How Do They Diagnose Schizophrenia?
A diagnosis of schizophrenia requires the presence of at least two symptoms, severe enough to impact work or social functioning, and not related to another disorder.
Schizophrenia can be mistaken for other conditions like bipolar I disorder or schizoaffective disorder, so it's important to differentiate the specific symptoms and seek a professional opinion.
Following a schizophrenia diagnosis, treatment options like medication, psychotherapy, and lifestyle changes can help manage symptoms and improve overall quality of life.
A diagnosis of schizophrenia can help clarify the symptoms you may be told you're experiencing.
Friends and family may tell you to visit a doctor, but you may not feel it's warranted. In other cases, you may realize that something seems off in your day-to-day interactions and want a professional opinion.
Disturbances in your perception of reality signify the hallmark of schizophrenia. These disturbances usually include delusions or hallucinations. They can lead to distorted beliefs or the perception of something that isn't there.
Managing these symptoms starts with getting the right help. Schizophrenia can sometimes be confused with other mental health conditions, so it's important to talk with a mental health specialist.
How is schizophrenia diagnosed?
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), at least one negative symptom and one positive symptom must be present for a mental health professional to make a schizophrenia diagnosis.
Symptoms have to be severe enough to interfere with your work or social function, and they can't be related to another disorder.
A person must have two or more of the following symptoms:
delusions
hallucinations
disorganized speech
grossly disorganized or catatonic behavior
negative symptoms
At least one of these symptoms must be delusions, hallucinations, or disorganized speech.
The amount of time you experience the symptoms is also important. You must have symptoms for the majority of at least 1 month within a period of at least 6 months.
Symptoms of schizophrenia
The DSM-5-TR groups symptoms of schizophrenia into two categories: positive and negative. These categories indicate how each particular symptom affects your function.
Positive symptoms
Positive symptoms are the trademark of schizophrenia. They indicate changes in behavior or thoughts. Positive symptoms are sometimes collectively referred to as 'psychosis,' which indicates a disturbance in your perception of reality.
Positive symptoms include:
hallucinations
delusions
disorganized or catatonic behavior
confused thoughts or speech
Negative symptoms
Negative symptoms indicate a withdrawal from the world. Symptoms include:
reduced emotional expression
lack of motivation
fewer words spoken
social withdrawal
reduced ability to experience pleasure
low energy
impaired attention
indifference
Alternative diagnoses of schizophrenia
Other disorders can resemble schizophrenia. While they're not quite the same, they do share some features that can sometimes confuse the diagnosis.
Bipolar I disorder
Bipolar I disorder is typically defined by episodes of mania, which is different from psychosis. However, sometimes manic or depression symptoms can be so severe that you experience a delusion or hallucination. These severe episodes may seem like schizophrenia to a doctor at first.
Schizoaffective disorder
This diagnosis features a combination of symptoms from both schizophrenia and bipolar disorder. Since it's a combination of two mood disorders, it's a bit more complex than schizophrenia. For this reason, schizoaffective disorder can be difficult to diagnose.
Schizoaffective disorder is also very rare. According to the American Psychiatric Association, it's about one-third as common as schizophrenia, affecting around 0.3% of people.
Drug-induced psychosis
Certain drugs can lead to episodes of psychosis. If you're not taking any drugs but recently experienced psychosis, it's likely that drugs did not cause the psychosis.
Some drugs that can produce psychosis include:
benzodiazepines
corticosteroids
dextromethorphan
ketamine
phenytoin
Always be sure to follow your prescribing doctor's dosage recommendations. Changing your dose can sometimes lead to severe side effects or other unwanted symptoms.
What to do after a schizophrenia diagnosis
Schizophrenia can make your life challenging, but there are various treatment options that can improve your quality of life and help manage your symptoms. Finding the treatment plan that works best for you can make living with schizophrenia less challenging.
Major treatment goals in schizophrenia are usually the prevention of psychosis and the improvement of quality of life. A doctor commonly prescribes a combination of therapies to achieve these goals.
Medication
Treatment for schizophrenia typically begins with antipsychotic medications. They can prevent episodes of psychosis, which can help improve quality of life and social functioning, according to 2018 research.
Commonly prescribed antipsychotics include:
Abilify (aripiprazole)
Geodon (ziprasidone)
Invega (paliperidone)
Latuda (lurasidone)
Rexulti (brexpiprazole)
Risperdal (risperidone)
Saphris (asenapine)
Seroquel (quetiapine)
Vraylar (cariprazine)
Zyprexa (olanzapine)
In some cases, a doctor may prescribe benzodiazepines to improve anxiety and behavior. However, antipsychotics are usually prescribed first. It's normal to take some time to find a compatible medication.
Psychotherapy
Psychotherapy is also recommended for schizophrenia. Cognitive behavioral therapy (CBT), in particular, has been shown to improve positive symptoms, according to a 2018 meta-analysis.
The effectiveness of CBT for negative symptoms is still being studied. It's also thought that CBT may help prevent episodes of psychosis altogether, but more research is needed.
Education and lifestyle
One of the biggest contributors to poor health in schizophrenia is cardiovascular disease, according to 2022 research.
Your doctor will likely discuss the importance of lifestyle strategies to help reduce your risk of cardiovascular disease. These recommendations usually include:
Bottom line
Diagnosing schizophrenia is the first step in getting the care you may need. This may start with a visit to your primary care doctor, but regardless of where you go first, it will usually end in the office of a psychiatrist. This mental health specialist can confirm your diagnosis.
Working with the right care team and doing your best to stick with your recommended treatments can significantly improve your quality of life. Your friends and family can also play an important role in helping you feel better and make any needed lifestyle changes.
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