Schizophrenia

Last reviewed: 6 Nov 2022
Last updated: 08 Oct 2019

Summary

Definition

History and exam

Key diagnostic factors

  • auditory hallucinations
  • delusions
  • avolition
  • anhedonia
  • asocial behavior
  • affective blunting
  • alogia
  • cognitive deficits
  • somatization
More key diagnostic factors

Other diagnostic factors

  • bizarre or disorganized/catatonic behavior
  • tangentiality and looseness of association (derailment)
  • circumstantiality
  • pressured speech
  • distractible speech
  • depression
  • suicidality
  • anxiety
  • elation
  • incongruent affect
  • verbigeration
  • perseveration
  • word salad
  • derealization
  • nonauditory hallucinations
  • déjà-vu
  • stilted goal-directed behaviors
  • catatonic symptoms
  • "soft" neurologic deficits
Other diagnostic factors

Risk factors

  • family history of schizophrenia
  • increasing paternal age
  • obstetric complications
  • cannabis use
  • low IQ
  • motor dysfunction
  • psychological stress
  • childhood abuse
  • birth in late winter/early spring season
  • cooler climate
  • migrant status
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
More 1st investigations to order

Investigations to consider

  • CT/MRI head
  • serum HIV enzyme-linked immunosorbent assay
  • serum rapid plasma reagin (RPR) test
  • CBC
  • urine drug screen
  • plasma drug level monitoring
More investigations to consider

Treatment algorithm

INITIAL

at risk of developing psychosis

ACUTE

acute psychotic episode

ONGOING

chronic symptoms

Contributors

Authors

Adrian Preda, MD
Adrian Preda

Professor of Clinical Psychiatry

Department of Psychiatry and Human Behavior

University of California, Irvine School of Medicine

Irvine

CA

Disclosures

AP declares that he has no competing interests.

Robert G. Bota, MD
Robert G. Bota

Health Sciences Clinical Professor of Psychiatry

University of California

Irvine

CA

Disclosures

RGB declares that he has no competing interests.

Peer reviewers

David Taylor, PhD

Chief Pharmacist

South London and Maudsley NHS Foundation Trust

London

UK

Disclosures

DT declares that he has no competing interests.

Joel Yager, MD

Professor

Department of Psychiatry

University of New Mexico School of Medicine

Albuquerque

NM

Disclosures

JY declares that he has no competing interests.

Kemal Sagduyu, MD

Professor of Psychiatry

University of Missouri Kansas City

Kansas City

MO

Disclosures

KS declares that he has no competing interests.

  • Differentials

    • Schizoaffective disorder
    • Substance-induced psychotic disorder
    • Dementia with psychosis
    More Differentials
  • Guidelines

    • Guidelines for biological treatment of schizophrenia - a short version for primary care
    • Psychosis and schizophrenia in children and young people: recognition and management
    More Guidelines
  • Patient leaflets

    Schizophrenia: what is it?

    Schizophrenia: what treatments work?

    More Patient leaflets
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