Sentiens Health

Making A Diagnosis

The first signs of schizophrenia often appear as confusion or significant changes in behaviour and emotions. This makes accurate diagnosis, especially in the early stages, extremely difficult.  Unfortunately, there is no blood test or any other definitive diagnostic test which can confirm schizophrenia.  Therefore, it is left up to the medical professional to determine, based on the available evidence, whether a diagnosis of schizophrenia is appropriate, and the necessary course of action. 

The person and the family may not know what is occurring and it may take some time for symptoms to evolve.  Coping with the symptoms of schizophrenia can be especially difficult for family members who remember how involved or vivacious a person was before they became ill. The sudden onset of severe psychotic (‘positive’) symptoms is referred to as an acute phase of schizophrenia. Psychosis is a common condition in schizophrenia. Psychosis is a state of mental impairment marked by hallucinations, which are disturbances of sensory perception, and/or delusions, which are false yet strongly held personal beliefs that result from an inability to separate real from unreal or perceived experiences (See the Psychotic Disorders brochure on this website). Less obvious symptoms, such as social isolation or withdrawal, or unusual speech, thinking, or behavior, may precede, be seen along with, or follow the psychotic symptoms.

The person may say that they can hear people talking about them, commenting on what they are doing, being insulting or making a running commentary. They may hear these voices when they are alone or in company. They may think they come from the television or radio or from invisible beings. People with schizophrenia at times experience reality differently. They may say that they can pick up other people’s thoughts, or that they can read minds. These experiences may be frightening or exhilarating, unsettling or fascinating. They are almost always extraordinary. They form the basis of beliefs and actions. To the person they are intensely real, often even more so than ordinary events. This makes them hard to differentiate from ‘real’ life itself.

Some other symptoms may be observed rather than reported. Some people may be very quiet and withdrawn. They may do little and say that they lack interest or motivation. Others may speak in a way which is hard to understand. They may use strange words or their sentences may be fragmented.
It is important to rule out other illnesses, as sometimes people suffer severe mental symptoms or even psychosis due to undetected underlying medical conditions. For this reason, a medical history should be taken and a physical examination and laboratory tests should be done to rule out other possible causes of the symptoms before concluding that a person has schizophrenia. In addition, since commonly abused drugs may cause symptoms resembling schizophrenia, blood or urine samples from the person can be tested for the presence of these drugs.

At times, it is difficult to tell one mental disorder from another. For instance, some people with symptoms of schizophrenia exhibit prolonged extremes of elated or depressed mood, and it is important to determine whether such a patient has schizophrenia or actually has bipolar disorder or major depressive disorder. Persons whose symptoms cannot be clearly categorized are sometimes diagnosed as having a ‘schizoaffective disorder’. At times depression and anxiety disorders may be reactions to or coexist with the schizophrenia and need also to be treated.