Schizophrenia Diagnosis: Rule Out Other Conditions
A diagnosis involves what someone is experiencing as well as what he is not. Some disorders have some features or symptoms that are shared with schizophrenia therefore, doctors check to see if something else fits better than schizophrenia. Some of the conditions that, according to criteria in the DSM-5, have some similarities with schizophrenia are
- Mood disorders with psychotic features
- Schizophreniform
Take Action If You Think You Or Your Loved One Is In Danger
If you think your loved one is at risk of harming themselves or others and they refuse help, it is possible to have them evaluated by a psychiatrist under the Mental Health Act. This process may involve police and other first responders, and it can be a difficult and stressful process for everyone. But it can also be a necessary step if someone is in danger. You can learn more about the Mental Health Act in the info sheet Families Coping with a Crisis and you can find the Guide to the Mental Health Act at www.health.gov.bc.ca/library/publications/year/2005/MentalHealthGuide.pdf. For a more in-depth discussion of the Mental Health Act, see a video with lawyer and health law consultation Gerrit Clements.
If your loved one says that they have thoughts of ending their life, its important to take action. Call 1-800-SUICIDE at any time or message online at www.crisiscentrechat.ca between noon and 1am. If you think your loved one is in immediate danger, you can always call 911 or go to a hospital emergency room.
Where can I learn more?
- Dealing with Psychosis: A Toolkit for Moving Forward with Your Life is aimed at people experiencing schizophrenia, but it has good information on symptoms and strategies for managing the illness. There is also a chapter for support people
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What Are The Symptoms
Schizophrenia typically happens in three stages. The active stage of schizophrenia is when symptoms are at their worst. The key symptoms of schizophrenia are:
- Negative symptoms.
Paranoia and what it looks like
Paranoid schizophrenia was once a subtype of this condition because paranoia commonly happens with schizophrenia. Paranoia is a pattern of behavior where a person feels distrustful and suspicious of other people and acts accordingly.
Delusions and hallucinations are the two symptoms that can involve paranoia.
- Delusions. These are persistent false beliefs. A person who has a delusional belief usually won’t change their mind even if faced with strong evidence. Delusions involving paranoia are often “persecutory,” which means a person believes that someone is trying to harm them or negatively affect their life.
- Hallucinations. These are events a person imagines . A person who has a hallucination typically can’t tell that what they’re experiencing isn’t real. These commonly feed into delusions by giving the person additional “evidence” to confirm that someone is trying to harm or upset them.
Lack of insight
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Vocational And Social Services
While treatment and support can help successfully manage symptoms of schizophrenia, patients still may be left with deficits in function. For instance, they may struggle with holding down a job or finding housing and managing money. To really live an independent and normal life with schizophrenia requires a range of services and assistance. Vocational training can help someone get and keep a job, while housing services can help find a recovering patient an affordable place to live. Other services may include transportation, academic support, or social groups.
Voluntary And Compulsory Detention
More serious acute schizophrenic episodes may require admission to a psychiatric ward at a hospital or clinic. You can admit yourself voluntarily to hospital if your psychiatrist agrees it’s necessary.
People can also be compulsorily detained at a hospital under the Mental Health Act , but this is rare.
It’s only possible for someone to be compulsorily detained at a hospital if they have a severe mental disorder and if detention is necessary:
- in the interests of the person’s own health and safety
- to protect others
People with schizophrenia who are compulsorily detained may need to be kept in locked wards.
All people being treated in hospital will stay only as long as is absolutely necessary for them to receive appropriate treatment and arrange aftercare.
An independent panel will regularly review your case and progress. Once they feel you’re no longer a danger to yourself and others, you’ll be discharged from hospital. However, your care team may recommend you remain in hospital voluntarily.
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Diagnosing Schizophrenia Using Symptoms And Features
Professionals use specific diagnostic features in the DSM-5 to help determine whether someone meets the criteria for schizophrenia. The DSM-5 delineates five main criteria. Paraphrased:
A. Two or more of
B. Level of functioning has declinedC. The symptoms in Criterion A have persisted for at least 6 monthsD. Schizoaffective disorder, major depression, and bipolar disorder have been ruled outE. Substance use/abuse has been ruled out as a cause
In order for someone to be diagnosed with schizophrenia, he must experience a group of these symptoms and features. One or two are not enough.
To receive a schizophrenia diagnosis, someone can have any of the symptoms and features, but he must have the following:
- At least two symptoms from Criteria A
- One of those two must be delusions, hallucinations, or disorganized speech.
- These must have been present for at least one month.
The symptoms must impair ones life and get in the way of her ability to work , have positive relationships , and practice self-care. The problems in these areas must be new, a decline in the previous status.
Duration of the symptoms is also important for a schizophrenia diagnosis. Someone must have been experiencing steady symptoms for at least one month. Symptoms must be present some of the time for six consecutive months.
Recognizing The Signs Of Schizophrenia
Schizophrenia can cause hallucinations, delusions, and unusual behaviors, as well as cognitive challenges, such as problems with memory, attention, and concentration.
Recognizing the signs of schizophrenia.
Schizophrenia is a treatable serious mental illness that affects a persons thoughts, feelings, mood, and overall functioning. This disorder can cause hallucinations, delusions, and unusual behaviors. People with the disorder might also have cognitive challenges, such as problems with memory, attention, and concentration.
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Patients Are Commonly Misdiagnosed With Schizophrenia
A retroactive review of patients referred to a psychiatric consultant found that most patients left with a different diagnosis.
Russell L. Margolis, MD
Schizophrenia may have become a trigger-happy diagnosis.
A retroactive analysis of patients referred to a psychiatry consultation clinic with an initial schizophrenia diagnosis found that about half of all such diagnoses were inaccurate upon further review.
The study, from the Johns Hopkins Early Psychosis Intervention Clinic , reported that a multitude of factors may influence a physician too readily diagnosing a patient with schizophrenianot the least of which being a desire to treat the chronic psychiatric condition with speed and efficacy.
Early detection of schizophrenia is very important, so the patient can get the correct pharmacologic and non-pharmacologic care they need to stay on the best possible path of their life, study author Russell L. Margolis, MD, told MD Magazine®.
The investigators conducted a retroactive chart review of 78 patients who has been referred to EPIC with an early psychosis diagnosis. Of the 78 observed patients, 43 had a primary diagnosis of schizophrenia spectrum disorder at the time of their referral. Among those 43 cases, 22 concluded with a different diagnosis following the consultation, and 18 were not diagnosed with any form of primary psychotic disorder.
There can be an overreaction to mental health conditions, he explained.
How Does This Condition Affect My Body
Schizophrenia is a condition that has severe effects on a persons physical and mental well-being. This is because it disrupts how your brain works, interfering with your thinking ability, memory, how your senses work and more.
Because your brain isnt working correctly, having schizophrenia often causes you to struggle in many parts of your day-to-day life. Schizophrenia often disrupts your relationships . It can also cause you to have trouble organizing your thoughts, and you might behave in ways that put you at risk for injuries or other illnesses.
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What Is Paranoid Schizophrenia
The term paranoid schizophrenia is an outdated name for a subtype of schizophrenia. Experts no longer use or recognize this term. Instead, experts recognize schizophrenia as a specific disease, which is part of a spectrum of related conditions that involve psychosis.
The American Psychiatric Association removed paranoid schizophrenia from the list of official diagnoses when updating the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition , published in 2013. The World Health Organization removed paranoid schizophrenia from the International Classification of Diseases when updating to the 11th edition in 2019.
Tip : Take Care Of Yourself
Making simple lifestyle changes can have a huge impact on the way you feel as well as your symptoms.
Try to get plenty of sleep. When youre on medication, you most likely need even more sleep than the standard 8 hours. Many people with schizophrenia have trouble with sleep, but getting regular exercise, reducing sugar in your diet, and avoiding caffeine can help.
Avoid alcohol and drugs. It can be tempting to try to self-medicate the symptoms of schizophrenia with drugs and alcohol. But substance abuse complicates schizophrenia treatment and only worsens symptoms. If you have a substance abuse problem, seek help.
Eat a healthy, balanced diet. Eating regular, nutritious meals can help avoid psychosis and other schizophrenia symptoms brought on by substantial changes in blood sugar levels. Minimize sugar and refined carbs, foods that quickly lead to a crash in mood and energy. Boost your intake of omega-3 fatty acids from fatty fish, fish oil, walnuts, and flaxseeds to help improve focus, banish fatigue, and balance your moods.
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Maintain Your Social Network
Try to maintain your friendships or the network of people that you have in your life. These will later become important supports as your loved one recovers. Educate them and update them on your loved one’s recovery. People are sometimes afraid to ask questions about schizophrenia and this will put them at ease.
How Does Schizophrenia Progress
The first signs of schizophrenia usually appear between your late teens and mid-30s. According to one large analysis, the median age of the start of schizophrenia around the world was 25, meaning that half of the cases appeared before that age and half appeared later.
It may take a year or two before the vaguely strange early symptoms of schizophrenia â during whatâs called a âprodromal phaseâ â turn serious enough to prompt a visit to a psychiatrist. In some people, the illness never goes beyond this point, but in most cases, it does.
The active phase of your schizophrenia may last several years or up to a decade. This can be an alarming period for you and your loved ones. But itâs often followed by a less stormy phase where your more intense symptoms, like hallucinations, stabilize. But such symptoms as loss of interest, trouble thinking, and relationship problems are more likely to linger.
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Dont Take It Personally
Schizophrenia can be a difficult illnessfor everyone. During episodes of psychosis, your loved one may experience frightening sensations that you cant understand. They may act in ways that you dont understand. Other symptoms of schizophrenia can make it hard for people to express emotions or feelings, communicate clearly, or seem interested in others. Its important to know that these are symptoms of an illness. They are no ones fault, but they can still be hard to cope with. Consider reaching out to a family and friends support group for your own support. The BC Schizophrenia Society has a directory of groups around BC at www.bcss.org/monthly-meetings-calendar/.
The Importance Of Residential Treatment For Schizophrenia
Symptoms of schizophrenia can be very troubling and disruptive. They can also be severe and cause significant impairment in a persons life. In some cases an episode of symptoms may even be severe enough to require temporary hospitalization. For anyone diagnosed with this mental health condition, residential treatment is strongly recommended.
Residential care gives patients the opportunity to focus on and engage with treatment without worrying about home, family, work, and other responsibilities. Inpatient care is also more intensive and helps patients jump-start recovery, guiding them through strategies and exercises that will help them manage their illness once back at home. Treatment in a residential facility gives patients all the tools they need to be successful once they leave, while also providing a safe environment in which to go through therapy.
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Tip : Get Involved In Treatment And Self
The earlier you catch schizophrenia and begin treatment with an experienced mental health professional, the better your chances of getting and staying well. So, if you suspect you or a loved one is exhibiting schizophrenia symptoms, seek help right away.
Successful schizophrenia treatment depends on a combination of factors. Medication alone is not enough. Its important to also educate yourself about the illness, communicate with your doctors and therapists, build a strong support system, take self-help measures, and stick to your treatment plan. Pursuing self-help strategies such as changing your diet, relieving stress, and seeking social support may not seem like effective tools to manage such a challenging disorder as schizophrenia, but they can have a profound effect on the frequency and severity of symptoms, improve the way you feel, and increase your self-esteem. And the more you help yourself, the less hopeless and helpless youll feel, and the more likely your doctor will be able to reduce your medication.
While schizophrenia treatment should be individualized to your specific needs, you should always have a voice in the treatment process and your needs and concerns should be respected. Treatment works best when you, your family, and your medical team all work together.
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Schizophrenia Management Is Possible
Living a normal life with schizophrenia doesnt necessarily mean never having symptoms againit means being able to manage this chronic illness in order to live independently, or mostly independently, and do all the things other adults do, such as work and have families. The key to managing and living well with this condition is treatment. With good and ongoing treatment it is possible to live an enjoyable and fulfilling life. Most people improve with treatment, although recurrences are possible. There are certain factors that make some people more likely to see the best improvement in function, such as:
- Functioning well before the onset of schizophrenia
- Being older when the symptoms first began
- Not having a family history of schizophrenia
- Having symptoms begin suddenly, rather than beginning slowly
- Having a higher IQ
While these factors seem to contribute to greater success in recovery from schizophrenia, anyone with this condition can improve and live normally with good treatment.
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What Can I Do If A Loved One Shows Signs Of Schizophrenia Or A Similar Condition
Because people with schizophrenia often cant recognize their symptoms or condition, they often dont believe they need medical care or treatment. That can be frustrating or frightening for both the person with the symptoms and those who care about them.
If you notice a loved one showing signs of schizophrenia or a related condition, you can try helping them by doing the following:
A note from Cleveland Clinic
Schizophrenia can be a frightening condition for the people who have it and their loved ones. Despite stereotypes, this isnt a condition where any thought of recovery or living a happy, fulfilling life is impossible. If you think you have symptoms of schizophrenia, its important to talk to a healthcare provider as soon as you can. Their job is to help you, and healthcare providers especially those who specialize in mental health conditions like schizophrenia have the training to help you not feel judged, ashamed or embarrassed. If you notice a loved one struggling with symptoms of psychosis or schizophrenia, encourage them gently and supportively to get care. Early diagnosis and treatment can make a big difference in helping people recover and manage this condition.
Employment And Financial Support
Avoid too much stress, including work-related stress. If you are employed, you may be able to work shorter hours or in a more flexible way.
Under the Equality Act 2010, all employers must make reasonable adjustments for people with disabilities, including people diagnosed with schizophrenia or other mental illnesses.
Several organisations provide support, training and advice for people with schizophrenia who wish to continue working.
Your community mental health team is a good first point of contact to find out what services and support are available for you.
Mental health charities such as Mind or Rethink Mental Illness are also an excellent source of information on training and employment.
If you are unable to work as a result of your mental illness, you are entitled to financial support, such as Incapacity Benefit.
Want to know more?
There are also other places that offer support to people with schizophrenia and other mental illnesses.
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How Is Schizophrenia Diagnosed
What does a diagnosis of schizophrenia mean?
For some a diagnosis of schizophrenia is an emotional body blow and seems to represent the beginning of a lifetime of low achievement and stigma. But for others it represents a breakthrough and the starting point of their recovery and is met with a great sense of relief. At last they are able to explain in a simple way all of the bizarre and distressing experiences that they have been having over many months of disturbed thinking and behaviour.1
Some see the process of diagnosis as simply a convenient method of labelling different behaviour so that it can be controlled. In fact, the diagnosis process is not approached lightly by the mental health professionals and the diagnosis is based not simply on the professional judgement of the doctors but on the long experience we have of treating schizophrenia over many decades and in many countries.
Getting a correct diagnosis of your problems has a number of major advantages1:
· It will help you to understand the problems that you have been having.· It will give you access to the right methods of treatment· It will be the starting point of your recovery journey· It will help the people around you to understand more about your struggle· It will give you access to the right benefits· It will give you access to other kinds of support such as help with housing and debt
How is a diagnosis of schizophrenia made?
Diagnostic methods
Are there different kinds of schizophrenia?
References