Schizophrenia (cont.)

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What are schizophrenia symptoms and signs?

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), symptoms of schizophrenia include the following:

Positive, more overtly psychotic symptoms

  • Delusions are beliefs that have no basis in reality. Types of delusions include erotic, grandiose (for example, religious), jealous, persecutory, physical (somatic), mixed, and nonspecific.
  • Hallucinations: hearing (for example, hearing voices), seeing, feeling (for example, feeling like bugs are crawling on the skin), smelling, or tasting things that have no basis in reality
  • Disorganized speech: incoherent or often grossly off topic (derailed)
  • Disorganized behaviors

Negative symptoms, potentially less overtly psychotic

  • Inhibition of facial expressions, lack of emotional responsiveness
  • Catatonic behaviors: difficulty moving, resistance to moving, hyperactivity, repetitive or otherwise abnormal movements, and/or nonsense word repetition or of what others say or do
  • Self-neglect, poor grooming, and lack of good hygiene
  • Lack of speech
  • Apathy/lack of motivation

Prior to the development of the full-blown disorder, people who go on to develop schizophrenia often exhibit more subtle and/or less specific symptoms, also called prodromal symptoms. Some such symptoms may include slowness in activity and thought, lower cognitive functioning, including memory loss, disorientation and mental confusion; abnormal speech, including circumstantial, vague, or stereotyped speech. People with prodromal schizophrenia also tend to have mood problems, like general discontent, inappropriate emotional responses, fear, mistrust, hostility, aggression, excitability, agitation and inability to feel pleasure; social isolation, self-centeredness that borders on narcissism, and other problems socializing.

How do health-care professionals diagnose schizophrenia? Are there particular tests that detect schizophrenia?

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As is true with virtually any mental-health diagnosis, there is no one test that definitively indicates that someone has schizophrenia. Therefore, health-care professionals like psychiatrists or other psychiatric medication prescribers, clinical psychologists or primary-care providers diagnose this illness by gathering comprehensive medical, family, and mental-health information. Patients tend to benefit when the practitioner takes into account their client's entire life and background. Examples of this include the person's gender, sexual orientation, cultural, religious and ethnic background, socioeconomic status, family, and other social relationships. The symptom sufferer might be asked to fill out a self-test that the professional will review if the person being evaluated is able to complete it.

The practitioner will also either perform a physical examination or request that the individual's primary-care doctor perform one. The medical assessment will usually include lab tests to evaluate the person's general health and to explore whether or not the individual has a medical condition or has been exposed to certain medications (for example, amphetamines like methylphenidate [Ritalin or Concerta] or amphetamine and dextroamphetamine [Adderall] in the treatment of attention deficit hyperactivity disorder or corticosteroids for the treatment of severe asthma) that might produce psychological symptoms.

In asking questions about mental-health symptoms, mental-health professionals are often exploring if the individual suffers from hallucinations or delusions, depression and/or manic (for example, excessive anger or elevated mood, rapid, pressured, or frenzied speaking, overexcitement, decreased need for sleep) symptoms, anxiety, substance abuse, as well as some personality disorders (for example, schizotypal personality disorder) and developmental disorders (for example, autism spectrum disorders including the condition that was formerly called Asperger disorder). Since some of the symptoms of schizophrenia can also occur in other mental illnesses, the mental-health screening is to determine if the individual suffers from schizoaffective disorder or other psychotic disorder, depressive disorder, bipolar disorder, anxiety disorder, or a substance-abuse (for example, marijuana, cocaine, amphetamines, or psychedelic drugs) or personality disorder. Any disorder that is associated with bizarre behavior, mood, or thinking, like borderline personality disorder or another psychotic disorder, as well as dissociative identity disorder (DID), previously called multiple personality disorder (MPD), may be particularly challenging to distinguish from schizophrenia. However, people with DID often suffer from feeling detached from oneself, as well as what looks like amnesia for their dissociative episodes, which does not tend to be a characteristic of schizophrenia. In order to assess the person's current emotional state, health-care professionals perform a mental-status examination, as well. In addition to providing treatment that is appropriate to the diagnosis, determining the presence of mental-health conditions that may co-occur (be comorbid) with schizophrenia is important in improving the life of schizophrenia sufferers. For example, people with schizophrenia are at increased risk of having a substance-abuse, depressive, or anxiety disorder and committing suicide.

Medically Reviewed by a Doctor on 2/2/2016


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