Schizophrenia is a chronic, severe, and disabling brain disorder. About 1 percent of Americans have this illness. Researchers are developing more effective medications.
Schizophrenia is a chronic, severe, and disabling brain disorder. About 1 percent of Americans have this illness. Researchers are developing more effective medications.
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Schizophrenia is a chronic, severe, and disabling brain disorder. About 1 percent of Americans have this illness. Researchers are developing more effective medications.
Copyright:
Attribution Non-Commercial (BY-NC)
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Download as DOC, PDF, TXT or read online from Scribd
Schizophrenia is a chronic, severe, and person to do things, or warn the person of disabling brain disorder that has affected danger. Sometimes the voices talk to each people throughout history. About 1 percent other. People with schizophrenia may of Americans have this illness. hear voices for a long time before family and People with the disorder may hear voices friends notice the problem. other people don't hear. They may believe Other types of hallucinations include seeing other people are reading their minds, people or objects that are not there, controlling their thoughts, or plotting to harm smelling odors that no one else detects, and them. This can terrify people with the illness feeling things like invisible fingers and make them withdrawn or extremely touching their bodies when no one is near. agitated. Delusions are false beliefs that are not part People with schizophrenia may not make of the person's culture and do not sense when they talk. They may sit for change. The person believes delusions even hours without moving or talking. Sometimes after other people prove that the beliefs people with schizophrenia seem are not true or logical. People with perfectly fine until they talk about what they schizophrenia can have delusions that seem are really thinking. bizarre, such as believing that neighbors can Families and society are affected by control their behavior with magnetic schizophrenia too. Many people with waves. They may also believe that people schizophrenia have difficulty holding a job or on television are directing special caring for themselves, so they rely on messages to them, or that radio stations are others for help. broadcasting their thoughts aloud to Treatment helps relieve many symptoms of others. Sometimes they believe they are schizophrenia, but most people who have someone else, such as a famous historical the disorder cope with symptoms throughout figure. They may have paranoid delusions their lives. However, many people with and believe that others are trying to harm schizophrenia can lead rewarding and them, such as by cheating, harassing, meaningful lives in their communities. poisoning, spying on, or plotting against Researchers are developing more effective them medications and using new research tools or the people they care about. These beliefs to understand the causes of schizophrenia. are called "delusions of persecution." In the years to come, this work may help Thought disorders are unusual or prevent and better treat the illness. dysfunctional ways of thinking. One form of What are the symptoms of thought disorder is called "disorganized schizophrenia? thinking." This is when a person has trouble The symptoms of schizophrenia fall into organizing his or her thoughts or connecting three broad categories: positive symptoms, them logically. They may talk in a negative symptoms, and cognitive garbled way that is hard to understand. symptoms Another form is called "thought blocking." Positive symptoms This is when a person stops speaking Positive symptoms are psychotic behaviors abruptly in the middle of a thought. When not seen in healthy people. People with asked why he or she stopped talking, the positive symptoms often "lose touch" with person may say that it felt as if the thought reality. These symptoms can come and go. had been taken out of his or her head. Sometimes they are severe and at other Finally, a person with a thought disorder times hardly noticeable, depending on might whether the individual is receiving treatment. make up meaningless words, or They include the following: "neologisms." Hallucinations are things a person sees, Movement disorders may appear as hears, smells, or feels that no one else can agitated body movements. A person with a see, hear, smell, or feel. "Voices" are the movement disorder may repeat certain most common type of hallucination in motions over and over. In the other extreme, schizophrenia. Many people with the a person may become catatonic. Catatonia disorder hear voices. The voices may talk to is a state in which a person does not the move and does not respond to others. Schizophrenia rarely occurs in children, but Catatonia is rare today, but it was more awareness of childhood-onset common when treatment for schizophrenia schizophrenia is increasing. was not available. It can be difficult to diagnose schizophrenia "Voices" are the most common type of in teens. This is because the first signs hallucination in schizophrenia. can include a change of friends, a drop in Negative symptoms grades, sleep problems, and irritability -- Negative symptoms are associated with behaviors that are common among teens. A disruptions to normal emotions and combination of factors can predict behaviors. These symptoms are harder to schizophrenia in up to 80 percent of youth recognize as part of the disorder and can who are at high risk of developing the be mistaken for depression or other illness. These factors include isolating conditions. These symptoms include the oneself and withdrawing from others, an following: increase in unusual thoughts and · "Flat affect" (a person's face does not suspicions, and a family history of move or he or she talks in a dull or psychosis. In monotonous voice) young people who develop the disease, this · Lack of pleasure in everyday life stage of the disorder is called the · Lack of ability to begin and sustain planned "prodromal" period. activities Are people with schizophrenia violent? · Speaking little, even when forced to People with schizophrenia are not usually interact. violent. In fact, most violent crimes are not People with negative symptoms need help committed by people with schizophrenia. with everyday tasks. They often neglect However, some symptoms are associated basic personal hygiene. This may make with violence, such as delusions of them seem lazy or unwilling to help persecution. Substance abuse may also themselves, but the problems are symptoms increase caused by the schizophrenia. the chance a person will become violent. If a Cognitive symptoms person with schizophrenia becomes Cognitive symptoms are subtle. Like violent, the violence is usually directed at negative symptoms, cognitive symptoms family members and tends to take place at may home. be difficult to recognize as part of the The risk of violence among people with disorder. Often, they are detected only when schizophrenia is small. But people with the other tests are performed. Cognitive illness attempt suicide much more often than symptoms include the following: others. About 10 percent (especially · Poor "executive functioning" (the ability to young adult males) die by suicide. It is hard understand information and use it to predict which people with to make decisions) schizophrenia are prone to suicide. If you · Trouble focusing or paying attention know someone who talks about or attempts · Problems with "working memory" (the suicide, help him or her find professional ability to use information immediately help right away. after learning it). People with schizophrenia are not usually Cognitive symptoms often make it hard to violent. lead a normal life and earn a living. They What about substance abuse? can cause great emotional distress. Some people who abuse drugs show When does schizophrenia start and who symptoms similar to those of schizophrenia. gets it? Therefore, people with schizophrenia may Schizophrenia affects men and women be mistaken for people who are affected equally. It occurs at similar rates in all ethnic by drugs. Most researchers do not believe groups around the world. Symptoms such as that substance abuse causes hallucinations and delusions usually schizophrenia. However, people who have start between ages 16 and 30. Men tend to schizophrenia are much more likely to experience symptoms a little earlier than have a substance or alcohol abuse problem women. Most of the time, people do not get than the general population. schizophrenia after age 45. Substance abuse can make treatment for associated with an increased risk of schizophrenia less effective. Some drugs, schizophrenia, but that no gene causes the like marijuana and stimulants such as disease by itself. In fact, recent research has amphetamines or cocaine, may make found that people with schizophrenia symptoms worse. In fact, research has tend to have higher rates of rare genetic found increasing evidence of a link between mutations. These genetic differences marijuana and schizophrenia symptoms. In involve hundreds of different genes and addition, people who abuse drugs are less probably disrupt brain development. likely to follow their treatment plan. Other recent studies suggest that Schizophrenia and smoking schizophrenia may result in part when a Addiction to nicotine is the most common certain form of substance abuse in people with gene that is key to making important brain schizophrenia. They are addicted to nicotine chemicals malfunctions. This problem at three times the rate of the general may affect the part of the brain involved in population (75 to 90 percent vs. 25 to 30 developing higher functioning skills. percent). Research into this gene is ongoing, so it is The relationship between smoking and not yet possible to use the genetic schizophrenia is complex. People with information to predict who will develop the schizophrenia seem to be driven to smoke, disease. and researchers are exploring whether Despite this, tests that scan a person's there is a biological basis for this need. In genes can be bought without a prescription addition to its known health hazards, or several studies have found that smoking a health professional's advice. Ads for the may make antipsychotic drugs less tests suggest that with a saliva sample, a effective. company can determine if a client is at risk Quitting smoking may be very difficult for for developing specific diseases, including people with schizophrenia because nicotine schizophrenia. However, scientists don't yet withdrawal may cause their psychotic know all of the gene variations that symptoms to get worse for a while. Quitting contribute to schizophrenia. Those that are strategies that include nicotine replacement known raise the risk only by very small methods may be easier for patients to amounts. Therefore, these "genome scans" handle. Doctors who treat people with are unlikely to provide a complete picture schizophrenia should watch their patients' of a person's risk for developing a mental response to antipsychotic medication disorder like schizophrenia. carefully if the patient decides to start or In addition, it probably takes more than stop genes to cause the disorder. Scientists think smoking. interactions between genes and the What causes schizophrenia? environment are necessary for Experts think schizophrenia is caused by schizophrenia to several factors. develop. Many environmental factors may Genes and environment. Scientists have be involved, such as exposure to viruses long known that schizophrenia runs in or malnutrition before birth, problems during families. The illness occurs in 1 percent of birth, and other not yet known the general population, but it occurs in 10 psychosocial factors. percent of people who have a first-degree Scientists are learning more about brain relative with the disorder, such as a chemistry and its link to schizophrenia. parent, brother, or sister. People who have Different brain chemistry and structure. second-degree relatives (aunts, uncles, Scientists think that an imbalance in grandparents, or cousins) with the disease the complex, interrelated chemical reactions also develop schizophrenia more often of the brain involving the than the general population. The risk is neurotransmitters dopamine and glutamate, highest for an identical twin of a person with and possibly others, plays a role in schizophrenia. He or she has a 40 to 65 schizophrenia. Neurotransmitters are percent chance of developing the disorder. substances that allow brain cells to We inherit our genes from both parents. communicate with each other. Scientists are Scientists believe several genes are learning more about brain chemistry and its link to schizophrenia. One of these medications, clozapine Also, in small ways the brains of people with (Clozaril) is an effective medication that schizophrenia look different than those treats of healthy people. For example, fluid-filled psychotic symptoms, hallucinations, and cavities at the center of the brain, called breaks with reality. But clozapine can ventricles, are larger in some people with sometimes cause a serious problem called schizophrenia. The brains of people with agranulocytosis, which is a loss of the the illness also tend to have less gray white blood cells that help a person fight matter, and some areas of the brain may infection. People who take clozapine must have get their white blood cell counts checked less or more activity. every week or two. This problem and the Studies of brain tissue after death also have cost of blood tests make treatment with revealed differences in the brains of clozapine difficult for many people. But people with schizophrenia. Scientists found clozapine is potentially helpful for people small changes in the distribution or who do not respond to other antipsychotic characteristics of brain cells that likely medications. occurred before birth. Some experts think Other atypical antipsychotics were also problems during brain development before developed. None cause agranulocytosis. birth may lead to faulty connections. The Examples include: problem may not show up in a person until · Risperidone (Risperdal) puberty. The brain undergoes major · Olanzapine (Zyprexa) changes during puberty, and these changes · Quetiapine (Seroquel) could trigger psychotic symptoms. · Ziprasidone (Geodon) Scientists have learned a lot about · Aripiprazole (Abilify) schizophrenia, but more research is needed · Paliperidone (Invega). to When a doctor says it is okay to stop taking help explain how it develops. a medication, it should be gradually Scientists have learned a lot about tapered off, never stopped suddenly. schizophrenia, but more research is needed What are the side effects? to Some people have side effects when they help explain how it develops. start taking these medications. Most side How is schizophrenia treated? effects go away after a few days and often Because the causes of schizophrenia are can be managed successfully. People who still unknown, treatments focus on are taking antipsychotics should not drive eliminating the symptoms of the disease. until they adjust to their new medication. Treatments include antipsychotic Side effects of many antipsychotics include: medications and various psychosocial · Drowsiness treatments. · Dizziness when changing positions Antipsychotic medications · Blurred vision Antipsychotic medications have been · Rapid heartbeat available since the mid-1950's. The older · Sensitivity to the sun types · Skin rashes are called conventional or "typical" · Menstrual problems for women. antipsychotics. Some of the more commonly Atypical antipsychotic medications can used cause major weight gain and changes in a typical medications include: person's metabolism. This may increase a · Chlorpromazine (Thorazine) person's risk of getting diabetes and high · Haloperidol (Haldol) cholesterol. A person's weight, glucose · Perphenazine (Etrafon, Trilafon) levels, and lipid levels should be monitored · Fluphenazine (Prolixin). regularly by a doctor while taking an atypical In the 1990's, new antipsychotic medications antipsychotic medication. were developed. These new Typical antipsychotic medications can cause medications are called second generation, side effects related to physical or "atypical" antipsychotics. movement, such as: · Rigidity · Persistent muscle spasms · Tremors of all the medications that person is taking. · Restlessness. Doctors need to know about prescription Long-term use of typical antipsychotic and over-the-counter medicine, vitamins, medications may lead to a condition called minerals, and herbal supplements. People tardive dyskinesia (TD). TD causes muscle also need to discuss any alcohol or other movements a person can't control. The drug use with their doctor. movements commonly happen around the To find out more about how antipsychotics mouth. TD can range from mild to severe, work, the National Institute of Mental and in some people the problem cannot be Health (NIMH) funded a study called CATIE cured. Sometimes people with TD recover (Clinical Antipsychotic Trials of partially or fully after they stop taking the Intervention Effectiveness). This study medication. compared the effectiveness and side effects TD happens to fewer people who take the of atypical antipsychotics, but some people five antipsychotics used to treat people with may still get TD. People who think that they schizophrenia. In general, the study might have TD should check with their found that the older typical antipsychotic doctor before stopping their medication. perphenazine (Trilafon) worked as well as How are antipsychotics taken and how the newer, atypical medications. But do people respond to them? because people respond differently to Antipsychotics are usually in pill or liquid different form. Some anti-psychotics are shots that medications, it is important that treatments are given once or twice a month. be designed carefully for each person. Symptoms of schizophrenia, such as feeling Psychosocial treatments agitated and having hallucinations, Psychosocial treatments can help people usually go away within days. Symptoms like with schizophrenia who are already delusions usually go away within a few stabilized on antipsychotic medication. weeks. After about six weeks, many people Psychosocial treatments help these patients will see a lot of improvement. deal with the everyday challenges of the However, people respond in different ways illness, such as difficulty with to antipsychotic medications, and no one communication, self-care, work, and forming can tell beforehand how a person will and keeping relationships. Learning and respond. Sometimes a person needs to try using coping mechanisms to address these several medications before finding the right problems allow people with schizophrenia one. Doctors and patients can work to socialize and attend school and work. together to find the best medication or Patients who receive regular psychosocial medication combination, as well as the right treatment also are more likely to keep dose. taking their medication, and they are less Some people may have a relapse -- their likely to have relapses or be hospitalized. A symptoms come back or get worse. Usually, therapist can help patients better understand relapses happen when people stop taking and adjust to living with schizophrenia. their medication, or when they only take it The therapist can provide education about sometimes. Some people stop taking the the disorder, common symptoms or medication because they feel better or they problems patients may experience, and the may feel they don't need it anymore. But no importance of staying on medications. one should stop taking an antipsychotic Illness management skills. People with medication without talking to his or her schizophrenia can take an active role in doctor. When a doctor says it is okay to stop managing their own illness. Once patients taking a medication, it should be gradually learn basic facts about schizophrenia and tapered off, never stopped suddenly. its treatment, they can make informed How do antipsychotics interact with decisions about their care. If they know how other medications? to watch for the early warning signs of Antipsychotics can produce unpleasant or relapse and make a plan to respond, dangerous side effects when taken with patients certain medications. For this reason, all can learn to prevent relapses. Patients can doctors treating a patient need to be aware also use coping skills to deal with persistent symptoms. Integrated treatment for co-occurring perceptions, how to "not listen" to their substance abuse. Substance abuse is voices, and how to manage their symptoms the most common co-occurring disorder in overall. CBT can help reduce the severity of people with schizophrenia. But ordinary symptoms and reduce the risk of relapse. substance abuse treatment programs Self-help groups. Self-help groups for usually do not address this population's people with schizophrenia and their families special are becoming more common. Professional needs. When schizophrenia treatment therapists usually are not involved, but programs and drug treatment programs are group members support and comfort each used together, patients get better results. other. People in self-help groups know that Rehabilitation. Rehabilitation emphasizes others are facing the same problems, which social and vocational training to help can help everyone feel less isolated. The people with schizophrenia function better in networking that takes place in self-help their communities. Because groups can also prompt families to work schizophrenia usually develops in people together to advocate for research and more during the critical career-forming years of hospital and community treatment life (ages 18 to 35), and because the programs. Also, groups may be able to draw disease makes normal thinking and public attention to the discrimination functioning many people with mental illnesses face. difficult, most patients do not receive training Once patients learn basic facts about in the skills needed for a job. schizophrenia and its treatment, they can Rehabilitation programs can include job make counseling and training, money informed decisions about their care. management How can you help a person with counseling, help in learning to use public schizophrenia? transportation, and opportunities to practice People with schizophrenia can get help from communication skills. Rehabilitation professional case managers and programs work well when they include both caregivers at residential or day programs. job However, family members usually are a training and specific therapy designed to patient's primary caregivers. improve cognitive or thinking skills. People with schizophrenia often resist Programs like this help patients hold jobs, treatment. They may not think they need remember important details, and improve help their functioning. because they believe their delusions or Family education. People with hallucinations are real. In these cases, schizophrenia are often discharged from the family hospital and friends may need to take action to keep into the care of their families. So it is their loved one safe. Laws vary from important that family members know as state to state, and it can be difficult to force much a person with a mental disorder into as possible about the disease. With the help treatment or hospitalization. But when a of a therapist, family members can learn person becomes dangerous to himself or coping strategies and problem-solving skills. herself, or to others, family members or In this way the family can help make friends may have to call the police to take sure their loved one sticks with treatment their loved one to the hospital. and stays on his or her medication. Treatment at the hospital. In the Families should learn where to find emergency room, a mental health outpatient and family services. professional Cognitive behavioral therapy. Cognitive will assess the patient and determine behavioral therapy (CBT) is a type of whether a voluntary or involuntary admission psychotherapy that focuses on thinking and is behavior. CBT helps patients with needed. For a person to be admitted symptoms that do not go away even when involuntarily, the law states that the they take medication. The therapist professional must witness psychotic teaches people with schizophrenia how to behavior and hear the person voice test the reality of their thoughts and delusional thoughts. Family and friends can provide responsiveness.[1] It most commonly needed information to help a mental health manifests as auditory hallucinations, professional make a decision. paranoid or After a loved one leaves the hospital. bizarre delusions, or disorganized speech Family and friends can help their loved and thinking with significant social or ones get treatment and take their medication occupational dysfunction. Onset of once they go home. If patients stop symptoms typically occurs in young taking their medication or stop going to adulthood, follow-up appointments, their symptoms with around 1.5% lifetime prevalence of the likely will return. Sometimes symptoms population affected. Diagnosis is based become severe for people who stop their on the patient's self-reported experiences medication and treatment. This is and observed behavior. No laboratory test dangerous, since they may become unable for schizophrenia currently exists. to care Studies suggest that genetics, early for themselves. Some people end up on the environment, neurobiology, psychological street or in jail, where they rarely receive and the kind of help they need. social processes are important contributory Family and friends can also help patients set factors; some recreational and realistic goals and learn to function in prescription drugs appear to cause or the world. Each step toward these goals worsen symptoms. Current psychiatric should be small and taken one at a time. research is focused on the role of The neurobiology, but no single organic cause patient will need support during this time. has been When people with a mental illness are found. As a result of the many possible pressured and criticized, they usually do not combinations of symptoms, there is debate get well. Often, their symptoms may get about whether the diagnosis represents a worse. Telling them when they are doing single disorder or a number of discrete something right is the best way to help syndromes. Despite the etymology of the them move forward. term from the Greek roots skhizein It can be difficult to know how to respond to (σχίζειν, "to split") and phrēn, phren- (φρήν, someone with schizophrenia who makes φρεν-; "mind"), schizophrenia does not strange or clearly false statements. imply a "split mind" and it is not the same as Remember that these beliefs or dissociative identity disorder hallucinations (previously known as multiple personality seem very real to the person. It is not helpful disorder or split personality), a condition to say they are wrong or imaginary. But with which it is often confused in public going along with the delusions is not helpful, perception. either. Instead, calmly say that you see Increased dopamine activity in the things differently. Tell them that you mesolimbic pathway of the brain is acknowledge that everyone has the right to commonly see found in people with schizophrenia. The things his or her own way. In addition, it is mainstay of treatment is antipsychotic important to understand that medication; this type of drug primarily works schizophrenia is a biological illness. Being by suppressing dopamine activity. respectful, supportive, and kind without Dosages of antipsychotics are generally tolerating dangerous or inappropriate lower than in the early decades of their use. behavior is the best way to approach people Psychotherapy, and vocational and social with this disorder. rehabilitation are also important. In more People with schizophrenia can get help from serious cases—where there is risk to self professional case managers and and others—involuntary hospitalization may caregivers at residential or day programs. be necessary, although hospital stays are Schizophrenia (pronounced /ˌskɪtsɵˈfrɛniə/ less frequent and for shorter periods than or /ˌskɪtsɵˈfriːniə/) is a serious mental they were in previous times.[7] illness characterized by a disintegration of The disorder is thought to mainly affect the process of thinking and of emotional cognition, but it also usually contributes to chronic problems with behavior and Schneiderian classification emotion. People with schizophrenia are The term Schizophrenia was coined by likely to Eugen Bleuler have additional (comorbid) conditions, The psychiatrist Kurt Schneider (1887– including major depression and anxiety 1967) listed the forms of psychotic disorders; the lifetime occurrence of symptoms substance abuse is around 40%. Social that he thought distinguished schizophrenia problems, such as long-term unemployment, from other psychotic disorders. These poverty and homelessness, are are called first-rank symptoms or common. Furthermore, the average life Schneider's first-rank symptoms, and they expectancy of people with the disorder is 10 include to 12 years less than those without, due to delusions of being controlled by an external increased physical health problems and a force; the belief that thoughts are being higher suicide rate (about 5%). inserted into or withdrawn from one's Signs and symptoms conscious mind; the belief that one's A person diagnosed with schizophrenia may thoughts experience hallucinations (most are being broadcast to other people; and commonly hearing voices), delusions (often hearing hallucinatory voices that comment bizarre or persecutory in nature), and on one's thoughts or actions or that have a disorganized thinking and speech. The latter conversation with other hallucinated may range from loss of train of thought, voices. Although they have significantly to sentences only loosely connected in contributed to the current diagnostic criteria, meaning, to incoherence known as word the specificity of first-rank symptoms has salad been questioned. A review of the diagnostic in severe cases. There is often an studies conducted between 1970 and 2005 observable pattern of emotional difficulty, for found that these studies allow neither a example lack of responsiveness or reconfirmation nor a rejection of Schneider's motivation. Impairment in social cognition is claims, and suggested that first-rank associated with schizophrenia, as are symptoms be de-emphasized in future symptoms of paranoia, and social isolation revisions of diagnostic systems. commonly occurs. In one uncommon Positive and negative symptoms subtype, the person may be largely mute, Schizophrenia is often described in terms of remain motionless in bizarre postures, or positive and negative (or deficit) exhibit purposeless agitation; these are symptoms. The term positive symptoms signs of catatonia. refers to symptoms that most individuals do Late adolescence and early adulthood are not normally experience but are present in peak years for the onset of schizophrenia. schizophrenia. They include delusions, In 40% of men and 23% of women auditory hallucinations, and thought diagnosed with schizophrenia, the condition disorder, and are typically regarded as arose manifestations of psychosis. Negative before the age of 19.[11] These are critical symptoms are things that are not present in periods in a young adult's social and schizophrenic persons but are normally vocational development. To minimize the found in healthy persons, that is, symptoms developmental disruption associated with that reflect the loss or absence of normal schizophrenia, much work has recently been traits or abilities. Common negative done to identify and treat the prodromal symptoms include flat or blunted affect and (pre-onset) phase of the illness, which has emotion, poverty of speech (alogia), been detected up to 30 months before the inability to experience pleasure (anhedonia), onset of symptoms, but may be present lack of desire to form relationships longer.[12] Those who go on to develop (asociality), and lack of motivation schizophrenia may experience the non- (avolition). Research suggests that negative specific symptoms of social withdrawal, symptoms contribute more to poor quality of irritability and dysphoria in the prodromal life, functional disability, and the burden period,[13] and transient or self-limiting on others than do positive symptoms. psychotic symptoms in the prodromal phase Diagnosis before psychosis becomes apparent.[14] Diagnosis is based on the self-reported one voice participating in a running experiences of the person, and commentary of the patient's actions or of abnormalities hearing two or more voices conversing with in behavior reported by family members, each other, only that symptom is friends or co-workers, followed by a clinical required above. The speech disorganization assessment by a psychiatrist, social worker, criterion is only met if it is severe clinical psychologist, mental health enough to substantially impair nurse or other mental health professional. communication. Psychiatric assessment includes a 2. Social/occupational dysfunction: For a psychiatric history and some form of mental significant portion of the time since status examination. the onset of the disturbance, one or more Standardized criteria major areas of functioning such as The most widely used standardized criteria work, interpersonal relations, or self-care, for diagnosing schizophrenia come from are markedly below the level the American Psychiatric Association's achieved prior to the onset. Diagnostic and Statistical Manual of Mental 3. Duration: Continuous signs of the Disorders, version DSM-IV-TR, and the disturbance persist for at least six months. World Health Organization's International This six-month period must include at least Statistical Classification of Diseases and one month of symptoms (or less, if Related Health Problems, the ICD-10. The symptoms remitted with treatment). latter criteria are typically used in European If signs of disturbance are present for more countries, while the DSM criteria are than a month but less than six months, used in the United States and the rest of the the diagnosis of schizophreniform disorder is world, as well as prevailing in research applied.[5] Psychotic symptoms lasting studies. The ICD-10 criteria put more less than a month may be diagnosed as emphasis on Schneiderian first-rank brief psychotic disorder, and various symptoms, conditions may be classed as psychotic although, in practice, agreement between disorder not otherwise specified. the two systems is high. Schizophrenia cannot be diagnosed if According to the revised fourth edition of the symptoms of mood disorder are Diagnostic and Statistical Manual of substantially Mental Disorders (DSM-IV-TR), to be present (although schizoaffective disorder diagnosed with schizophrenia, three could be diagnosed), or if symptoms of diagnostic pervasive developmental disorder are criteria must be met:[5] present unless prominent delusions or 1. Characteristic symptoms: Two or more hallucinations are also present, or if the of the following, each present for symptoms are the direct physiological result much of the time during a one-month period of a general medical condition or a (or less, if symptoms remitted substance, such as abuse of a drug or with treatment). medication. o Delusions o Hallucinations o Disorganized speech, which is a manifestation of formal thought disorder o Grossly disorganized behavior (e.g. dressing inappropriately, crying frequently) or catatonic behavior o Negative symptoms: Blunted affect (lack or decline in emotional response), alogia (lack or decline in speech), or avolition (lack or decline in motivation) If the delusions are judged to be bizarre, or hallucinations consist of hearing