There isn.t a diagnostic test, which will identify schizophrenia though research has showed some interesting abnormalities in the brain. However, there is not enough research to back up these findings at present. A diagnosis is normally done by a face-to-face doctor evaluation. Doctors will gather as much information as they can to get a picture of the total mental state of the person in question. A diagnosis is rarely given during the first episode of psychosis because there are other mental illnesses such as Bipolar I Disorder, which will also include the classic hallucinations and delusions associated with schizophrenia. It is even more difficult to correctly diagnosis the negative symptoms of schizophrenia such as lack of affect or lack of motivation. These symptoms could also be characteristic of major depression. Often the doctor will wait until a second episode occurs and measure the intensity, the frequency, and the symptoms. The doctor will be looking to rule out other types of mental illness such as organic disorders or substance induced psychosis.

Doctors will rely upon a personal evaluation, family history, emotional history, and medical history including other diagnosed conditions and presenting symptoms to make their final diagnosis.

Though Schizophrenia can appear very similar to Bipolar I Disorder; the changes in the moods from mania to depression do not follow the Bipolar Disorder pattern. There is also Schizoaffective Disorder, which also looks similar to schizophrenia. In schizophrenia the mania stage (such as hallucinations and delusions) can occur in the early, in the active and in the late stages of the disease whereas in Schizoaffective Disorder they occur during the active stage only. These moods must be present for a good period of time during the episode and they must last for at least two weeks. Schizoaffective Disorder has a better prognosis than schizophrenia but still not as good as for a mood disorder such as Bipolar Disorder.

Brief Psychotic Disorder only requires as little as one symptom of hallucination, delusion, thought disorder or flat affect, but it lasts about one month and then it is over. Therefore the doctor will not diagnosis full blown schizophrenia.

Organic Disorders

Organic disorders are brain disorders. They can resemble the symptoms of schizophrenia. For example, the doctor will rule out encephalitis, which can mimic the hallucinations found in schizophrenia. Encephalitis is caused by a virus, which causes swelling in the brain. Delirium can cause mental confusion, hallucinations, incoherent speech, and disorientation. Delirium can be due to many things such as substance abuse, illness, anxiety, and shock. This condition too must be ruled out.

Drug abuse

Certain illicit drugs can bring on the symptoms of schizophrenia such as hallucinations, delusions, bizarre behavior and babbling. Phencyclidine (PCP) or angel dust can cause negative symptoms of schizophrenia, such as an emotionless stupor. The doctor can take blood tests to determine if the symptoms of schizophrenia are really caused by the ingestion of these drugs. The doctors would also observe the patient at times when he or she has abstained from illegal drug use (most likely in a hospital setting) to see if there is a difference.

Also other mental disorders such as Obsessive Compulsive Disorder, Schizoid Personality and Post Traumatic Stress Disorder can resemble schizophrenia when the patient is exhibiting hallucinations, disorganized behavior, paranoia, and delusional thinking.

The diagnosis for schizophrenia is given according to the criteria set out by the American Psychiatric Association and published in The Diagnostic Statistical Manuel (DSM IV).

In order to meet the criteria:

The person must exhibit at least two of the following conditions: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, or presence of negative symptoms.

There is significant impairment to carry on daily living, school, or work.

The symptoms persist for at least six months

Only one symptom is required if the person is suffering from a persistent voice or voices in their head directing their behavior.

There are also five subsets of schizophrenia: Paranoid: Catatonic, Disorganized, Undifferentiated, and Residual.

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