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Schizophrenia is a serious mental health condition that is treatable with the right medication. But it but can be hard to diagnose correctly. In fact, misdiagnosis can be common. The good news is that with more information, affected individuals and families can get a correct diagnosis….
Why a Correct Diagnosis Is Key But Often Elusive
When an individual experiences distressing symptoms, such as hearing voices or being unable to put together a sentence, they and their doctor both want the disorder diagnosed as quickly as possible so that treatment can begin. Unfortunately, all too often, this eagerness results in an incorrect diagnosis.
In 2019, a small study was conducted on those who were referred to Johns Hopkins Early Psychosis Intervention Clinic for treatment for schizophrenia. Researchers discovered that about half of those who were referred with a schizophrenia diagnosis didn’t actually have this condition. In most cases, those who were misdiagnosed with schizophrenia had symptoms of anxiety.
According to Russell L. Margolis, MD, the clinical director of the Johns Hopkins Schizophrenia Center at the Johns Hopkins University School of Medicine and the author of the study, these patients were likely misdiagnosed as a result of “checklist psychiatry.” In other words, a patient may describe their symptoms to their primary care doctor, and based on that, the doctor makes a diagnosis to get the ball rolling on a treatment plan.
The reality is that correctly diagnosing a mental health generally requires more than checking symptoms off of a list. Many disorders have symptoms in common and in some cases, drug addiction can masquerade as a mental disorder. Basing a diagnosis off of a couple symptoms that are commonly associated with schizophrenia, such as auditory hallucinations, can result in ineffective treatment.
According to Margolis, “Hearing voices is a symptom of many different conditions, and sometimes it is just a fleeting phenomenon with little significance. At other times when someone reports ‘hearing voices’ it may be a general statement of distress rather than the literal experience of hearing a voice. The key point is that hearing voices on its own doesn’t mean a diagnosis of schizophrenia.”
Generally speaking, the first step for someone wanting to know how to deal with a schizophrenic problem and get a correct diagnosis is to set up a consultation with a mental health professional who specializes in treating complex disorders like schizophrenia.
How Is Schizophrenia Diagnosed?
Diagnosing schizophrenia includes outlining all of the individual’s symptoms and making sure that these symptoms aren’t due to a medical condition, substance abuse, or a side effect from the medication. This typically involves:
- Psychiatric evaluation. A primary care physician or mental health professional conducts an evaluation of the individual’s mental status by observing their appearance and behavior and asking questions about their moods, delusions, hallucinations, and whether they’re taking any prescription or recreational drugs. Some mental health disorders like schizophrenia tend to run in families, so the individual may also be asked about personal and family medical history.
- Physical exam. A physical exam is conducted to further rule out other medical conditions and pinpoint any co-occurring disorders.
- Screenings. These may include imaging studies such as a CT scan or an MRI to identify brain abnormalities. The doctor may also screen for drugs and alcohol and conduct other tests to make sure that the symptoms aren’t caused by a similar mental health disorder.
- Diagnostic criteria. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines information and guidelines for treatment for recognized disorders and is the standard for diagnosing a wide array of mental health disorders, including schizophrenia. A doctor or mental health care professional may consult this manual to see if their patient’s symptoms align with the symptoms for a given disorder.
Why Is Schizophrenia Misdiagnosed?
To be diagnosed with schizophrenia, an individual has to have at least two of these symptoms, at least one of which has to be among the top three:
- Delusions
- Hallucinations
- Disorganized speech
- Disorganized or catatonic behavior
- Other negative behaviors such as limited or no changes in tone of voice or facial expressions, a lack of personal hygiene, or a lack of motivation to participate in recreational activities
While these symptoms are tell-tale signs of schizophrenia, they are also associated with a broad range of other disorders. Hallucinations, for example, are considered by many to be the most prominent symptom of schizophrenia. However, they may also occur with migraines, brain tumors, epilepsy, PTSD, sleep disorders, and drug use. Disorganized speech may be linked to anxiety, depression, a traumatic brain injury, or a mood disorder. Depression may be connected to a lack of personal hygiene or motivation to engage with once-enjoyed activities. Nutritional deficiencies, metabolic disorders, hyperthyroidism, and even allergies can all mimic schizophrenia.
Because schizophrenia’s most common symptoms are also associated with a myriad of other conditions, this disorder is commonly misdiagnosed. Oftentimes, this condition is diagnosed by a general practitioner who doesn’t specialize in identifying and treating mental illnesses. Unfortunately, a regular primary care visit generally doesn’t allow for enough time to properly assess an individual’s condition. Early diagnosis and treatment are important for avoiding serious long-term complications, so general health practitioners may jump the gun and diagnose their patient’s condition based on a few symptoms, without fully exploring their root cause.
Self-diagnosing schizophrenia is even more challenging. Some of the characteristics of schizophrenia, as well as disorders that mimic it, are poor insight, delusions, hallucinations and difficulty with thought processes. These can all cloud the individual’s judgment and make them unable to accurately evaluate their own mental status.
An Incorrect Diagnosis Leads to Ineffective Treatment
Treatment for schizophrenia typically involves interventions like social skill training, individual and family therapy, and vocational rehabilitation, along with powerful antipsychotic medications. Unless a correct diagnosis was made, the treatment won’t work and may even end up causing significant harm. At best, the individual may end up living with an illness that never clears. At worse, they may have to endure serious side effects from the medication or display suicidal or even homicidal behavior.
Getting a Second Opinion at FHE
Thanks to modern research and technology, we’ve developed a wide variety of therapies to treat serious mental illnesses such as depression, anxiety, bipolar disorder, and schizophrenia. Today’s treatments are tailored specifically for the conditions that they’re addressing, so a proper diagnosis is essential for effective treatment.
Schizophrenia is commonly misdiagnosed by primary care doctors who don’t specialize in working with clients with schizophrenia. After an initial diagnosis, it’s important to get a second opinion at a specialized schizophrenia clinic to cut down on the risk of misdiagnosis and ensure appropriate treatment.
While there’s no cure for schizophrenia at this time, a normal, productive life is possible with treatment. At FHE, we diagnose schizophrenia through a comprehensive psychiatric evaluation to develop the best treatment. Through treatment, we provide clients with the tools and educational resources to achieve the quality of life that they’re seeking. To learn more about our treatment for schizophrenia, click here or call us at (844) 647-7458.
