Fast Five Quiz: Schizophrenia Presentation and Diagnosis

Stephen Soreff, MD


April 13, 2021

In making the psychiatric diagnosis, the key method is not only to obtain a complete social and psychiatric history but also to perform a comprehensive mental status examination. Throughout this examination, patients with schizophrenia are typically oriented to person, time, and place. They may exhibit feelings of suspicion and social awkwardness, express odd beliefs, and demonstrate thought blocking (ie, a long pause before answering a clinician's question). In addition, patients may also exhibit looseness of associations, so clinicians may have difficulty following their train of thought during the interview. Schizophrenia has been called a "thought disorder." This means that individuals have trouble organizing their thoughts and presenting them coherently.

Patients with schizophrenia often exhibit a flat affect. Schizophrenia is a split between affect (emotion) and the thought content. For instance, a patient might describe a frightening delusion with a flat affect. While affect in patients with schizoaffective disorder can range from appropriate to flat, ongoing reevaluation over the course of the illness is important for confirming the diagnosis. Schizoaffective disorder should be considered when a patient exhibits features of both schizophrenia and a mood disorder but does not strictly meet diagnostic criteria for either one.

Prior to initiation of treatment, some patients with schizophrenia demonstrate motor disturbances, including catatonic symptoms, irregular muscle contractions, facial fibrillations, and tremors. Although findings from the general physical examination of patients with schizophrenia are usually noncontributory, it is still an essential part of the workup to rule out other conditions and disorders.

Learn more about the workup and examination findings for schizophrenia.


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