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Diagnosis
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Based on DSM-5 diagnostic criteria, diagnosis of schizophrenia can be made if the patient have experienced at least 2 of the following symptoms during a 1-month period (or less if successfully treated):
- Delusions
- Hallucinations
- Disorganized speech
- Disorganized or catatonic behavior
- Negative symptoms like reduced emotional expression
- The above symptoms should have at least any accompanying delusions, hallucinations or disorganized speech
- DSM-5 also added the following criteria in diagnosing schizophrenia:
- Continuous occurrence of the disturbance for at least 6 months with at least a month of active symptoms (or less if successfully treated)
- The patient’s level of functioning socially or occupationally is deteriorating over a significant amount of time
- Other conditions such as schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out
- Occurrence of symptoms is not related to physiological effects of a substance or another medical condition
- In cases of childhood onset communication disorder or a history of autism spectrum an additional diagnosis of schizophrenia can only be made if together with the required symptoms of schizophrenia there is prominent delusions or hallucinations
- According to DSM-5, after a year of having schizophrenia, the disorder can be specified as:
- First episode, currently in acute episode where the initial manifestation of the disorder met the criteria and presenting in acute time period
- First episode, currently in remission where there was improvement of symptoms in a period of time after previous episode and the episode only met partially the criteria
- Multiple episodes, currently in acute episode where at least 2 episodes occurred
- Multiple episodes, currently in partial remission
- Multiple episodes, currently in full remission
- Continuous where diagnostic symptoms remain for the majority of the course of the disorder with very brief threshold symptom periods
- Unspecified
- Specify if the symptoms have catatonia
- Specify also the current severity (Note: Diagnosis of schizophrenia can be made without using this specifier)
- Primary symptoms of psychosis, including delusions, hallucinations, disorganized speech, abnormal motor behavior and negative symptoms may be rated for its current severity (most severe in the last 7 days) on a 5-point scale ranging from 0 (not present) to 4 (present and severe)
Physical Examination
- Patient should have a thorough initial work-up which may include, but is not limited to, the following:
- Complete psychiatric and general medical histories
- Physical and mental status exams
- Interviews with family members or close contacts (especially important if patient is unable to provide a reliable history)
- Neurologic exam
Laboratory Tests
- Urine screen to assess for alcohol or drug abuse
- Blood levels of antipsychotic medication
- Basic labs: Complete blood count (CBC), blood electrolytes, glucose and liver, renal and thyroid function
- If indicated and permissible: Test for human immunodeficiency virus (HIV) status, syphilis test
