Schizophrenia

Abstract

Schizophrenia is a complex and confusing illness that can baffle family members, friends, the patient, and mental health professionals alike. Schizophrenia can be contrasted to psychiatric illnesses such as major depression, manic—depression, and anxiety disorders that were described long ago by Hippocrates as common behavioral disturbances. Schizophrenia has been recognized only over the past 100 years as a separate illness with its own unique pattern of onset, symptomatology, course, and treatment. The diagnosis of schizophrenia can be complicated by two important factors: First, the symptoms of the illness overlap with those of many other disorders (e.g., affective disorders, substance abuse), requiring careful attention to issues of differential diagnosis. Second, patient self-report is critical to establishing the diagnosis of schizophrenia, yet many patients deny the characteristic symptoms or are inconsistent in their report of these internal experiences. While there are difficulties inherent in the assessment of schizophrenia, accurate diagnosis has important implications for pharmacological and psychosocial intervention for the disorder. Indeed, misdiagnosis can result in ineffective treatment and a poor outcome. In order to accurately diagnose schizophrenia, the interviewer must possess an adequate fund of knowledge about the psychopathology of the illness, the relative merits of available assessment instruments, interviewing techniques, and methods for obtaining information necessary for the assessment. We begin this chapter with an overview of the nature of schizophrenia, including its prevalence, course, and outcome, followed by a review of its symptomatology and the criteria for its diagnosis.