Today Schizophrenia awareness week starts. (From 22 May 2022 to 28th May 2022). Theme for this year is "Connecting with Hope". I have tried my best to cover everything about schizophrenia a type of severe mental illness.

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How schizophrenia is diagnosed ? Schizophrenia
Awareness Week
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How schizophrenia is diagnosed ?
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How schizophrenia is diagnosed ?
Schizophrenia comes under severe chronic mental disorder. It affects, nearly 20
million population across the world.
In schizophrenia, person may feel like, they have lost touch with reality. It results in
significant distress for the individual, family members, and their friends.
Caring for and supporting a loved one with schizophrenia is not very easy. It can be
difficult to know, how to react to someone, who is having schizophrenia positive
symptoms and schizophrenia negative symptoms.
With the correct treatment and support, person with schizophrenia can live better
life.
What is schizophrenia?
Schizophrenia is a type of serious mental illness that affects a person’s capability to
feel, think and doing appropriate behavior.
The precise cause of schizophrenia is still not known. But a combination of genes,
environment, distorted brain structure and chemical imbalance in the brain may
have some role.
Symptoms of schizophrenia can be persistent and disabling, if not treated properly.
Though effective treatment options are available.
Treatment of schizophrenia should be delivered in a proper coordinated and timely
manner.

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Thus it can help affected person to engage in school or work. It also leads to get
independence and benefit from their personal relationships.
Symptoms of schizophrenia
Symptoms of schizophrenia are very different and strange at times. It can change
from mild to severe form. Most of the time it includes delusion, hallucination,
disorganized and impulsive behavior.
Person with schizophrenia usually not always show full symptoms, since these types
of symptoms used to increase or decrease during course of treatment. Some
schizophrenic person have mild symptoms and demonstrate some signs of illness.
A large number of schizophrenic patients have severe symptoms, as a result they
must take medicines to treat them.
Schizophrenia is usually seen in late teen years to the early thirties and more earlier
in males (late adolescence – early twenties) in comparison to females (early twenties
– early thirties).
First episode of psychosis is usually seen in diagnosis of schizophrenia, in which
person shows first symptoms of this illness.
In this first episode, which starts around mid-adolescence, gradual changes in
mood, thinking, behavior and social functioning occur slight earlier.
Schizophrenia can arise in younger children also, but it is not so common before
late adolescence.
What are the symptoms of schizophrenia?
Symptoms of schizophrenia typically divided into the following three categories:

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1-Positive symptoms
2-Negative symptoms
3-Cognitive symptoms
1-Schizophrenia positive symptoms
It include distorted perceptions (like changes in hearing, vision, touch, smell and
taste), strange behaviors and abnormal thinking.
Person with such symptoms may lose a common sense of reality. They experience
world and themselves in a unclear and hazy way.
Typically schizophrenic patients experience:
Hallucinations
There are two common types of hallucinations, auditory and
visual.
In auditory hallucination patient complains of hearing voices that
are not there. In visual hallucination patient sees things that are
not present there.
Delusions

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Delusions are false firm beliefs that are not supported by
objective evidence.
For example paranoia, in which irrational fears means someone is
out to get you. He used to believe that radio, television or internet
are spreading particular messages about himself.
Thought disorder
In this kind, he used to start thinking unusually. His way of speaking changes, he start talking
irrelevantly and in disorganized fashion.
2- Schizophrenia negative symptoms
As the name indicates, It include loss of interest, motivation and enjoyment in
daily routine activities. Person does not socially involve with anyone.
He/she does not able to express his/her emotion to anyone. Patient’s tone of voice
and expression of face change.
He does not speak much, remain confined to himself/herself. In medical language it
is called as flat effect. Even faces problems in daily functioning. Person also has
difficulty in making planning or beginning any task.
3-Cognitive symptoms
It include difficulty in making attention and concentration. Although memory is
preserved but person has problem in memorizing things.
In some person with schizophrenia, the cognitive symptoms are not much issue, but
for others it is problematic.
In such type of patient, there are interference in daily activities like conversation
problem. Person is not able to communicate reciprocally, even may not able to make
proper eye contact, while talking.
Patient has no interest in learning new thing and recalling activities and schedules.
Patient with schizophrenia has difficulty in making decision. They usually find
problem in focusing and paying attention to the particular topic.

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How schizophrenia is diagnosed ?
How schizophrenia is diagnosed ?
How schizophrenia is diagnosed ? Diagnosis of schizophrenia is purely clinical.
It depends upon history and mental status examination of the patient.
In making diagnosis of schizophrenia, we should rule out other mental health
related disorders carefully.
Psychotic problems due to drugs, medications, stimulants or any other medical
condition should also be consider in making the diagnosis of schizophrenia.
Still, some diagnostic tool can be used which can tell, How schizophrenia is
diagnosed ?
1-Physical examination
It is important for ruling out other problems and related complications.
2-Screening test
It helps in ruling out those conditions with similar symptoms. It is useful in screening for
drugs and alcohol in body.
The doctor may also ask for imaging studies, like MRI or CT scan of brain.
3-Psychiatric evaluation

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It is usually done by a doctor (Psychiatrist) or mental health professional.
Psychiatric evaluation mainly consists of history and mental status
examination(MSE).
In history part, presenting complains, relevant past history, personal history and
family history are mainly included.
History of substance and suicide also comes under psychiatric evaluation.
4-Diagnostic criteria for diagnosis of schizophrenia
How schizophrenia is diagnosed ? Psychiatrist and other mental health
professionals use the certain criteria for making diagnosis of schizophrenia. For this
they take help of DSM-5 & ICD-10.
DSM-5 (Diagnostic and Statistical Manual of Mental Disorders-5) & ICD-10
(International classification of disease) are the two most important diagnostic
system for making diagnosis of mental health related disorders.
Risk Factors for schizophrenia
Numerous factors contribute in the development of schizophrenia.
Genetics
Family history is usually seen in schizophrenia. But it does not
mean that if someone in a family has schizophrenia, the other
family members of the family will have it as well.

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Genetic studies strongly recommend that many different genes
increase the risk of developing schizophrenia.
Though, no single gene is directly responsible for causing
schizophrenia.
Even till date, It is not possible to use genetic information for
prediction of schizophrenia.
Environment
Environmental factors and interaction with genes may play role in
development of schizophrenia.
These factors include living in scarcity and poverty, stressful
Environmental factors that may be involved include living in
poverty, stressful atmosphere and exposure to certain viruses or
nutritional problems prior to birth.
How schizophrenia is diagnosed ?
Structural & functional abnormality in brain
Irregularity in brain structure and function may leads to development of schizophrenia.
There are certain chemicals in brain which are known as neurotransmitters. Alterations
in this chemicals specially dopamine in brain may also cause for schizophrenia.

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Brain is divided into various parts. Each part is designed for specific functions. They are
interconnected in brain circuit and work together. Changes in the volume of these brain
areas have been seen in patient with schizophrenia.
Differences in brain connections and brain circuits have been seen before birth, in person
with schizophrenia. These changes trigger psychotic episodes during puberty in these
people. Schizophrenic patients are very susceptible due to environmental, genetic
exposure and changes in the brain components.
Communication difficulty in patient with schizophrenia
Patients with schizophrenia have two major classes
of communication difficulties: First is problems in conveying meaning to others
that is known as expressive language.
Second is difficulty in understanding the messages of others also called as receptive
language.
There are some definite characteristics of a schizophrenic patient that is responsible
for their communication problem. It mainly includes lack of awareness about his
illness.
Patient finds difficulty in not connecting thought to speech. He may refuse to speak
or answer any question.
Patient may not showing any response to the treatment. Most of the time patient
may be in unpleasant or strange look.
Some patients are usually non verbal. It is not possible for us that how much they
understand unless we ask specific questions. Sometimes, We feel How
schizophrenia is diagnosed ? is very pertaining topic these days specially during
schizophrenia awareness week.

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How to treat schizophrenia ?
Treatment of schizophrenia depends upon patient’s symptoms, severity of the
problems and response to medicines.
Though, medicine is the main stay of treatment for schizophrenia yet, combination
of medicine and psychotherapy are the best options specially in order to improve
symptoms.
The cause of schizophrenia are multifactorial and complex. They are not fully
understood. This is the reason, why current treatments focus on managing
symptoms and solving problems associated to day to day functioning. Treatment
options include:
Antipsychotic medications
These medicines are first line choices for treatment of schizophrenia.
They can help decrease the frequency and intensity of psychotic symptoms. These
medicines are usually taken every day in tablet or liquid forms.
Some antipsychotic medicines are available in the form of injections, which are
given once or twice in a month. Injections are more convenient to those patients
who don’t want to take medicines regularly.
There are some patients whose symptoms do not improve with typical antipsychotic
medication. Such patients need a medicine popularly known as clozapine.

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How schizophrenia is diagnosed ?
Patients who are on clozapine must check their routine blood test to detect a
potentially dangerous side effect known as agranulocytosis (In this absolute
neutrophil counts decreases significantly resulting in septicemia). It occurs in 1-2%
of chronic schizophrenic patients.
Schizophrenic patients usually report side effects such as weight gain, dry mouth ,
restlessness, and drowsiness, when they take antipsychotic medications.
Most of side effects fall down over the time, but other side effects remain may
continue. It results some patients to think stopping their antipsychotic medicines.
Abruptly stopping medicines can be dangerous sometimes and it can make
schizophrenic symptoms even more worse.
Patient should not stop taking antipsychotic medication without advice of
psychiatrist.
Shared decision making It is the recommended strategy between doctors and
patients for determining the best type of medicine in combination and the proper
dose.
US Food and drug administration (FDA) site gives the latest information on any
antipsychotic medicine, its uses, side effects, warnings, interactions even any new
drug.

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How schizophrenia is diagnosed ?
Psychological Treatments
There are many psychosocial treatment options available for schizophrenia. Some
examples are cognitive behavioral therapy (CBT), supported employment,
behavioral skills training and cognitive remediation therapy.
These treatments are helpful in negative and cognitive symptoms of schizophrenia.
These psychosocial treatments can also be helpful for teaching and improving
coping skills to tackle the daily challenges of schizophrenia.
These therapies are helpful for the patient to follow their goals in life.
It has been seen that the patient who follow these psychological treatment, they are
least likely to relapse and minimum chance of their hospitalization.
A combination of these psychological therapies and antipsychotic medication is the
best option for schizophrenia.
Role of family support
Family support is the one of the most important part in management of
schizophrenia.

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Educational programmes specially designed for family members give information
about symptoms and treatment of schizophrenia.
It helps in making strategy for fight against schizophrenia. Family members
understand the psychotic symptoms, available treatment options and course of
recovery.
This help in decreasing their distress, encourage coping and enforce their capacity
for fighting against this chronic illness.
One more service known as family based service may also be given on individual
basis. It also includes multi support groups and family workshops.
How schizophrenia is diagnosed ?
Coordinated Specialty Care (CSC) What goes on in the mind of
schizophrenic ?
This treatment modality is a type of recovery oriented treatment specially designed
for the first episode psychosis or early stage in schizophrenia.
A holistic team approach, including all mental health professional is required in this
management. Psychiatrist, Clinical psychologist and psychosocial workers are
included in this team work.
Antipsychotic medicines, psychotherapy, education and employment support, case
management, family education and support are included in this approach.
Patient with schizophrenia with early psychotic symptoms and the entire team
work together to make treatment decisions. Emphasis should be given on the
involvement of family members as much as possible.
Over all, Coordinated specialty care (CSC) is more useful in reducing symptoms,
increasing participation in school and work. It also improves quality of life.
How schizophrenia is diagnosed ?

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How schizophrenia is diagnosed ?
Assertive Community Treatment (ACT)

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The key components of this therapy is a multidisciplinary team that includes a medication
prescriber, a shared caseload among all team members and direct service provision given
by team members
Other important highlight of this therapy are low patient to staff ratios, high incidence of
patient contact and outreach to patients in the community.
This treatment option is especially for those patients with schizophrenia who are at
greater risk for frequent hospitalizations. Also useful for those patient who don’t have any
shelter or home.
Conclusion
I have discussed in detail about this topic How schizophrenia is diagnosed ? Now I
conclude and extract some important points.
Schizophrenia is a severe mental disorder. It has a major impact on the lives of
people. It does not only affects the particular patient but also the people around
them. As a result it is very important to learn to live and love with patients with
schizophrenia.
Family members of the patient need to be tolerant and accepting the symptoms of
this disorder. Psychotic symptoms in schizophrenia will be different from person to
person and may change during course of time over time.
It is very important for family members to know about the signs and symptoms of
this illness. It helps in better understanding of this chronic mental illness.
Patients should be encouraged for taking proper treatment for entire course.
We should be very respectful, kind and supportive without tolerating any
inappropriate or dangerous behavior
Some psychotic symptoms are such that they require immediate emergency
treatment. If any person showing any type of harming behavior or suicidal
tendency, always immediately take the help of psychiatrist.