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Schizophrenia: Difficult to Diagnose?

According to the National Institute of Mental Health (NIMH), approximately 1 percent of the population develops schizophrenia during their lifetime. In other words, more than TWO MILLION Americans suffer from schizophrenia in a given year. If schizophrenia is so prevalent, then why is it so difficult to diagnose? Why are so many people undiagnosed or misdiagnosed?

Unfortunately, there is still a very great stigma attached to schizophrenia. In addition, much of society is still uninformed or misinformed about schizophrenia, still believing that schizophrenia is a "multiple personality" disorder, rather than the chronic, severe, and disabling brain disease that it is. Even if someone suspects he/she has schizophrenia, he/she may be unwilling to seek help for the disorder due to fear of societal, occupational, or familial repercussions.

People with schizophrenia often suffer terrifying symptoms such as hearing voices inside their heads or believing that other people are reading their minds, controlling their thoughts, or plotting to harm them. These symptoms may leave them fearful and withdrawn. Their speech and behavior can be so disorganized that others may not be able to understand what they say, or be frightened by what they say or do. This may lead to isolation, so that they may go undiagnosed for a long period of time.

Available treatments for schizophrenia can relieve many symptoms, but most people with schizophrenia continue to suffer some symptoms throughout their lives. It has been estimated that no more than one in five individuals recovers completely. Although there is no cure for schizophrenia, symptoms are usually managed by anti-psychotic medications.

The severity of the symptoms of schizophrenia and long-lasting, chronic pattern of schizophrenia often cause a high degree of disability. Medications and other treatments for schizophrenia, when used regularly and as prescribed, can help reduce and control the most debilitating symptoms of the illness.
Unfortunately, some people are not greatly helped by available treatments or may prematurely discontinue treatments because of unpleasant side effects or other reasons. Even when treatment is effective, persisting consequences of the illness - loss of job or family, stigma, residual symptoms, and medication side effects - may be very troubling.

According to the National Institute of Mental Illness (NAMI), the greatest cause of acute, symptomatic schizophrenia is the failure to take medication regularly. Too often, a person with schizophrenia will stop taking medication when they "feel better," for instance, and symptoms of schizophrenia will return. Another reason given for failure to take medication is the cost of the medication.

The first signs of schizophrenia often appear as confusing, or even shocking, changes in behavior. The sudden onset of severe psychotic symptoms is referred to as an "acute" phase of schizophrenia. "Psychosis," a common condition in schizophrenia, 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 experiences. Less obvious symptoms, such as social isolation or withdrawal, or unusual speech, thinking, or behavior, may occur before, be seen along with, or follow the psychotic symptoms of schizophrenia.

Some people have only one psychotic episode; others have many episodes during a lifetime, but lead relatively normal lives during the interim periods. However, the individual with "chronic" schizophrenia, or a continuous or recurring pattern of schizophrenia, often does not fully recover normal functioning and typically requires long-term treatment, generally including medication for schizophrenia, to control the symptoms of schizophrenia.

Because schizophrenia can mimic other physical conditions, it is important to rule out any other physical illnesses before a diagnosis of schizophrenia can be made. 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.

Substance abuse is one way in which schizophrenia goes undiagnosed or misdiagnosed, since commonly abused drugs may cause symptoms resembling schizophrenia. In fact, many people undiagnosed with schizophrenia may use drugs or alcohol to "self-medicate" an undiagnosed case of schizophrenia. For this reason, blood or urine samples from the person could be tested at a hospital, walk-in clinic or physician's office for the presence of these drugs.

Another reason schizophrenia is often undiagnosed or misdiagnosed is that, at times, it is difficult to tell one mental disorder from another due to overlapping symptoms. 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," a cross between schizophrenia and bipolar disorder.

Schizophrenia often affects a person's ability to "think straight." Thoughts may come and go rapidly; the person may not be able to concentrate on one thought for very long and may be easily distracted, unable to focus attention. In this way, schizophrenia may mimic ADHD, and may be misdiagnosed as such. People with schizophrenia may not be able to sort out what is relevant and what is not relevant to a situation which, again, may mimic ADHD; however, in the person with schizophrenia, that person may be unable to connect thoughts into logical sequences, with thoughts becoming disorganized and fragmented.

People with schizophrenia often show "blunted" or "flat" affect. This refers to a severe reduction in emotional expressiveness. A person with schizophrenia may not show the signs of normal emotion, perhaps may speak in a monotonous voice, have diminished facial expressions, and appear extremely apathetic (uncaring). The person may withdraw socially, avoiding contact with others; and when forced to interact, he/she she may have nothing to say, seeming to be shy, or overly distracted. Motivation can be greatly decreased, as can interest in or enjoyment of life. In some severe cases, a person can spend entire days doing nothing at all, even neglecting basic hygiene. These symptoms are too often misdiagnosed as depression, or a major depressive disorder.

Because the cause for schizophrenia is still unknown, yet another reason for undiagnosis or misdiagnosis of schizophrenia is that health care professionals cannot determine who will have schizophrenia and who will not. Scientists, however, are studying genetic factors in schizophrenia.

It has long been known that schizophrenia runs in families. People who have a close relative with schizophrenia are more likely to develop the disorder than are people who have no relatives with schizophrenia. A child whose parent has schizophrenia has about a 10% chance of also having schizophrenia. However, it is not yet understood how the genetic predisposition is transmitted, and it cannot yet be accurately predicted whether a given person will or will not develop schizophrenia.

There have also been dramatic advances in neuroimaging technology that permit scientists to study brain structure and function in living individuals. Many studies of people with schizophrenia have found abnormalities in brain structure. Still, there is no "advanced notice" given of whether someone will have schizophrenia or not. Diagnosis is still based on signs and symptoms of the disorder.

Since there is no blood test or other such testing to determine if a person has schizophrenia, a diagnosis of schizophrenia must still be determined by a mental health professional, according to guidelines set by the American Psychiatric Association in the DSM-IV. However, suspicion of a diagnosis of schizophrenia lies largely (if not with the individual himself), with the individual's loved ones and friends, who will notice the signs and symptoms of schizophrenia written about in this article. In that case, they should seek out a qualified mental health professional to make the diagnosis of schizophrenia. In addition, a physician can help by ruling out other medical disorders or physical conditions.

Although there is yet no cure for schizophrenia, the disorder can be managed with proper medication, therapy, and a strong support system.

About the Author

Michele Soloway has dealt with bipolar disorder from a very young age. Her grandmother, mother, herself, and her teenage son all have the disorder. She also lost her sister to suicide because of bipolar disorder. Michele has a blog for bipolar survivors at http://bipolarsurvivor.blogspot.com, and is also a contributing writer to www.bipolarcentral.com.

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