DSM IV Schizophrenia Diagnosis

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Schizophrenia is a serious mental disorder characterised by hallucinations and delusions that affects roughly one percent of individuals around the world. If you have a close family member with Schizophrenia then the risk rises to around ten percent but if that family member is an identical twin then the other twin has a fifty percent chance of developing Schizophrenia.

No one knows what causes Schizophrenia but we now know that genetics certainly do play a part as it does tend to run in families. Other causes that have been implicated include maternal stress in the very early stages of pregnancy, biological, environmental and social factors. Scientists now believe that Schizophrenia may be a whole range of different disorders as opposed to just one which would explain why there are so many variations and potential triggers.

There are no diagnostic tests that will identify Schizophrenia so a diagnosis is made according to the symptoms that are present.

The DSM-1V criteria for Schizophrenia

Two or more of the following symptoms have to have been present for more than one month coinciding with reduced social or personal or occupational functioning that has been present for six months. These symptoms must not be a result of drug abuse or any other medical condition or medication and Schizoaffective and Mood Disorder have been ruled out.

•    Hallucinations (the most common type of hallucinations in Schizophrenia are auditory hallucinations where the individual may hear voices but hallucinations can affect any of the senses for example sight, hearing, taste, touch and smell)
•    Delusions (holding bizarre ideas and beliefs which are evidently false)
•    Disorganised Speech (speech may be rambling and incoherent)
•    Disorganised or Catatonic Behaviour
•    Negative Symptoms (a flattening of the emotions, apathy, social withdrawal etc.)

If another disorder is present, an additional diagnosis of Schizophrenia may be made if delusions or hallucinations are also present and have been for at least one month.

Symptoms and Sub Categories of Schizophrenia

The symptoms of Schizophrenia are classified into positive and negative symptoms. The positive symptoms can be described as behaviour that is in addition to what you would normally expect such as hallucinations and delusions. Negative symptoms can be described as behaviour that is missing from what you would normally expect such as lack of emotion, lack of facial expressions, and an inability to function effectively.

There are five different sub categories of Schizophrenia and the type of Schizophrenia diagnosed will depend on which type most suits the symptoms. For example:

•    Paranoid Schizophrenia – feelings of persecution or that someone or something is out to get you
•    Disorganized Schizophrenia – speech and behaviour that is disorganized and chaotic, there may be inappropriate social responses
•    Catatonic Schizophrenia – disturbances affecting movement, echolalia and echopraxia may be present
•    Undifferentiated Schizophrenia – where the symptoms don’t clearly fit in with any other category
•    Residual Schizophrenia – currently no positive symptoms but a past history of Schizophrenia. This is the long term state of Schizophrenia.

What is the prognosis?

Although Schizophrenia is a distressing disorder, most people can and do lead very fulfilling lives. Around a quarter of people with Schizophrenia will go on to make a full recovery, about half will have periods of remission but will still need support and the remaining quarter will require long term treatment and support.

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