Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
To diagnose schizophrenia, one has first to rule out any medical illness that may be the actual cause of the behavioral changes. Once medical causes have been looked for and not found, a psychotic illness such as schizophrenia could be considered. The diagnosis will best be made by a licensed mental health professional (preferably a psychiatrist) who can evaluate the patient and carefully sort through a variety of mental illnesses that might look alike at the initial examination.
The physician will examine someone in whom schizophrenia is suspected either in an office or in the emergency department. The physician's role is to ensure that the patient doesn't have any medical problems, including active drug use, since those conditions can mimic the symptoms of schizophrenia. The doctor takes the patient's history and performs a physical examination. Laboratory and other tests, sometimes including a computerized tomography (CT) scan of the brain, are performed. Physical findings can relate to the symptoms associated with schizophrenia or to the medications the person may be taking.
People with schizophrenia can exhibit signs of mild confusion or clumsiness.
Subtle minor physical features, such as highly arched palate or wide or narrow set eyes, have been described, but none of these findings alone allow the physician to make the diagnosis.
Generally, results are normal in schizophrenia for the lab tests and imaging studies available to most doctors. If the person has a particular behavior as part of their mental disorder, such as drinking too much water, then this might show as a metabolic abnormality in the person's laboratory results. Other medication risks include the triggering of a decreased immune response, reflected by a low number of white blood cells in the blood. Likewise, in people with neuroleptic malignant syndrome (NMS), metabolism may be abnormal.
Family members or friends of the person with schizophrenia can help by giving the doctor a detailed history and information about the patient, including behavioral changes, previous level of social functioning, history of mental illness in the family, past medical and psychiatric problems, medications, and allergies (to foods and medications), as well as the person's previous physicians and psychiatrists. A history of hospitalizations is also helpful so that old records at these facilities might be obtained and reviewed.