Diagnosis of schizophrenia

overview about the diagnosis of schizophrenia

Diagnosis of schizophrenia is the decision of a doctor when they meet someone. While the doctor is with someone they watch and listen to what someone is doing to decide if they have a schizophrenia (sz) problem. Doctors make a decision using their senses.

In the past

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In the 1911 publication of Dr Bleuler, sz is diagnosed by recognition of "large symptom-complexes", one of which "peculiar association disturbance" is always a symptom that exists for diagnosis to be made, examples of this are "blocking" and "spliting of ideas". The Fundamental symptoms are present in every diagnosed case, the Accessory symptoms are present also in other illnesses. [1] The "key" symptom is the association disorder [2]

The fundamental symptoms of Dr Bleuler were:[1]

  • disturbances of association and affectivity
  • a liking, [3] preference, [4] ("prediliction") for fantasy against reality
  • the inclination to "divorce" from reality (autism)

A past definition of the most important symptoms of sz, which are described as the "First-Rank Symptoms" were described by Kurt Schneider during 1938 [5] these are:

  • positive symptoms: auditory hallucinations; thought withdrawal, insertion and interruption; thought broadcasting; somatic hallucinations; delusional perception; feelings or actions as made or influenced by external agents [6]
  • negative symptoms: deficits of emotional responses or other thought processes [6]

How a decision is made

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To decide if a person has schizophrenia [7] a doctor uses The Diagnostic and Statistical Manual of Mental Disorders (DSM) [8] made by the American Psychiatric Association [9] for the United States of America (US) [10] and the International Classification of Diseases (ICD), [11] made by World Health Assembly and the World Health Organisation, [9] for all of the world, [10] although used in the US with a US only version made by The Centers for Disease Control and Prevention (CDC) because of the different cultures. [12]

Differential diagnosis

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There are no medical tests that can be used to say if a person has sz or not, so getting a diagnosis depends on which list of symptoms are used. It also depends on the doctor or psychologist who talks to the person. Some scientists think that sz is several separate illnesses that have some of the same symptoms. These scientists claim that the research done on sz is not accurate since different researchers mean different things when they use the word "schizophrenia" in scientific studies. Similarly named mental illnesses include schizotypal personality disorder, schizoaffective disorder, and schizoid personality disorder.

Unlike what the name suggests, people with sz do not have a split personality.

Splitting also occurs in Borderline Personality Disorder. [13][14]

The praecox feeling

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A study of 2018 found that some doctors, perhaps many, [15] diagnose sz within the first few minutes [16][15] based on the "praecox feeling". [15] The "feeling" is perhaps like first impressions. [17][18][19][20] The "praecox feeling" is not in the "symptom checklists" of DSM and ICD [8][11] which are intended for use by psychiatrists for diagnosis.

Other problems that go with sz

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Additional problems as defined by clinicians and medical services are described in medical terms as "comorbidities". One research group found "substance misuse" was mostly the morbidity which people with sz had; [21] substances are known as psychoactive [22]

References

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  1. 1.0 1.1 Bleuler, Eugen (1911). Dementia Praecox oder Gruppe der Schizophrenien (MONOGRAPH SERIES ON SCHIZOPHRENIA NO. 1 Dementia Praecox or the Group of Schizophrenias). archive.org: International Universities Press (Translated by J. Zinkin, 1950). pp. 13 14.
  2. Burkhart Brückner, Ansgar Fabri (2015) Bleuler, Paul Eugen.: "Research on schizophrenia" In: Biographical Archive of Psychiatry. (retrieved:10.11.2023)
  3. https://dictionary.cambridge.org/dictionary/english/predilection
  4. https://www.thefreedictionary.com/predilection
  5. Schneiderian first- and second-rank symptoms Oxford Reference
  6. 6.0 6.1 Karla Soares‐Weiser, Nicola Maayan, Hanna Bergman, Clare Davenport, Amanda J Kirkham, Sarah Grabowski, Clive E Adams, and Cochrane Schizophrenia Group First rank symptoms for schizophrenia First rank symptoms for schizophrenia
  7. van Os J, Kapur S (August 2009). "Schizophrenia" (PDF). Lancet. 374 (9690): 635–45. doi:10.1016/S0140-6736(09)60995-8. PMID 19700006. S2CID 208792724. Archived from the original (PDF) on 2013-06-23. Retrieved 2013-04-15.{{cite journal}}: CS1 maint: date and year (link)
  8. 8.0 8.1 DSM-IV to DSM-5 Schizophrenia Comparison Substance Abuse and Mental Health Services Administration. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 June
  9. 9.0 9.1 ICD vs. DSM October 2009, Vol 40, No. 9 American Psychological Association
  10. 10.0 10.1 Ellen Doernberg, Eric Hollander (2016) Neurodevelopmental Disorders (ASD and ADHD): DSM-5, ICD-10, and ICD-11 CNS Spectrums, 21(4), 295-299. 01 July 2016 doi:10.1017/S1092852916000262
  11. 11.0 11.1 11.2 "ICD-11: 6A20 Schizophrenia". World Health Organization. Retrieved 23 August 2022.
  12. Freddy A. Paniagua ICD-10 Versus DSM-5 on Cultural Issues SAGE Open, 8(1). https://doi.org/10.1177/2158244018756165
  13. Scott O. Lilienfeld, Katheryn C. Sauvigné, Steven Jay Lynn, Robin L. Cautin, Robert D. Latzman, Irwin D. Waldman Fifty psychological and psychiatric terms to avoid: a list of inaccurate, misleading, misused, ambiguous, and logically confused words and phrases (34) Splitting Front. Psychol., 03 August 2015 Sec. Educational Psychology Volume 6 - 2015 | https://doi.org/10.3389/fpsyg.2015.01100
  14. Ondrej Pec, Petr Bob, Jiri Raboch Splitting in Schizophrenia and Borderline Personality Disorder March 6, 2014 https://doi.org/10.1371/journal.pone.0091228
  15. 15.0 15.1 15.2 Tudi Gozé How to Teach/Learn Praecox Feeling? Through Phenomenology to Medical Education Front Psychiatry. 2022; 13: 819305. Published online 2022 Mar 18. doi: 10.3389/fpsyt.2022.819305
  16. Marcin Moskalewicz , Michael Schwartz , Tudi Gozé Phenomenology of Intuitive Judgment: Praecox-Feeling in the Diagnosis of Schizophrenia AVANT, Vol. IX, No. 2/2018 ISSN: 2082-6710 avant.edu.pl/en
  17. Matthew Rabin, Joel L. Schrag First Impressions Matter: A Model of Confirmatory Bias The Quarterly Journal of Economics, Volume 114, Issue 1, February 1999
  18. Philip E. Tetlock Accountability and the Perseverance of First Impressions Social Psychology Quarterly Vol. 46, No. 4 (Dec., 1983) American Sociological Association
  19. Omri Gillath, Angela J. Bahns, Fiona Ge, Christian S. Crandall Shoes as a source of first impressions Journal of Research in Personality Volume 46, Issue 4, August 2012
  20. Harris, M. J., & Garris, C. P. (2008). You never get a second chance to make a first impression: Behavioral consequences of first impressions. In N. Ambady & J. J. Skowronski (Eds.), First impressions (pp. 147–168). Guilford Publications. American Psychological Association
  21. Peter F. Buckley, Brian J. Miller, Douglas S. Lehrer, David J. Castle Psychiatric Comorbidities and Schizophrenia Schizophrenia Bulletin, Volume 35, Issue 2, March 2009, Pages 383–402, https://doi.org/10.1093/schbul/sbn135 Published: 14 November 2008
  22. Rassool GH (2012) Substance misuse in older people 1: types of substance misuse and risk factors. Nursing Times [online]; 108: 30/31, 12-14.