Understanding Schizophrenia On A Spectrum-Diagnosis, Treatment & Management

A Quick Guide

The Diagnostic and Statistical Manual (DSM-V) was updated by the American Psychiatric Association in 2013 to reflect the growing consensus that schizophrenia is one of a spectrum of psychotic disorders. Different forms and intensities of schizophrenia symptoms can be present. That is more truly reflected in the change. A little over ten years ago, schizophrenia was the only term used to describe patients with a schizophrenia spectrum disorder. The name of the disease category was altered by the American Psychiatric Association in 2013 to reflect the fact that symptoms can manifest themselves in a variety of ways and to differing degrees.

The fifth Diagnostic and Statistical Manual of Mental Disorders (DSM-V) of the APA formally adopted this change and renamed the disease category as “schizophrenia spectrum and other psychotic disorders.”

Today, schizophrenia is a distinct condition and a component of a spectrum of disorders connected to a larger family of psychotic disorders. Though theories are continually developing, it is important to remember that, prior to the DSM-V, there were five distinct categories (or subtypes) of schizophrenia based on the symptoms they presented: residual, paranoid, catatonic, undifferentiated, and disorganized. These diagnostic categories are no longer in use.

What Is Schizophrenia?

Schizophrenia is a severe and persistent mental illness that impairs a person’s capacity for rational thought, reality judgment, emotional control, interpersonal interaction, and cognitive performance.

There are three primary groups of schizophrenia symptoms.

Positive Symptoms (Psychotic Symptoms)

Positive symptoms reveal elements that should not be present, such as:

• Delusions: Incorrect beliefs that persist even when a person is shown evidence that contradicts them. Severe paranoia or irrational anxieties may appear as a result of this.
• Hallucinations: Perceiving imaginary sounds, sights, tastes, smells, or sensations through touch.
• Thought disorder: Strange thinking or disorganized speech.

Negative Symptoms

On the other side, negative symptoms are traits that ought to exist but do not. These could consist of:

• A drop in motivation
• Inability to express feelings.
• Keeping to oneself and speaking less in public.
• Lack of enthusiasm or interest in regular activities.
• Planning, starting, and maintaining activities with difficulty.
• Putting on “a flat affect” (problem expressing feelings using facial expression or voice tone).

Cognitive Symptoms

These include issues with focus, memory, and attention, such as:

• Having trouble applying knowledge right away after learning it.
• inability to concentrate or pay attention.
• Issues with information processing are needed to make judgments.

These symptoms will be assessed by a medical professional or mental health specialist to help determine whether schizophrenia or another psychotic disorder is present.

Diagnosis

The American Psychiatric Association has published a reference book called the DSM-5 as discussed before. It outlines the requirements that must be satisfied for a diagnosis of a particular disorder and is regarded as the gold standard in the diagnosis of mental health conditions.

Usually, a schizophrenia diagnosis is obtained following the first psychotic episode. According to the DSM-5 criteria, a person must exhibit at least two of the symptoms listed below (at least one of which must be among the top three) throughout time in order to be diagnosed:

• Delusions.
• Hallucinations.
• Disorganized speech.
• Catatonic or disorganized behavior.
• Negative symptoms.

There should also be a decreased degree of functioning in the areas of employment, interpersonal relationships, or self-care.

Diagnosing Schizophrenia With Other Factors

The symptoms of schizophrenia are comparable to those of other diseases. To evaluate if a person has schizophrenia specifically, certain conditions must be considered and ruled out.

Other Conditions on the Schizophrenia Spectrum

Only one condition on the spectrum, schizophrenia, exists. Schizophrenia may resemble other similar disorders, but a qualified mental health expert should be able to tell them apart. Here is a brief overview:

Schizophreniform Disorder

Schizophreniform disorder and schizophrenia are quite similar; the key distinction is the length of the symptoms. This condition is the most likely diagnosis if a person exhibits psychosis, delusions, disordered thinking, and improper behaviors for longer than one month but less than six months. The basis of treatment is antipsychotics and psychosocial care (cognitive behavioral therapy, family support, and social skills training). Medication is gradually taken off as patients get well.

Schizoaffective Disorder

Combined with their other schizophrenia symptoms, people with schizoaffective disorder also have depressive symptoms. Both psychotherapy and medication are effective treatments for the disease.

Brief Psychotic Disorder

According to the DSM-V, this disease is marked by one or more of the following symptoms: hallucinations, delusions, and slurred speech, as well as the possibility of “grossly disorganized or catatonic behavior.” Antipsychotics are the first-line treatment for the illness, which normally lasts no longer than a month.

Delusional Disorder

Individuals with this disorder have at least one delusion for a month or more. People with this condition can function and behave more or less normally, save from experiencing one or more delusions. Delusions that are accompanied by mood problems are often temporary.

Schizotypal personality disorder

Schizotypal personality disorder symptoms can resemble schizophrenia symptoms, however, they are less severe and intrusive. Some symptoms include:

• Being aloof or reserved.
• Disorganized perception and thought.
• Having a strong aversion to intimacy or proximity.
• Inadequate communication abilities.

Shared psychotic disorder

The DSM-5 no longer recognizes shared psychotic disorder, sometimes known as folie à deux. But given that it has been used in therapeutic settings for a considerable amount of time, it is classified here. This rare disease develops when two or more people in a somewhat close relationship share a delusion. On the basis of the incorrect belief, one individual with delusions affects the other.  Although commonly observed in pairs, it can also impact larger groups.

Psychotic disorder from a general medical condition

In this disease, psychotic symptoms coexist with persistent or temporary sickness. The symptoms occur independently of delirium and are not caused by drug use or withdrawal.

According to doctors, this occurs because of alterations in brain function brought on by illnesses like:

• Autoimmune diseases.
• Epilepsy.
• Multiple sclerosis.
• Stroke.
• Thyroid disease.

Depending on the underlying medical problem, your treatment will vary. The symptoms normally stop when the condition is treated.

Substance-induced psychotic disorder

It may be a case of substance-induced psychotic disorder if psychotic symptoms are brought on by prescription medication, illicit substances, or alcohol.

If they misuse substances or go through withdrawal from substances, people with a mental health issue with a diagnosis or those who are predisposed to psychosis are more likely to suffer this.

These signs include:

• Absence of speech.
• Delusions or hallucinations.
• False beliefs of persecution.
• Hostile behavior.
• Lower emotional intensity.
• Poor judgment.
• Strange or unconventional beliefs.

What distinguishes schizophrenia from psychosis?

The term “psychosis” refers to a group of symptoms that demonstrate a lack of real awareness. There are numerous potential causes of psychosis, including:

• Mental health issues.
• Other medical conditions.
• Substance abuse.

One of the psychotic illnesses is schizophrenia. These are mental health conditions that may occasionally result in psychosis.

Psychosis is only one symptom of schizophrenia; there may be others as well, including:

• Incoherent thinking.
• Speech and movement problems.
• Variations in emotional response, such as flat affect.

How are schizophrenia and psychosis related?

A person with schizophrenia may go through psychotic episodes. They might experience delusions and hallucinations at this time. Positive symptoms are another name for the psychotic signs and symptoms of schizophrenia.

Antipsychotic drugs are used to treat severe psychotic episodes in schizophrenia patients. Additionally, these drugs can be taken as maintenance drugs to aid in preventing the recurrence of symptoms.

Sometimes a psychotic episode is followed by a schizophrenia diagnosis. However, there are certain additional symptoms and particular diagnostic requirements for schizophrenia.

Psychosis can occur in someone who does not already have schizophrenia or another mental illness. Substance abuse, certain illnesses, and drugs are only a few causes of psychosis.

Other related conditions

Other illnesses can occasionally coexist with or mimic schizophrenia. In order to receive the right treatment, a proper diagnosis is crucial. These additional conditions may consist of:

• Autism spectrum disorder.
• Bipolar disorder with psychotic or catatonic features.
• Brain tumors.
• Cushing’s syndrome.
• Delirium.
• Dementia.
• Lupus.
• Major depressive disorder.
• Obsessive-compulsive disorder (OCD).
• Porphyria.
• Post-traumatic stress disorder (PTSD).
• Substance use disorders.
• Temporal lobe epilepsy.
• Thyroid disorder.
• Vitamin B12 deficiency.
• Wilson’s disease.

In certain research, it was found that people with schizophrenia spectrum disorders had higher levels of autistic traits than people without such diseases, but lower levels of such traits than people with autism.

Treating schizophrenia spectrum disorders

Depending on the particular disease, there are many ways to treat schizophrenia spectrum disorders. The majority of instances may not be curable, but they can be managed and treated. Only psychotic disorders caused by medical conditions are an exception to this rule. In this scenario, treating the underlying medical problem reduces the psychotic symptoms.

Treatment options include:

• Antipsychotic medications.
• Education.
• Psychotherapy, such as supportive therapy or cognitive behavioral therapy.
• Self-management strategies.

Managing Schizophrenia Spectrum Disorders

The normal approach to treating schizophrenia involves working together with the patient, their friends and family, medical professionals, mental health specialists, and community supporters.

There are methods to make living with schizophrenia more tolerable in addition to official treatment involving medications and therapies.

A person with schizophrenia can engage in the following lifestyle choices:

• Consuming a nutritious, balanced diet.
• Exercising on a regular basis.
• Having a regular sleep schedule and getting enough sleep.
• Interacting with friends and family.
• Practicing strategies and exercises for relaxation and awareness.
• Reducing or stopping one’s use of other drugs, alcohol, and cigarettes.
• Taking part in stress-relieving healthy activities they enjoy.

Those close to a loved one who has schizophrenia can support them by:

• Assist them in creating a crisis plan.
• Assisting them in finding and beginning treatment.
• Finding local or online support groups that the person and their loved ones can benefit from.
• Maintain contact.
• Motivating them to continue their treatment.
• Setting and enforcing limits while being respectful, helpful, and kind, especially not accepting risky or improper behavior.

Following are a few crisis hotlines that can offer urgent assistance and support:

• Crisis Text Line by texting HOME to 741741
• National Suicide Prevention Lifeline by calling 1-800-273-8255
• The International Association for Suicide Prevention website for crisis helplines and other resources outside the United States

How to check in?

• Give them a brief call or text to let them know you were thinking of them. 
• If they initiate contact, be encouraging. It makes me happy to hear from you. I appreciate your call!
• Offer the two of you things to do, like going to a movie, going for a stroll, or playing a game.
• Regularly check in, even if it’s only to see if they need anything. Even if they consistently decline your assistance, you shouldn’t stop offering it.

Outlook

Although schizophrenia is a chronic illness, it’s crucial to recognize that our knowledge of the disorder is changing. There are grounds for hope because the sector’s research has increased dramatically over the last 50 years. There will soon be more effective therapies that target symptoms other than psychosis and have fewer adverse effects.

We hope you found this article useful in learning more about how schizophrenia exists on a spectrum along with its symptoms, comorbidities, and how it is diagnosed, treated, and managed.