Hi.
I'm Jeanie Tse, and I'm here to tell you about the symptoms of schizophrenia and the criteria
for diagnosis.
There are five main symptom areas in schizophrenia that we look at.
One is delusions, which are fixed false beliefs that are not shared by other people in the
culture.
So, those can include paranoid delusions that other people are trying to harm you or that
there's a plot against you.
Or, grandiose delusions, where you feel that you are more important than perhaps you are,
that you have a mission to accomplish or things like that.
There are many kinds of delusions and there are different kinds of hallucinations, which
is the second symptom area, as well.
So, hallucinations are problems of perception where you might think that someone is speaking
to you, when no one is in fact speaking to you.
Or, you might see things that other people don't see.
So, those are hallucinations.
There's disorganized thought and disorganized behavior as well, which affect how you communicate
with others, how you are understood, and as well your ability to take care of yourself
and organize your activities.
The fifth symptom area of schizophrenia is negative symptoms, and so people who have
negative symptoms may have a very flat affect.
So, no smiles, no crying, just looking flat.
They may not have a lot of motivation to do things.
Their thinking may be slowed or even largely absent, and so they don't enjoy things as
much as they used to.
So, those are the main five symptom areas of schizophrenia.
But to have the diagnosis of schizophrenia, these things have to be present for at least
one month and there has to be at least six months where there's a decline in the usual
areas of functioning.
So, somebody may have been able to work and take care of their family and over six months
that starts to deteriorate.
So, those and sort or excluding that substance use or that medical condition could be causing
these symptoms are what is needed to make a diagnosis.
We make this diagnosis by doing a clinical interview, so interviewing the person and
also finding out from people who know them what has been going on so that we can corroborate
that history.
There are no brain tests or blood tests that reliably tell us whether someone has schizophrenia.
So, it's really that human interaction, trying to find out what that person is experiencing
that tells us whether they have schizophrenia or not.
Of note, the DSM-5, the Diagnostic and Statistical Manual that we use in psychiatry to make diagnosis,
has just been revised, and so it's just come out in May of this year.
There are some changes to the diagnosis.
Largely, the criteria I've just talked about haven't changed.
But, there used to be a lot of subtypes of schizophrenia, including paranoid type, disorganized
type, and those have been eliminated because they didn't seem to hold up in the research
as being separate.
In fact, schizophrenia is probably a heterogeneous condition.
It's probably a mix of many different kinds of disorders.
But the subtypes that we were using before don't seem to be accurate.
We should also note that schizoaffective disorder is a very closely related condition to schizophrenia.
So, it's basically schizophrenia with the addition of mood episodes on top of it, including
depressive episodes where, obviously, you feel sad or depressed and may have troubles
with sleep, with appetite, with enjoying things, and even suicidal thinking.
Or, manic episodes on top of schizophrenia, which include an elevated mood, increased
energy, lack of sleep, inflated self-esteem and increased activity, and sometimes reckless
behaviors.
So, those symptoms, if they are present in the presence of schizophrenia, qualify you
for schizoaffective disorder.