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How Is Schizophrenia And Depression Diagnosed?

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Posted on Mon, 13 Oct 2014
Question: Hello,

I am thinking to do Masters by Research next year so I want to gather data for my project. The topic of my work is about the diagnosis and treatment of mental illnesses.

I have some questions that I would like you to ask you. Would you be willing to answer them? Thank you very much for your time.
1.     How would you diagnose a patient with schizophrenia/bipolar /depression?

2.     What examination would you conduct in order to diagnose the patient with Bipolar/schizophrenia/depression?

3.     What is the difference between the paranoid syndrome, paranoid depressive syndrome and paranoid schizophrenia? Are they all the same illnesses?

4.     What brain changes would you encounter in person with psychosis /schizophrenia or bipolar?

5.     What is the difference between acute psychosis and schizoaffective disorder?

6.     Why someone can not be diagnosed with psychosis?

7.     Why do the doctors conduct thyroid gland test before diagnosing someone with schizophrenia?

8.     Antipsychotic drugs lower dopamine level. How long does the patient diagnosed with schizophrenia or psychotic episodes have to take them to lower dopamine?

9.     Can someone develop psychosis?

10.     What does it mean that acute psychosis is common name and not a disease?

11.     Why is it said that people who have mental illnesses have memory problems?

12.     What is the reason why mentally ill experience memory problems?

doctor
Answered by Dr. Vipul Prajapati (1 hour later)
Brief Answer:
DSM IV and ICD 10

Detailed Answer:
Hi Dear,

Thank you for your Query.

There are two types of criteria to diagnose any psychiatric illness i.e. DSM IV and ICD 10.

For any psychiatric illness , mental status examination and some psychological test will always helpful.
Paranoid syndrome is only symptom, paranoid depressive syndrome is a one in which paranoid symptoms occur in depression and paranoid schizophrenia is illness in which paranoid symptom is the main symptom.

Anyone can develop psychosis but whose family history is positive has high chance of developing the illness.

Psychiatric illness particularly schizophrenia affects cognition mainly but other psychiatric illness has not much effect on memory like depression affects memory but only temporarily.

If a person is not fulfilling the criteria for particular illness, then it is not diagnosed as psychosis.

Antipsychotic lowers the dopamine level but the duration of treatment depends on duration of illness, improvement on treatment, family history etc..

Thyroid test is sometimes done to rule out it, as in thyroid dysfunction also the causative agent for development of many psychiatric illness.

Acute psychosis and schizo-affective illness both are different as to diagnosis. The duration of illness is different.

Awaiting your response.
Thank you
Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Vipul Prajapati (32 hours later)
Thank you for your response.
     I have already intervened one psychiatrist. According to her in thyroid health problems especially in hyperthyroidism the
paranoid syndrome can occur? Is that correct? Why is that happening?

     Also she claims that acute psychosis is just colloquial name, one off episode and not an illness.
Is that correct? How would you respond to that?
     Why someone can not be diagnosed with psychosis?
If a person is not fulfilling the criteria for particular illness, then it is not diagnosed as psychosis.
In the in literature I have gathered the psychosis is not mental illness per se.
One cannot be diagnosed with psychosis but they can be diagnosed for example with having schizophrenia because:
Is that correct? Would you like to comment on that one?
     .What is the difference between the paranoid syndrome, paranoid depressive syndrome and paranoid schizophrenia? Are they all the same illnesses?
I am assuming that they are three different independent but connected diagnoses? Am I correct?
     What brain changes would you encounter in person with psychosis /schizophrenia or bipolar?
     From your experience as a doctor how long would you medicate a person with diagnosis of acute psychosis/bipolar or schizophrenia to see improvement?
     How effective are haloperidol or olanzapine or clozapine in the above diagnoses to stop the symptoms?
According to literature I gathered it may take 2-3 months before you get the full benefit of haloperidol or olanzapine? What is your position in that matter?
doctor
Answered by Dr. Vipul Prajapati (23 minutes later)
Brief Answer:
consult psychiatrist

Detailed Answer:
Hi dear,

Thyroid dysfunction whether hypothyroid or hyperthyroid it cause psychiatric illness, not necessarily hyperthyroid state.
Thyroid dysfunction mostly cause neurotic illness rather than psychotic illness.
It is the hormonal imbalance which is underlying cause for psychiatric illness.

acute psychosis is mostly occur when there is underlying stressful condition but not necessarily. yes it is a episode which may progress to bipolar illness or schizophrenia in future.
In acute psychosis you need to give anti psychotic medication as ealry as possible and i would prefer to give injections mostly olanzepine or haloperidol.

We can diagnose a person psychosis if he or she fulfill the criteria for a particularly psychotic illness. If a person is not fulfilling the criteria for particular illness, then it is not diagnosed as psychosis but there is other diagnosis and it is depend on symptoms..
Psychosis is a broad terminology, there are many psychiatric illness we called it psychotic illness like brief psychotic reaction, schizophreniform disorder, schizophrenia, schizoaffective disorder, bipolar disorder etc..
So we would likely put a particular diagnosis rather than broad terminology.

yes you are assuming right that they are three different independent but connected diagnoses.
Brain changes would be different in different psychiatric illness like ventricular dilatation, amygdala dysfunction or hypo-function, grey or white matter changes etc...

Duration of Treatment of psychiatric illness depends on duration of illness, response to medication, family history, episode of illness, concomitant illness etc....
For particular medication we have to wait for a month to see whether any improvement or not, if improvement then continue it and if not then add other molecule or change it.

Haloperidol or olanzapine or clozapine All three are has very good result in bipolar and schizophrenia particularly aggressive and irritable patients.
Clozapine is very useful in treatment resistant schizophrenia.

Thank you
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Vipul Prajapati (15 hours later)
Hello,
Thank you for your response.
1. I assume then that someone can not be diagnosed with the expression (term) psychosis because it is a broad terminology. But they can be diagnosed with having schizophrenia, bipolar or other psychotic illness. Correct?
People experience psychosis in the course of psychotic based disorders like schizophrenia but they can not (or it’s unlikely to) receive diagnosis of psychosis. Correct?

“People with schizophrenia experience many symptoms including psychosis”
So psychosis is a symptom like paranoid syndrome is only symptom. And when we think symptom that means there is an underlying issue of this symptom. For example schizophrenia. Am I correct?

So paranoid syndrome may be a symptom for example of hyperthyroidism.Correct?
“The psychiatric disturbances which accompany hyperthyroidism or hypothyrodism MIMIC mental illness for example (it can mimic schizophrenia)”. How would you comment on that one?

2.”Unfortunately psychiatric diagnosis is not an exact science” How would you respond to that statement?
3. Why is vitamin b12 deficiency associated with psychotic disorders?
4. Why there is an association between schizophrenia and autoimmune diseases?
5.I would also think that the thinking process of people with psychotic disorders is disorganized? Correct?
6. “Schizophrenia is unfortunately a brain disease”.Correct? XXXXXXX XXXXXXX psychiatrist:
“psychiatrists prescribe medications to treat symptoms rather than correcting known biological abnormalities, our understanding of the neurobiology of psychiatric symptoms is limited, and there are not objective biomarkers to guide diagnosis or to match individual patients with particular drugs”
Psychiatric diagnoses are based on symptoms rather than pathophysiology, our treatments are insufficiently effective, newer medications have provided limited (if any) benefit over older medications, the pharmaceutical industry has had inappropriate relationships with individuals and organizations within our profession, there are problems in access to psychosocial treatments for psychiatric disorders.
Any comments on the above?

Thank you very much for all your help.I really appreciate all your help.
doctor
Answered by Dr. Vipul Prajapati (18 minutes later)
Brief Answer:
Consult psychiatrist

Detailed Answer:
Hi dear,

Yes you are right that psychosis is a broad terminology, but they can be diagnosed with having schizophrenia, bipolar or other psychotic illness.

Psychosis is the category rather than symptom, and schizophrenia, bipolar etc are psychotic disorder.

Yes, paranoid syndrome may be a symptom for example of hyperthyroidism.

The psychiatric disturbances which accompany hyperthyroidism or hypothyroidism actually cause psychiatric illness.It does not mimic and for that you have to take psychiatric medication.

Psychiatric diagnosis is exact science and its diagnosis depends on specific criteria as i already mentioned.

Vitamin b12 deficiency is associated with psychotic disorders because it is involved in major CNS pathways.

Autoimmune diseases is long term illness so due to that person comes in frustration so due to that neurotransmitter changes occur and result in psychiatric illness, and in some auto immune disorder affects brain itself so changes occur in neurotransmitters.

Thinking process of people with psychotic disorders is not always disorganized sometimes it is disorganized particularly disorganized schizophrenia.

Schizophrenia is a brain disease but not structural but neurotransmitter imbalance is there..

Now a days psychiatric research is on psychopathology more and towards psycho social intervention where it has significant impact.
but where there is biological abnormalities is there one have to balance that abnormalities.

Thank you


Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
doctor
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Follow up: Dr. Vipul Prajapati (1 hour later)
Thank you.

So the most important are in fact neurotransmitters, their imbalance and
the excessive amount of dopamine; that‘s the reason why it is said that the antipsychotic drugs are effective .Correct?

And patients need to take antipsychotic drugs for a long period of time in order to see improvement. Correct?

Can I quote you as an expert in the field in my research?

doctor
Answered by Dr. Vipul Prajapati (3 hours later)
Brief Answer:
Yes it is all about neurotransmitter imbalance

Detailed Answer:
Hi dear,

yes it is all about neurotransmitter imbalance.
That is the reason why anti psychotic medication is needed.

Sometimes anti psychotic medication has its effect with in a week and sometimes its take 1 month also.

Yes, you can quote me as an expert in your research if you feel .

Wish you best luck for your research. Please close our discussion now and rate my answer.
Thank you.
Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Vipul Prajapati

Psychiatrist

Practicing since :2009

Answered : 849 Questions

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How Is Schizophrenia And Depression Diagnosed?

Brief Answer: DSM IV and ICD 10 Detailed Answer: Hi Dear, Thank you for your Query. There are two types of criteria to diagnose any psychiatric illness i.e. DSM IV and ICD 10. For any psychiatric illness , mental status examination and some psychological test will always helpful. Paranoid syndrome is only symptom, paranoid depressive syndrome is a one in which paranoid symptoms occur in depression and paranoid schizophrenia is illness in which paranoid symptom is the main symptom. Anyone can develop psychosis but whose family history is positive has high chance of developing the illness. Psychiatric illness particularly schizophrenia affects cognition mainly but other psychiatric illness has not much effect on memory like depression affects memory but only temporarily. If a person is not fulfilling the criteria for particular illness, then it is not diagnosed as psychosis. Antipsychotic lowers the dopamine level but the duration of treatment depends on duration of illness, improvement on treatment, family history etc.. Thyroid test is sometimes done to rule out it, as in thyroid dysfunction also the causative agent for development of many psychiatric illness. Acute psychosis and schizo-affective illness both are different as to diagnosis. The duration of illness is different. Awaiting your response. Thank you