National Alliance on Mental Illness
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Symptoms, Causes and Diagnosis

Diagnosing Schizophrenia

Diagnosing schizophrenia is not easy. The first signs of its manifestation may only be a change of friends, a drop in grades or irritability and not even appear to be "typical" signs of psychosis. Complicating diagnosis further is that the symptoms of schizophrenia also resemble those of other mental and physical health problems, such as bipolar disorder and brain tumors. Schizophrenia symptoms can also be mimicked in the effects of illicit drugs, including the use of methamphetamines. As a consequence there is no one single physical or lab test that is able on its own to accurately diagnosis schizophrenia. However, a health care provider who evaluates the symptoms and the course of a person's illness over six months can help ensure a correct diagnosis.

The difficulty of diagnosing schizophrenia is compounded with the fact that many individuals who are diagnosed do not believe they have the disease. The Diagnostic and Statistical Manual of Mental Disorders, fourth-edition (DSM-IV), the book health care professionals use to diagnose mental illnesses, states that a majority of individuals with schizophrenia do not believe they have a psychotic illness. Evidence suggests that poor insight, or awareness, is an expression of the illness rather than a coping strategy. Named Anosognosia, this lack of insight according to some studies occurs in 50-80 percent of patients diagnosed with schizophrenia.

It is extremely important to identify schizophrenia as early as possible. According to research, identifying schizophrenia early-just like cancer-can increase the chances of managing the illness and recovery. If identified and treated early on, schizophrenia can be managed fairly well and the chances of subsequent psychotic episodes are greatly reduced.

The DSM-IV contains five sub-classifications of schizophrenia. However, as scientific knowledge changes the diagnostic criteria for diagnosing schizophrenia changes as well. The developers of the DSM-5, to be published in 2013, are recommended that the classifications be dropped.

Ethnicity and its Effect on Diagnosis

Despite extreme similarity in genetics across race there is a surprisingly different rate of diagnosis. One study found that African Americans were three times more likely to be diagnosed with schizophrenia than whites; when socioeconomic status was adjusted for, there was still a two-fold difference. Other studies have suggested that this is because clinicians more readily diagnose African Americans with schizophrenia rather than an affective disorder because of the way symptoms are exhibited.

The expression of schizophrenia varies vastly across cultures, even among similar cultures. Studies conducted on Asian participants in East Asian countries revealed that there is a relationship between symptoms of schizophrenia and culture. For example, the content of hallucinations and delusions appeared to be culturally specific. This demonstrates that cultural differences, no matter how small, play an integral role in the appearances of diseases.

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