Schizophrenia

Abstract

Schizophrenia is a complex, heterogeneous disorder for which an accurate diagnosis is critical to the provision of appropriate information and treatment recommendations to individuals and their family members. Unlike most disorders in medicine, the symptoms of schizophrenia cannot be linked to a specific pathophysiological mechanism, and must be assessed solely on the basis of observations, verbal reports, and inferences. Thus, patient self-report is central to making a diagnosis. However, for various reasons, individuals with schizophrenia may have difficulty describing their experiences. This difficulty may be due to the direct effects of symptoms but can also be compounded by poor insight and cognitive impairment. Additionally, high rates of substance use, mood symptoms, and traumatic experiences in this population can complicate self-reporting and the differentiation of schizophrenia symptoms from these other factors. In this chapter, we will describe these challenges in detail and offer strategies to address them in the context of clinical and diagnostic interviews. We outline procedures for gathering information, present case illustrations, discuss the impact of race, culture, diversity, and age on assessment and diagnosis, summarize the information critical for making a diagnosis, and conclude by presenting suggestions for the “dos and don’ts” of conducting diagnostic interviews with individuals who are believed to have schizophrenia