Schizophrenia differential diagnosis

The differential diagnosis of depression is organized along both symptomatic and causative lines. Symptomatically, major depression is differentiated from other disorders by its clinical presentation or its long-term history. This is, of course, the primary means of distinguishing psychiatric disorders in DSM-1V. The symptomatic differential of major depression includes other mood disorders such as dysthymic disorder and bipolar disorder, other disorders that frequently manifest depressed mood including schizoaffective disorder, schizophrenia, dementia, adjustment disorder, and post-traumatic stress disorder, and, finally, other nonpsychiatric conditions that resemble depression such as bereavement and medical illnesses like cancer or AIDS. 

Pope H, Lipinski J. Differential diagnosis of schizophrenia and manic depressive illness a reassessment of the specificity of schizophrenia symptoms in the light of current research. Arch Gen Psychiatry 1978 35 811-828. 

The Diagnostic and Statistical Manual of Mental Disorders lists several distinct criteria necessary for a diagnosis of schizophrenia.5 These criteria include a marked disturbance in the thought process, which may include bizarre delusions and auditory hallucinations (i.e., hearing voices ). Also, a decreased level of function in work, social relations, and self-care may be present. Other factors include the duration of these and additional symptoms (at least 6 months) and a differential diagnosis from other forms of mental illness (such as affective disorders and organic brain syndrome). 

While the "classic" manic is readily diagnosed, differentiating between diagnostic subtypes may be more difficult, especially when a seasonal pattern exists. Further disorders to rule out in the differential diagnosis include attention deficit hyperactivity disorder, schizophrenia, and schizoaffective disorder. 

The DSM-IV-TR places a greater emphasis on the chronicity of schizophrenia and negative symptoms than do previous editions. Schizophrenia is a chronic disorder, and the patient s history must be carefully assessed for dysfunction that has persisted for longer than 6 months. After their first episode, patients with schizophrenia rarely have a level of adaptive functioning as high as before the onset of the disorder. Table 66-2 summarizes the DSM-IV-TR criteria, and this reference should be consulted for a more detailed discussion of the differential diagnosis. ... 

The differential diagnosis considerations include reactive psychosis, schizophrenia, that are excluded according to anamnesis data and lack of other specific features for these diseases. 

Variability of presentation characterizes this homocysteine remethylation defect as well. Several patients have been reported from one family one with seizures and muscle weakness, a second with schizophrenia and retardation, and a third who was asymptomatic. Subsequently, patients with a more malignant neonatal presentation were reported, and hence both variants should be part of the differential diagnosis of sepsis neonatorum . 

Schizophrenia-related disorders, such as schizophreniform disorder, can closely mimic an acute exacerbation of mania. Attention to premorbid personal and family history may help differentiate them from mood disorders. A definitive diagnosis may not be possible, however, until the course of the illness is followed for a period of time. Clinical clues include the propensity of bipolar manics (in contrast to schizophrenics) to demonstrate pressured speech, flight of ideas, grandiosity, and overinclusive thinking. Hallucinations are less common than delusions in both mania and depression, with delusions normally taking on the qualities of expansivity, hyperreligiosity, or grandiosity. Delusions are also relatively less fixed than in schizophrenia. 

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