Abstract
Diagnosis matters as it guides treatment with the goal of improving prognosis. In this chapter, I review how to make a clinical diagnosis of schizophrenia with the help of diagnostic criteria. Diagnostic errors leading to a missed or mistaken diagnosis of schizophrenia are discussed. In addition, this chapter describes the elements of a comprehensive assessment of schizophrenia, beyond the categorical diagnosis of schizophrenia. For treatment goals and outcomes, clinicians need to assess psychotic and nonpsychotic symptom clusters (dimensions of schizophrenia), function, and quality of life. Rating scales can inform and enhance clinical care.
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References
Miller H. The cosmological eye. New York: New Directions; 1939.
World Health Organization. International classification of diseases 11th revision (ICD-11). Available from: https://icd.who.int/en/. Accessed on 7/1/2019.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. Arlington: American Psychiatric Association; 2013.
Freudenreich O, Querques J, Kontos N. Checklist psychiatry’s effect on psychiatric education. Am J Psychiatry. 2004;161:930; author reply 930.
Hyman SE. The diagnosis of mental disorders: the problem of reification. Annu Rev Clin Psychol. 2010;6:155–79.
Keshavan MS, Morris DW, Sweeney JA, Pearlson G, Thaker G, Seidman LJ, et al. A dimensional approach to the psychosis spectrum between bipolar disorder and schizophrenia: the Schizo-Bipolar scale. Schizophr Res. 2011;133:250–4.
Heckers S. Is schizoaffective disorder a useful diagnosis? Curr Psychiatry Rep. 2009;11:332–7.
Kontos N, Freudenreich O, Querques J. Thoughtful diagnoses: not checklist psychiatry [Pearls series]. Curr Psychiatry. 2007;6:112.
Westen D. Prototype diagnosis of psychiatric syndromes. World Psychiatry. 2012;11:16–21.
de Leon J. Is psychiatry only neurology? Or only abnormal psychology? Deja vu after 100 years. Acta Neuropsychiatr. 2015;27:69–81.
Tiemstra J. The poor historian. Acad Med. 2009;84:723.
Gara MA, Minsky S, Silverstein SM, Miskimen T, Strakowski SM. A naturalistic study of racial disparities in diagnoses at an outpatient behavioral health clinic. Psychiatr Serv. 2019;70:130–4.
Verdoux H, van Os J. Psychotic symptoms in non-clinical populations and the continuum of psychosis. Schizophr Res. 2002;54:59–65.
Shapiro D. Neurotic styles. New York: Basic Books; 1965.
Scotti-Muzzi E, Saide OL. Schizo-obsessive spectrum disorders: an update. CNS Spectr. 2017;22:258–72.
Freudenreich O, Viron M, Shtasel D. Serious mental illness. In: Stern TA, Fava M, Wilens TE, Rosenbaum JF, editors. Massachusetts general hospital comprehensive clinical psychiatry. 2nd ed. London: Elsevier; 2016. p. 703–8.
Lambert M, Naber D, Schacht A, Wagner T, Hundemer HP, Karow A, et al. Rates and predictors of remission and recovery during 3 years in 392 never-treated patients with schizophrenia. Acta Psychiatr Scand. 2008;118:220–9.
McGlashan TH, Fenton WS. Classical subtypes for schizophrenia: literature review for DSM-IV. Schizophr Bull. 1991;17:609–32.
Overall JE, Gorham DR. The brief psychiatric rating scale. Psychol Rep. 1962;10:799–812.
Freudenreich O. Schizophrenia? Target 6 symptom clusters [Pearls series]. Curr Psychiatry. 2009;8:74.
Goldman HH. Do you walk to school, or do you carry your lunch? [editorial]. Psychiatr Serv. 2005;56:419.
World Health Organization. WHO disability assessment schedule 2.0 (WHODAS 2.0). Available from: https://www.who.int/classifications/icf/whodasii/en/. Accessed on 7/1/2019.
World Health Organization. The World Health Organization Quality of Life (WHOQOL). Available from: https://www.who.int/mental_health/publications/whoqol/en/. Accessed on 7/1/2019.
Boyer L, Lancon C, Baumstarck K, Parola N, Berbis J, Auquier P. Evaluating the impact of a quality of life assessment with feedback to clinicians in patients with schizophrenia: randomised controlled trial. Br J Psychiatry. 2013;202:447–53.
Aboraya A, Nasrallah HA, Elswick DE, Ahmed E, Estephan N, Aboraya D, et al. Measurement-based care in psychiatry-past, present, and future. Innov Clin Neurosci. 2018;15:13–26.
Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–13.
Freudenreich O. Self-rating scales tell you more than the score [Pearls series]. Curr Psychiatry. 2008;7:110.
Additional Resources
Websites
https://www.who.int/mental_health/publications/whoqol/en/ – Good introduction to the importance of quality of life for patient care and how to assess it quickly yet comprehensively, using a rating scale developed by the World Health Organization.
Books
North C, Yutzy S. Goodwin and Guze’s psychiatric diagnosis. 7th ed. New York: Oxford University Press; 2019. – Published originally in 1974, this book (particularly the preface to the first edition which is included in the 7th edition) is a must read for any psychiatrist who wants to critically examine the diagnostic validity of many of our current psychiatric diagnoses. The late Donald Goodwin and Samuel Guze (together with Eli Robins and George Winokur) belonged to an influential group of psychiatrists at the University of Washington in St. Louis that aligned psychiatric diagnosis with medical practice by introducing diagnostic criteria, ultimately resulting in the publication of DSM-III in 1980.
Article
Jansson LB, Parnas J. Competing definitions of schizophrenia: what can be learned from polydiagnostic studies? Schizophr Bull. 2007;33:1178–200. – Read this article to understand the vexing problem of validity of psychiatric diagnosis (and the limitations of our current approach to diagnosing schizophrenia). The issues raised over a decade ago are as pertinent today as they were then.
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Freudenreich, O. (2020). Diagnostic Assessment of Schizophrenia. In: Psychotic Disorders. Current Clinical Psychiatry. Humana, Cham. https://doi.org/10.1007/978-3-030-29450-2_8
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DOI: https://doi.org/10.1007/978-3-030-29450-2_8
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