Diagnosis

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A challenging part of diagnosing schizophrenia is that many of the symptoms can be found in other mental disorders. For example, some individuals with schizophrenia have prolonged periods of elation or depression, which can be confused with bipolar disorder (also called manic depression) or major depressive disorder. People with bipolar disorder and major depression can also experience psychotic symptoms. These conditions need to be ruled out before diagnosing schizophrenia.

A mental health professional such as a psychologist or psychiatrist typically diagnoses schizophrenia. The clinician begins with a complete medical history and physical examination followed by blood and urine tests to rule out other medical causes for the symptoms. For instance, commonly abused drugs such as cocaine, methamphetamines or LSD can cause symptoms that mimic schizophrenia (including hallucinations or paranoia).

Interestingly, people who have schizophrenia tend to abuse drugs and alcohol at a higher rate than the general population. So just because someone is abusing drugs doesn't mean the person doesn't also have schizophrenia.

Psychiatrists often diagnose schizophrenia when someone has had active symptoms of the disorder, such as a psychotic episode that includes delusions and hallucinations, for at least a month, with other symptoms, such as a decline in functioning and disturbed thoughts lasting six months or longer.

Schizophrenia appears to improve and worsen over the course of the illness. When it improves, the person suffering from the disease may appear perfectly normal. Unfortunately, this is when many people decide to stop taking their medication and relapse. During an acute psychotic episode, patients often lose their ability to think logically, or may also lose their perception of who they are or of others around them.

Most people with schizophrenia also have social and occupational problems, including problems in the workplace, with interpersonal relationships and in the way they care for themselves.

Symptoms of schizophrenia are usually split into positive, negative and neurocognitive categories.

Positive symptoms are unusual thoughts, perceptions or distortion of normal functions. They include:

• Delusions.

  These are firmly held erroneous beliefs that result from distortions or exaggerations of reasoning or misinterpretations of a person's perceptions or experiences. Common delusions include unrealistic beliefs that the person is being watched or followed (e.g. paranoia).

• Hallucinations.

  These are abnormalities of perception that can occur in any of the senses, although auditory hallucinations (hearing voices even though no one is speaking) are most common. These voices often insult the person, comment on his or her behavior or give commands. Visual hallucinations are the second most common type.

• Disorganized speech or thinking.

  This type of thought disorder is considered a central part of schizophrenia and generally appears as illogical thinking and speech that is difficult to understand or sometimes totally incoherent.

• Grossly disorganized behavior.

  This behavior includes difficulties with activities of daily living, unpredictable agitation or behavior that appears bizarre.

• Catatonic behavior.

  This behavior is characterized by a significant decrease in how someone responds to his or her immediate environment. Someone with this symptom might appear motionless or assume stiff or strange postures.

Negative symptoms of schizophrenia include the following.

• Affective flattening.

  Affective flattening in the spectrum of emotional expression, including facial expression, tone of voice, eye contact and the use of body language.

• Alogia.

  A dramatic decrease in a person's thinking and speech. Sometimes this can be detected through empty or disinterested replies to questions.

• Avolition.

  A noticeable reduction or difficulty in initiating or pursuing goal-oriented behavior. This symptom is often mistaken for a disinterested outlook.

Neurocognitive symptoms of schizophrenia are symptoms that have to do with the person's ability to think and reason. They include:

• Problems with attention
• Trouble with certain types of memory
• Problems with functions that allow one to plan and organize

Several subtypes of schizophrenia have been suggested, based on a person's range and intensity of symptoms. There are five recognized types of schizophrenia: catatonic schizophrenia, paranoid schizophrenia, disorganized schizophrenia, undifferentiated schizophrenia and residual schizophrenia.

• Paranoid schizophrenia

  A person experiences predominantly positive symptoms (delusions and hallucinations), without a lot of disorganization or negative symptoms. The person may feel suspicious, persecuted and/or grandiose.

• Disorganized schizophrenia (also called hebephrenic schizophrenia)

  People with disorganized schizophrenia have difficulty with logical, coherent thinking and speech. They also sometimes lack motivation, emotion and the ability to feel pleasure.

• Catatonic schizophrenia

  People with catatonic schizophrenia exhibit extreme inactivity or activity that's disconnected from his or her environment or encounters with other people. These episodes can last for minutes to hours.

• Undifferentiated schizophrenia

  People with undifferentiated schizophrenia meet diagnostic criteria for schizophrenia, but not the paranoid, disorganized or catatonic subtypes.

• Residual schizophrenia

  People with residual schizophrenia have a history of schizophrenic episodes characterized by negative symptoms or mild positive symptoms. People with this form of schizophrenia differ from those with other forms in that they lack prominent psychotic symptoms.