How schizophrenia is diagnosed ?: An expert view

How schizophrenia is diagnosed ?

• Schizophrenia comes under  severe chronic mental disorder. It affects, nearly 20 million population across the world.
• In schizophrenia, person may feel like, they have lost touch with reality. It results in significant distress for the individual, family members, and their friends.
• Caring for and supporting a loved one with schizophrenia is not very easy. It can be difficult to know, how to react to someone, who is having schizophrenia positive symptoms and schizophrenia negative symptoms.
• With the correct treatment and support, person with schizophrenia can live  better life.

What is schizophrenia?

• Schizophrenia is a type of serious mental illness that affects a person’s capability to feel, think and   doing appropriate behavior.
• The precise cause of schizophrenia is still not known. But a combination of genes, environment,  distorted brain structure and chemical imbalance in the brain  may have some role.
• Symptoms of schizophrenia can be persistent and disabling, if not treated properly. Though effective treatment options are available.
• Treatment of schizophrenia should be delivered in a proper coordinated and timely manner.
• Thus it can help affected person  to engage in school or work. It also leads to  get independence and benefit from their personal relationships.

Symptoms of schizophrenia

• Symptoms of schizophrenia are very different and strange at times. It can change  from mild to severe form. Most of the time it includes delusion, hallucination, disorganized and impulsive behavior.
• Person with schizophrenia usually not always show full symptoms, since these types of symptoms used to increase or decrease during course of treatment. Some schizophrenic person have mild symptoms and demonstrate some signs of illness.
•  A large number of schizophrenic patients have severe symptoms, as a result they must take medicines to treat them.
• Schizophrenia is usually seen in late teen years to the early thirties and more earlier in males (late adolescence – early twenties) in comparison to females (early twenties – early thirties).
• First episode of psychosis is usually seen in diagnosis of schizophrenia, in which person shows first symptoms of this illness.
• In this first episode, which starts around mid-adolescence, gradual changes in mood, thinking, behavior and social functioning occur slight earlier.
• Schizophrenia can arise in younger children also, but it is not so common  before late adolescence.

What are the symptoms of schizophrenia?

Symptoms of schizophrenia typically divided into the following three categories:

1-Positive symptoms

2-Negative symptoms

3-Cognitive symptoms

1-Schizophrenia positive symptoms

• It include distorted perceptions (like changes in hearing, vision, touch, smell and taste), strange behaviors and abnormal thinking.
• Person with such symptoms may lose a common sense of reality. They  experience world and  themselves in a unclear and hazy way.
• Typically schizophrenic patients experience:

Hallucinations

There are two common types of hallucinations, auditory and visual.

In auditory hallucination patient complains of   hearing voices that are not there. In visual hallucination patient  sees things that are not present there.

Delusions

Delusions are false  firm beliefs that are not supported by objective evidence.

For example paranoia, in which  irrational fears means someone is  out to get you. He used to believe that radio, television or internet are spreading particular messages about himself.

Thought disorder

In this kind, he used to  start thinking unusually. His way of speaking changes, he start talking irrelevantly and in disorganized fashion.

2- Schizophrenia negative symptoms

• As the name indicates, It include loss of interest, motivation and enjoyment in daily routine activities. Person does not socially involve with anyone.
• He/she does not  able to  express his/her emotion to anyone. Patient’s tone of voice and expression of face change.  
• He does not speak much, remain confined to himself/herself. In medical language it is called as flat effect. Even faces problems in daily functioning. Person also has  difficulty in making planning or beginning any task.

3-Cognitive symptoms 

• It include difficulty in making attention and concentration.  Although memory is preserved but person has problem in memorizing things.
• In some person with schizophrenia, the cognitive symptoms are not much issue, but for others it is problematic.
• In such type of patient, there are interference in daily activities like conversation problem. Person is not able to communicate reciprocally, even may not able to make proper eye contact, while talking.
• Patient has no interest in learning new thing and recalling activities and schedules.
• Patient with schizophrenia has difficulty in making decision. They usually find  problem in focusing and paying attention to the particular topic.

How schizophrenia is diagnosed ?

• How schizophrenia is diagnosed ? Diagnosis of schizophrenia is purely clinical. It depends upon history and mental status examination of the patient.  
• In making diagnosis of schizophrenia, we should rule out other mental health related disorders carefully.
• Psychotic problems due to drugs, medications, stimulants or any other medical condition should also be consider in making the diagnosis of schizophrenia.

Still, some diagnostic tool can be used which can tell, How schizophrenia is diagnosed ?

1-Physical examination

It is important for ruling out other problems and related complications.

2-Screening test 

It helps in ruling out those conditions with similar symptoms. It is useful in screening for drugs and alcohol in body.

The doctor may also ask for imaging studies, like MRI or CT scan of brain.

3-Psychiatric evaluation  

• It is usually done by a doctor (Psychiatrist) or mental health professional.
• Psychiatric evaluation mainly consists of history and mental status examination(MSE).
• In history part, presenting complains, relevant past history, personal history and family history are mainly included.
• History of substance and suicide  also comes under   psychiatric evaluation.

4-Diagnostic criteria for diagnosis of schizophrenia

• How schizophrenia is diagnosed ? Psychiatrist and other mental health professionals use the certain criteria for making diagnosis of schizophrenia. For this they take help of DSM-5 & ICD-10.
• DSM-5 (Diagnostic and Statistical Manual of Mental Disorders-5) & ICD-10 (International classification of disease) are the two most important diagnostic system for making diagnosis of mental health related disorders.

Risk Factors for schizophrenia

Numerous factors contribute in the development of schizophrenia.

Genetics

Family history is usually seen in schizophrenia. But it does not mean that if someone in a family has schizophrenia, the other family members of the family will have it as well.

Genetic studies strongly recommend that many different genes increase the risk of developing schizophrenia.

Though, no single gene is directly responsible for causing schizophrenia.

Even till date, It is not possible to use genetic information  for prediction of schizophrenia.

Environment

Environmental factors and interaction with genes may play role in development of schizophrenia.

These factors include living in scarcity and poverty, stressful

Environmental factors that may be involved include living in poverty, stressful atmosphere and exposure to certain viruses or nutritional problems prior to birth.

How schizophrenia is diagnosed ?

Structural & functional abnormality in brain

Irregularity in brain structure and function may leads to development of schizophrenia. 

There are certain chemicals in  brain which are known as neurotransmitters. Alterations in this chemicals specially dopamine in brain may also cause for schizophrenia.

Brain is divided into various parts. Each part is designed for specific functions. They are interconnected in brain circuit and work together. Changes in the volume of these brain areas have been seen in patient with schizophrenia.

Differences in brain connections and brain circuits have been seen before birth, in  person with schizophrenia. These changes trigger psychotic episodes during puberty   in these people. Schizophrenic patients are very susceptible due to environmental,  genetic exposure  and changes in the brain components.

Communication difficulty in patient with schizophrenia

• Patients with schizophrenia  have two major classes of communication difficulties: First is problems in conveying meaning to others that is known as expressive language.
• Second is difficulty in  understanding the messages of others also called as receptive language.
• There are some definite characteristics of a schizophrenic patient that is responsible for their  communication  problem. It mainly includes lack of awareness about his illness.
• Patient finds difficulty in not connecting thought to speech. He may  refuse to speak or answer any question.
• Patient may not showing any response to the treatment. Most of the time patient may be in unpleasant or strange look.
• Some patients are usually non verbal. It is not possible for us that how much they understand unless we ask specific questions. Sometimes, We feel How schizophrenia is diagnosed ? is very pertaining topic these days specially during schizophrenia awareness week.

How to treat schizophrenia ?

• Treatment of schizophrenia depends upon patient’s symptoms, severity of the problems and response to medicines.
• Though, medicine is the main stay of treatment for schizophrenia yet, combination of medicine and psychotherapy  are the best options specially in order to improve symptoms.
• The cause of schizophrenia are multifactorial and complex. They are not fully understood. This is the reason, why current treatments focus on managing symptoms and solving problems associated to day to day functioning. Treatment options include:

Antipsychotic medications

• These medicines are first line choices for treatment of schizophrenia. They can help decrease the  frequency and intensity of psychotic symptoms. These medicines are usually taken every day in tablet or liquid forms.
• Some antipsychotic medicines are available in the form of  injections, which are given once or twice in  a month. Injections are more convenient to those patients who don’t want to take medicines regularly.
• There are some patients whose symptoms do not improve with typical antipsychotic medication. Such patients need   a medicine popularly known as clozapine.

• Patients who are on clozapine must check their routine blood test  to detect a potentially dangerous side effect known as agranulocytosis (In this absolute neutrophil counts decreases significantly resulting in septicemia). It occurs in 1-2% of  chronic schizophrenic patients.
• Schizophrenic patients  usually report side effects such as weight gain, dry mouth , restlessness, and drowsiness, when they take antipsychotic medications.
• Most of side effects fall down over the time, but other side effects remain may continue. It results  some patients  to think stopping their antipsychotic medicines.

• Abruptly stopping medicines  can be dangerous sometimes and it can make schizophrenic symptoms even more worse.
• Patient  should not stop taking antipsychotic medication without advice of psychiatrist.
• Shared decision making It is the recommended strategy between doctors and patients for determining the best type of medicine in  combination and the proper dose.
• US Food and drug administration (FDA) site gives the latest information on any antipsychotic medicine, its uses, side effects, warnings,  interactions even any new drug.

Psychological Treatments

• There are many psychosocial treatment options available for schizophrenia. Some examples are cognitive behavioral therapy (CBT), supported employment, behavioral skills training and cognitive remediation  therapy.
• These treatments are helpful in negative and cognitive symptoms of schizophrenia. These psychosocial treatments can also be helpful for teaching and improving coping skills to tackle the daily challenges of schizophrenia.
• These therapies are  helpful for the patient to follow their goals in life.
• It has been seen that the patient who follow these psychological treatment, they are least likely to relapse and minimum chance of their hospitalization.
• A combination of these psychological  therapies and antipsychotic medication is the best  option for schizophrenia.

Role of family support

• Family support is the one of the most important part in management of schizophrenia.
• Educational programmes specially designed for family members give information about symptoms and treatment of schizophrenia.
• It helps in making strategy for fight against schizophrenia. Family members understand the psychotic symptoms, available treatment options and course of recovery.
• This help in decreasing their distress, encourage coping and enforce their capacity for fighting against  this chronic illness.
• One more service known as family based service may also be given on individual basis. It also includes multi support groups and family workshops.

How schizophrenia is diagnosed ?

Coordinated Specialty Care (CSC) What goes on in the mind of schizophrenic ?

• This treatment modality is  a type of recovery oriented treatment specially  designed for the first episode psychosis or early stage in schizophrenia.
• A  holistic team approach, including all mental health professional is required in this management. Psychiatrist, Clinical psychologist and  psychosocial workers are included in this team work. 
• Antipsychotic medicines, psychotherapy, education and employment support, case management, family education and support are included in this approach.
• Patient with schizophrenia with early  psychotic symptoms  and the entire team work together to make treatment decisions. Emphasis should be given on the involvement of family members as much as possible.
• Over all, Coordinated specialty care (CSC)  is more useful in reducing symptoms, increasing participation in school and work. It also  improves quality of life.

How schizophrenia is diagnosed ?

Assertive Community Treatment (ACT)

The key components of this therapy is a multidisciplinary team that includes a medication prescriber, a shared caseload among all team members and direct service provision given by team members

Other important highlight of this therapy are low patient to staff ratios, high incidence of patient contact  and outreach to patients in the community.

This treatment option is especially for those patients  with schizophrenia who are at greater risk for frequent hospitalizations. Also useful for those patient who don’t have any shelter or home.

Conclusion

I have discussed in detail about this topic How schizophrenia is diagnosed ? Now I conclude and extract some important points.

• Schizophrenia is a severe mental disorder. It   has a major impact on the lives of people. It does not only affects the particular patient but also the people around them. As  a result it is very important to learn to live and love with patients with schizophrenia.
• Family members of the patient need to be tolerant and accepting the symptoms of this disorder. Psychotic symptoms in schizophrenia will be different from person to person and may change during course of time over time.
• It is very important for family members  to know about the signs and symptoms of this illness. It helps in better understanding of this chronic mental illness.
• Patients should be encouraged for taking proper treatment for entire course.
• We should be very respectful, kind and supportive without tolerating any inappropriate or dangerous behavior
• Some psychotic symptoms are such that they require immediate emergency treatment. If any person showing any  type of harming behavior or suicidal tendency, always immediately take the help of psychiatrist.