Training of Core Trainers on

Clinical Practice Guidelines (CPG)

Management of Schizophrenia
(Second Edition)

Screening, Diagnosis & Referral

Dr. Ranimah Yahya, Family Medicine Specialist
Dr. Sharifah Nurul Aida Syed Ghazaili, Family Medicine Specialist

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 1.To increase awareness on diagnosis
of schizophrenia
Learning 2.To identify risk factors of
objectives schizophrenia
3.To emphasise early diagnosis &
referral if indicated

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  Introduction
 Risk factor
Outline of  Screening
presentation  Diagnosis
 Referral

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  Schizophrenia is a major psychiatric disorder that alters an
individual’s perception, thought, affect & behaviour.
 Globally schizophrenia was ranked as 11th leading cause of
disability in 2013.1
 Second report of National Mental Health Registry on
Schizophrenia in 2003 to 2005 stated that incidence rate in
Introduction Malaysia is 5 cases/100,000 population/year & expected cases
at about 100 cases/100,000/year.2

1. Global, regional, and national incidence, prevalence, and years lived with disability for
301 acute and chronic diseases and injuries in 188 countries, 1990-2013. Lancet.
2015;386(9995):743-800
2. Aziz AA, et al. Med J Malaysia. 2008;63 Suppl C:15-17

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 1. Family history of schizophrenia
2. Substance-induced psychoses associated with
cannabis, hallucinogens & amphetamines
3. Increasing paternal age
4. Most urban environment

Risk factors 5. Refugee & migrant status

6. History of obstetric complications e.g. pre-eclampsia
& extreme prematurity
7. Prenatal exposure to infection e.g. Herpes Simplex
(HSV-2) & toxoplasma gondii
8. History of childhood central nervous system infection

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 • More evidence is warranted before screening tools for
pre-psychosis in schizophrenia can be recommended.

• Prodromal phase is characterised by impairments in

psychosocial functioning, odd & eccentric behaviour,
poor communication & motivation, blunted or
Screening flattened affect & neglect of personal hygiene.

• People with risk factors in developing schizophrenia &

with prodromal symptoms may require further
assessment to rule out schizophrenia; this may be
repeated if indicated over time.

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 CLINICAL DIAGNOSIS
Diagnostic
Criteria for
Schizophreni - based on DSM 5 &
a (DSM-5) ICD-10

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Diagnostic
Criteria for
Schizophreni
a (DSM-5)-2

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Diagnostic
Criteria for
Schizophreni
a (DSM-5)-3

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Diagnostic
Criteria for
Schizophreni
a (DSM-5)-4

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International
Statistical
Classification
of Diseases
and Related
Health
Problems,
10th Revision
(ICD 10)

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International
Statistical
Classification
of Diseases
and Related
Health
Problems,
10th Revision
(ICD 10)-2

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International
Statistical
Classification
of Diseases
and Related
Health
Problems,
10th Revision
(ICD 10)-3

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Diagnosis

 To date, there is no evidence found on biological assessment for

schizophrenia. Nevertheless, relevant investigations should be
performed if a medical condition is suspected.

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 1. Prodromal or attenuated symptoms
2. Unclear diagnosis
3. Plan for psychosocial rehabilitation
Early 4. Treatment adherence issues
referral to 5. Poor response to treatment
specialist 6. Potential violent behaviour to self or others
care 7. Drug-related complications
8. Co-morbid substance abuse
9. Special groups e.g. pregnancy, paediatric &
geriatric age

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 1. Risk factors for schizophrenia include positive family
history, substance-induced psychosis, increasing
paternal age, history of obstetric complications,
prenatal exposure to infection & childhood central
nervous system infection.
Take Home 2. People with possible schizophrenia should be assessed
Messages thoroughly by history taking, physical examination,
mental state examination & relevant investigation (if
indicated).
3. Schizophrenia is a clinical diagnosis based on DSM 5 &
ICD 10.
4. Early referral to psychiatric service in people with
schizophrenia having diagnostic & treatment issues.

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Thank you

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