Schizophrenia: Clinical manifestations, course, assessment, and diagnosis
- Bernard A Fischer, MD
Bernard A Fischer, MD
- Assistant Professor of Psychiatry
- University of Maryland School of Medicine
- Robert W Buchanan, MD
Robert W Buchanan, MD
- Professor of Psychiatry
- University of Maryland School of Medicine
Schizophrenia is a psychiatric disorder involving chronic or recurrent psychosis. It is commonly associated with impairments in social and occupational functioning . It is among the most disabling and economically catastrophic medical disorders, ranked by the World Health Organization as one of the top ten illnesses contributing to the global burden of disease .
Characteristics of schizophrenia typically include positive symptoms such as hallucinations or delusions, disorganized speech, negative symptoms such as a flat affect or poverty of speech, and impairments in cognition including attention, memory and executive functions. A diagnosis of schizophrenia is based on the presence of such symptoms, coupled with social or occupational dysfunction, for at least six months in the absence of another diagnosis that would better account for the presentation.
This topic discusses clinical manifestations, assessment, diagnosis, and course of schizophrenia. The epidemiology and pathogenesis of schizophrenia are discussed separately. Anxiety, depression, and substance abuse in schizophrenia are discussed separately. The treatments for schizophrenia are discussed separately, as are other psychotic disorders. (See "Schizophrenia: Epidemiology and pathogenesis" and "Depression in schizophrenia" and "Anxiety in schizophrenia" and "Pharmacotherapy for schizophrenia: Acute and maintenance phase treatment" and "Pharmacotherapy for schizophrenia: Side effect management" and "Co-occurring schizophrenia and substance use disorder: Epidemiology, pathogenesis, clinical manifestations, course, assessment and diagnosis" and "First-generation antipsychotic medications: Pharmacology, administration, and comparative side effects" and "Second-generation antipsychotic medications: Pharmacology, administration, and side effects" and "Psychosocial interventions for schizophrenia" and "Psychosocial interventions for severe mental illness" and "Clinical manifestations, differential diagnosis, and initial management of psychosis in adults".)
Schizophrenia is a syndrome. People with schizophrenia generally present with several symptom domains (ie, areas of distinct psychopathology):
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- CLINICAL MANIFESTATIONS
- Positive symptoms
- - Hallucinations
- - Delusions
- - Disorganization
- Negative symptoms
- - Deficit schizophrenia
- Cognitive impairment
- Mood and anxiety symptoms
- Associated physical manifestations
- - Neurological disturbances
- - Catatonia
- - Metabolic disturbances
- Specifiers for schizophrenia in DSM-5
- Differential diagnosis
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS