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Schizophrenia Diagnosis

There is no test that can make a schizophrenia diagnosis. People with schizophrenia usually come to the attention of a mental health professional after others see them acting strangely.

Doctors make a diagnosis through interviews with the patient as well as with friends and family members.

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Psychiatrists have the most experience with diagnosing schizophrenia. A psychiatrist or other licensed mental health professional should be involved in making a schizophrenia diagnosis whenever possible.

A schizophrenia diagnosis can be made when all of the following are true about a patient:

  • Schizophrenia symptoms have been present for at least six months.
  • Patient is significantly impaired by the symptoms. For example, has serious difficulty working or with social relationships, compared to the period before symptoms began.
  • Symptoms can't be explained by another diagnosis, such as drug use or another mental illness.

Some people with schizophrenia are afraid of their symptoms. Or they may be suspicious of others (paranoid). They may conceal their symptoms from doctors or loved ones. This can make it more difficult to confirm a schizophrenia diagnosis.

Diagnosing Schizophrenia by Symptoms

People with schizophrenia have at least some of its main symptoms. For a psychiatrist to make a confident schizophrenia diagnosis, some of these symptoms must be present:

  • Hallucinations. This means hearing voices or other sounds that aren't there or seeing things that don't exist.
  • Delusions (unshakeable beliefs that aren't true).
  • Disorganized speech and behavior (talking and acting strangely).
  • Lack of motivation and emotional expression.
  • Lack of energy.
  • Poor grooming habits.

Specific types of psychotic symptoms (called first-rank symptoms), when present, make a schizophrenia diagnosis more likely:

  • Hearing your own thoughts spoken aloud.
  • Feeling that thoughts are being inserted into your mind, or removed from it, by an outside force.
  • Feeling like other people can read your mind.
  • Feeling that an outside force is making you feel something, want something, or act in a certain way.
  • Hearing voices discuss you or argue about you.
  • Hearing voices narrate your actions as you perform them.

A person with schizophrenia may describe these symptoms openly. Or a psychiatrist may deduce they are likely present based on observations of a person's speech and behavior.

Conditions With Similar Symptoms to Schizophrenia

Other mental illnesses and medical conditions sometimes include symptoms that are similar to schizophrenia.

To diagnose schizophrenia with confidence, a doctor needs to be sure that a patient doesn't have other conditions that are causing the symptoms.

Conditions that can potentially create confusion around a schizophrenia diagnosis include:

Bipolar disorder. This mood disorder includes mania and depression. It may also cause delusions, hallucinations, and disorganized thinking and speech.

Major depression. When severe, it can include:

  • Delusions
  • Hallucinations
  • Apathy
  • Lack of interaction

Drug use. Hallucinogens or chronic use of cocaine can cause:

  • Hallucinations
  • Delusions
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