Diagnosis & Treatment 

Diagnosis

Diagnosis of schizophrenia is usually based on discussion and reports of emotion and behaviour from the patient themselves and from those closely associated with them. A complex disorder with a great variety of causes and symptoms such as schizophrenia requires an individual and personal assessment of state-of-mind.

This is usually achieved by referral from a general practitioner to a psychiatrist or social worker, before taking a full psychiatric history and mental state examination.

Technical criteria are taken from the WHO International Statistical Classification of Diseases and Related Health Problems, the ICD-10 or the American Pyschiatric Association equivalent. Three general diagnostic criteria must be met:

Characteristic symptoms

• Delusions
• Hallucinations
• Disorganised speech
• Disorganised behaviour (i.e. catatonia, inappropriate conduct)
• Negative symptoms

Social/Occupation dysfunction

A level of at least one aspect of life should be significantly below the level achieved prior to onset. 

Duration

Continuous signs of disturbance for at least six months.

Subtypes

A diagnosis can be classified by subtype:

• Paranoid: Presence of delusions and hallucinations, but absence of thought disorder and disorganised behaviour.
• Disorganised: Thought disorder and disorganised behaviour present together.
• Catatonic: Patient may be almost immobile or produce agitated random movement.
• Undifferentiated: Psychotic symptoms present, but cannot be otherwise classified as one of the above subtypes.
• Residual: Positive symptoms present, but at a low intensity.

Similar Disorders

Diagnosis is not possible when symptoms of other disorders are present, or if the patient is taking recreational drugs. Schizophrenia is regularly confused with a number of other mental disorders such as bipolar disorder, schizoaffective disorder and borderline personality disorder (BPD). Other less common causes of symptoms similar to those seen in schizophrenia include infections such as HIV, syphilis, epilepsy, brain lesions or metabolic imbalance.

Information for diagnostic criteria courtesy of DSM-IV-TR  

Treatment

Schizophrenia is a vastly diverse and complex disorder, with so many contributory factors that it is understandably difficult to consider a complete cure. However, there are a number treatments designed with the aim of helping alleviate symptoms and restoring function.

Medication

The primary step in treatment of schizophrenia is prescription of antipsychotics. The mode of action of these drugs was discussed in the section entitled “Dopamine”.

• Chlorpromazine (pictured) is frequently prescribed in order to relieve positive symptoms. It was one of the first antipsychotics developed in the 1950’s and had a wide range of affects on the brain. Primarily, however, it acts to bind to dopamine D2 receptors and reduce the activity of dopaminergic transmission, causing a relative increase in intracellular cAMP levels and restoration of what can be considered normal reward pathway functioning.

Side effects

Associated side effects include dyskinesia, rigidity and tremor, tachycardia, hypotension, impotence, lethargy, seizures and other physiological disturbances controlled by related dopamine pathways. These are due to secondary functional binding of the higher levels of dopamine post-treatment to other subtypes of dopamine receptor.

Patients may also experience reductions in the sensations usually associated with the reward pathways. Dysphoria and lack of desire or enthusiasm can be prevalent and are not to be confused with negative symptoms which are thought to act via a different system in the brain.

Other Treatments

• Patients can improve with psychological intervention based around increasing self-esteem, improving insight and regaining social function. This form of Cognitive Behavioural Therapy (CBT) is considered a worthwhile approach to changing the lifestyle of schizophrenic patients.
• Family therapy, in which an individual approaches the whole family system related to schizophrenia, has also been consistently shown to benefit patients and those closest to them.
• Electroconvulsive therapy is considered a last point-of-call for combating symptoms and is rarely considered. There have been recognised cases of reduced positive symptoms due to ECT, yet the intrusive nature of psychosurgery has placed an emphasis on the development of pharmacological and psychiatric treatments.

Chlorpromazine image courtesy of Wikimedia Commons at https://commons.wikimedia.org/wiki/File:Chlorpromazine-3D-vdW.png

Diagnosis image courtesy of Flickr at https://www.flickr.com/photos/adrianclarkmbbs/495559275/sizes/l/