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 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 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".
- 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, these are the lack
of important abilities. Some of these include:
- lack of emotion - the inability to enjoy acitivities
as much as before
- Low energy - the person sits around and sleeps much
more than normal
- lack of interest in life, low motivation
- Affective flattening - a blank, blunted facial experession
or less lively facial movements 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 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).
- 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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- 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.
- 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.
- Decoding
Schizophrenia (Scientific American, January, 2004)
- The
Tests and Exams for Schizophrenia
- The Diagnostic
Criteria for Schizophrenia - American [external. link]
- The Diagnostic
Criteria for Schizophrenia - European [ext. link]
- The Importance of Early Detection and Treatment
for Schizophrenia
- Misdiagnosis Issues
- 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
- Disorders Related to (or sometimes similar to,
in their symptoms) as Schizophrenia:
- Early Identification of Schizophrenia - Recent
Research
- Dual Diagnosis (Schizophrenia and Drug Addiction/Alcoholism)
- Schizophrenia - Hypothetical Examples
- The Prodromal
(early) Phase of First-episode Psychosis: Past and Current Conceptualizations
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Early Schizophrenia Diagnosis and Treatment Centers
