Schizophrenia - Interviewing Guidelines
Guideline 7: Differential Diagnosis The symptoms of schizophrenia often overlap with those of many other psychiatric disorders; thus, the presence of other syndromes should be assessed and ruled out before the diagnosis of schizophrenia can be made. Schizoaffective and mood disorders are commonly confused with schizophrenia, because they are mistakenly thought to simply include both psychotic and affective symptoms (i.e., in bipolar disorder and major depressive disorder with psychotic features). But it is not the predominance of the psychotic versus the affective component that determines the diagnosis; rather, it is the timing of psychotic and affective symptoms. If psychotic symptoms and affective symptoms always overlap, the person is diagnosed with an affective disorder, whereas if psychotic symptoms are present some of the time, in the absence of an affective syndrome, the person meets criteria for either schizoaffective disorder or schizophrenia (the former, if the mood symptoms are prolonged). Recent research has revealed high rates of exposure to trauma and posttraumatic stress disorder (PTSD) comorbidity among people with a severe mental illness such as schizophrenia (Switzer et al., 1999). These findings, and the overlap in symptom presentation, make PTSD a highly relevant disorder when assessing schizophrenia. Dissociative or intrusive (reexperiencing) symptoms, such as trauma-related auditory phenomena and flashbacks, may be mistakenly interpreted as schizophrenia, so special attention is required to rule them out.
Schizophrenia Interviewing Guidelines
- Schizophrenia is a severe and complex psychiatric disorder; characteristic - positive and negative - symptoms, as well as other impairments, commonly accompany the disorder.
- Diagnostic interviewing for schizophrenia is facilitated by structured assessment tools.
- There are various challenges in diagnostic interviewing of people with schizophrenia, for which guidelines can be helpful.
- Many of the guidelines for diagnostic interviews of people with schizophrenia address clinical communication skills.
- Differential diagnosis should be given special attention in diagnostic interviews of people with schizophrenia.
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