Schizophrenia Diagnosis

Schizophrenia

Epidemiology

Schizophrenia is a chronic, debilitating disease that lasts lifelong. Although about 1% of people worldwide have schizophrenia, it is one of the top 15 causes of disability. In the United States 1.2% of the population has schizophrenia. For males it usually begins in their late teens to early 20’s and for women in their late 20’s to early 30’s. It is very uncommon to diagnose a person before 13 or after 40 years old. Schizophrenia occurs 2 to 3 times more frequently in males. There maybe a number of factors relating to genetics as well as more males than females abuse substances.

Diagnosis of Schizophrenia

So how do we diagnose schizophrenia? There are a number of criteria in the DSM 5 which you’ll remember is the Bible for psychiatry and psychology. There are lots of nuances but basically schizophrenia is characterized by at least two of the following for at least a six month period:

* Hallucinations- seeing, hearing, or feeling things that don’t exist. The most common is auditory hallucinations or hearing voices.

Here is an example of what hearing voices is like (if possible try this with earphones on):

* Delusions- Delusions are fixed beliefs that aren’t true.

• Delusions can be with paranoid/persecutory themes, such as another is out to get them.
• Another type of delusions include grandiose which means the person has an exaggerated belief that they are very important or abilities that others don’t have, have possessions that others don’t have, or special powers. I frequently have patients who believe they have an enormous amount of money in which they can own anything they please. I have patients who believe they can read another’s mind. Thought insertion is the belief that you can read other people’s thoughts where as thought broadcasting is when someone believes others can read their thoughts.
• Another type of delusion is called erotomania, and people with these delusions believe that another person such as a famous person is in love with them. For example, I had a patient who believed Elon Musk was in love with her and wanted to marry her. She went to his house and truly believed he loved her.
• There are mixed types and a few other types, but these are the main delusion types.

* Disorganized speech- Disorganized speech is when the person cannot organize their thoughts enough to make a coherent statement. Here is an example of disorganized thought process and speech.

* Grossly disorganized or catatonic behavior- Grossly disorganized behavior looks different for everyone. Sometimes it’s taking all their clothes off and running around naked. It may be throwing chairs at people or walking up and just punching a person.  It’s basically unpredictable behavior or behavior that does not flow with societal norms.

There are lots of different types of catatonia, but the following is what people think of when they think of catatonia.

* Negative symptoms- Negative symptoms are symptoms such as depression, flat affect, sluggishness, and withdrawal from normal activities. These symptoms cause significant inability to perform their jobs or interact appropriately with others. They often cannot care for their own needs such as taking care of their own hygiene.

Two of the above symptoms have to present for at least six months and doesn’t qualify for other mental illness such as schizoaffective disorder. Schizoaffective disorder is kind of like a combination of schizophrenia (hallucinations and/or delusions) and Bipolar I disorder.  Schizophrenia cannot also be CAUSED by substances such as drugs, alcohol, and medications.  That doesn’t mean that people with schizophrenia don’t take substances but true schizophrenia occurs regardless of these substances.

Why is this Important?

According to the National Institutes of Health, it is estimated that people with schizophrenia lose approximately 28.5 years of life.  That means you may live until 80, but a person with schizophrenia may be likely to die by 51.5 years old. Those with schizophrenia tend to die more often due to diabetes, heart disease, and liver disease.  In the general population, approximately 1.7% of people end their lives by suicide but 4.9% of people with schizophrenia die from suicide. They are more likely to be victims of violent crime and approximately half of people who suffer with schizophrenia have co-occurring mental illness disorders.  That could be depression, anxiety, substance abuse, ADHD, or any number of mental illnesses.

We are going to talk about what we can do as a society and individual to help those who suffer from these terrible mental illnesses in the future.  Next time, I will talk about what’s going on in the brain.