
More information on Schizophrenia Diagnosis and Treatment
Schizophrenia Diagnosis-related News Stories:
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Full List of News on Schizophrenia Diagnosis
Schizophrenia Symptoms and Diagnosis
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)
- 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):
- Delusions - false beliefs strongly held
in spite of invalidating evidence, especially as a symptom
of mental illness: for example,
- 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.
- 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.
- 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.
- 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.
- Hallucinations - Hallucinations can take
a number of different forms - they can be:
- Visual (seeing things that are not there or that
other people cannot see),
- Auditory (hearing voices that other people can't
hear,
- Tactile (feeling things that other people don't
feel or something touching your skin that isn't there.)
- Olfactory (smelling things that other people cannot
smell, or not smelling the same thing that other people
do smell)
- Gustatory experiences (tasting things that isn't
there)
- 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.
- Grossly disorganized or catatonic behavior
(An abnormal condition variously characterized by stupor/innactivity,
mania, and either rigidity or extreme flexibility of the
limbs).
- "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:
- lack of emotion - the inability to enjoy regular
activities (visiting with friends, etc.) as much as
before
- Low energy - the person tends to sit around and
sleep much more than normal
- lack of interest in life, low motivation
- Affective flattening - a blank, blunted facial expression
or less lively facial movements, flat voice (lack of normal intonations and variance) or physical movements.
- Alogia (difficulty or inability to speak)
- Inappropriate social skills or lack of interest
or ability to socialize with other people
- Inability to make friends or keep friends, or not
caring to have friends
- 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:
- disorganized thinking
- slow thinking
- difficulty understanding
- poor concentration
- poor memory
- difficulty expressing thoughts
- difficulty integrating thoughts, feelings and behavior
- 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).
- 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).
- 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.
- 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.
- 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).
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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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- 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.
Although there are currently no physical tests that absolutely confer
a diagnosis of schizophrenia, the science is becoming increasingly more
specific. Recent advances in diagnostic screening tests for schizophrenia
include the following:
- Early Detection and Treatment for Schizophrenia
- Articles and Recent Research/Tests
- Dual Diagnosis (Schizophrenia
and Drug Addiction/Alcoholism)
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Early Schizophrenia Diagnosis and Treatment Centers
