diagnosis
 
 
 
How Is Schizophrenia Diagnosed?
 
 
 
Introduction
 
The diagnosis of schizophrenia is made solely upon the patient’s history (information about the patient and what has happened in the past) and an assessment of their current state.  Historical information regarding events that relate to the development of symptoms and any decline in the patient's level of functioning in any area is particularly important.
 
Laboratory test and other studies, such at CAT or MRI scans, may be ordered.  While they may prove to be helpful, these tests do not confirm the diagnosis; they serve only to rule out other potential causes for the patient’s symptoms.  Urine or serum drug abuse screens are often included.  These tests may exclude drug or alcohol intoxication as a potential cause for symptoms or a factors that may be complicating the patient’s condition.  Some type of test for pregnancy is usually completed, especially if medications are to be considered.
 
Ultimately, the diagnosis of schizophrenia rests upon the history of symptom development and changes in functioning, and the MSE (Mental Status Examination).
 
 
History
 
The history includes:
 
  1. Identifying Information: Data related to the patient’s age, sex, race, marital status, current grade in school or occupation, place of residence (and whether or not the patient lives with someone or independently) and religious preference.  
  2.  
  3. The Chief Complaint: The primary reason the patient came to the office, usually expressed in their own words.  
  4.  
  5. The History of Present Illness: A description of the patient's symptoms and level of functioning in recent times.  
  6.  
  7. The Past Psychiatric History: The patient's past symptoms; treatment as an outpatient, as an inpatient, in residential treatment, or in community based programs.  This also includes previous psychotherapy and any prescribed psychotropic medications; particularly regarding response to treatment, medication side effects, and compliance.  
  8.  
  9. Past Medical History: This includes allergies (to medications and other allergies), medical illnesses, surgeries and any history of trauma, especially head trauma.  
  10.  
  11. Family History: Medical and psychiatric illnesses that other family members had or have, including children.  This area may also include any history of abuse or neglect, or anything that is unusual about the patient's family or origin.  
  12.  
  13. Substance Use History: This includes the use of tobacco products, alcohol and other substances, legal or illicit.  
  14.  
  15. Perinatal and Developmental History: Whether the patient experienced a normal or complicated childbirth and reached developmental milestones as expected.  
  16.  
  17. Social History: This includes historical information about he patient's education and employment, marriage, children or other relationships, involvement in organizations or groups, hobbies or other recreational pursuits, and military service.
  18.  
 
Observations and the Clinical Interview
 
The observation of the patients begins when they are first encountered.  The could conceivably occur in the parking lot outside the clinic or in the waiting room.  The more information that can be gathered directly and indirectly from the patient and about the patient, the more likely the clinician is to reach a reliable diagnosis.  
 
Candid observations have the added value of revealing information about patients when they are relaxed and unaware of scrutiny; when they are not consciously presenting themselves in a favorable light.
 
The observations and interview together constitute the Mental Status Examination.  An abbreviated version, referred to as the Folstein Mini Mental Status Examination,1 is often employed for screening purposes.  This instrument evaluates the areas of:
 
  1. orientation
  2. registration
  3. attention and calculation
  4. recall and language
 
Details regarding the Comprehensive Mental Status Examination can be reviewed by using the link below.
 
 
1Folstein MF et al., "Mini-mental state: A practical method for grading the cognitive state of patients for the clinician."  Journal of Psychiatric Research 12 (1975): 189-198.
 
 
 
(Sources: The author's knowledge base, unless otherwise noted.)
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Related Articles:
 
The Comprehensive Mental Status Examination
 
Differential Diagnosis
 
The Definition of Schizophrenia
 
Symptoms
 
Cognitive Impairment
 
Brain Anatomy or Brain Chemistry?
 
Mental Illness or Medical Illness?
 
Medical Advances
 
Psychotherapy
 
ACT: Assertive Community Treatment
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