Mental health articles

OF mental health care and mentally ill

how do we diagnose schizophrenia?

Let us stop for a second and take stock. Schizophrenia, as we described, is diagnosed, in the same way as a cold is diagnosed, through the presence of a number of symptoms. These symptoms are split into two distinct groups, the positive and the negative. The positives are exceptional experiences which people who do not have a diagnosis would recognize as strange.

The negative symptoms are the lack of skills, which lead people to seem flat and withdrawn, or who have limited social ability. We have also seen that a large number of other factors have to be taken into consideration when considering any single symptom. Auditory hallucinations can be experienced by so-called ‘normal’ people. Brain damage can also account for some of the symptoms, along with other physical causes. Depression and even the medication given for schizophrenia can mirror some of the negative symptoms, and we are even unclear about whether or not catatonia is a positive or a negative symptom. So how do we put it all together and come up with a diagnosis? What are the things we need to consider when confronted with one individual with the mixture of mental experiences that are causing concern?

Let us examine the World Health Organization classification criteria for a diagnosis of schizophrenia, often referred to as ICD 10, to see if we can f ind some answers. We can see that diagnosis following the experience is dependent on two things:

Time. It is important that we are not talking about fleeting experiences but ones that are experienced for at least four weeks.

Gross disturbance. In order for schizophrenia to be diagnosed there must be some gross disturbance to an aspect of functioning. The disturbance can be to the mental experience of perception as described above or social functioning and social performance. So there we have it. Significant disorders of perception experienced over a long period of time is what schizophrenia actually means. In addition, the course of schizophrenia can take many forms depending on the prominent symptoms and if they remain after the first episode.

As a consequence, it is better to view the overall care of people with schizophrenia with reference to their symptoms because:

1 There can never be one generic approach to ‘schizophrenia’ because the condition, as the above criteria indicate, contains too many variables.

2 Research studies need to ensure that population samples have similar symptom presentation, and not just rely on diagnosis. In evaluating research into schizophrenia we need to ask if there has been an attempt to ensure comparability of sample selection in this regard.

3 Treatments and interventions should identify exactly which symptoms or group of symptoms they aim to influence.

4 The variation in prognosis between different ends of the spectrum of psychotic experience is vast. It is very likely that this is influenced by time of onset (i.e., at what age symptoms first become disabling, acceptance of treatment in early stages, time between first onset and treatment), symptom presentation, and ability to control symptoms.

5 We need to re-evaluate outcome measures in line with the above symptom variables. In this way services must move from pejorative terms such as ‘revolving door clients’ and ‘treatment resistant clients’ which seem to view the ineffectiveness of treatment as the clients fault, rather than the treatments.

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