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schizophrenia
SCHIZOPHRENIA
Schizophrenia is a devastating mental illness characterized by symptoms eg hallucinations, disorganized thinking, loss of goal-directed behaviors and deterioration in social role functioning.
Positive or psychotic symptoms are delusions, hallucinations, and distorted perceptions.
Negative symptoms include flat or blunted emotions, lack of motivation or energy, lack of pleasure or interest in things, and limited speech.
Disorganized symptoms are confused thinking, disorganized speech and behavior.
Cognitive symptoms include impairment in attention verbal fluency memory, and executive functioning.

Diagnosis

  • 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

     

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