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When Schizophrenia is Misdiagnosed

by | Featured, Mental Illness, Research

Home Featured When Schizophrenia is Misdiagnosed

Schizophrenia is a mental disorder characterized by delusions, hallucinations (both auditory and visual), disorganized thought and speech patterns, and paranoia.  It affects approximately 1.1% of the adult population of the United States in any given year, a total of 2.4 million people.  Because there is no particular symptom that can be used to diagnosis schizophrenia, misdiagnosis can be a problem for people with the disorder, as well those with other disorders sharing symptoms with schizophrenia.  Bipolar disorder, borderline personality disorder, dissociative personality disorder, post-traumatic stress disorder, and autism spectrum disorders are among the mental disorders that exhibit symptom overlap with schizophrenia.
Symptoms related to schizophrenia are divided into three main categories: positive, negative, and cognitive.  Positive symptoms are those that reflect a magnification of characteristics related to normal functioning, such as hallucinations, delusions, and disorganized speech, thoughts, and behavior.  Negative symptoms are those that reflect a diminished or absence of characteristics related to normal functioning and include depression, withdrawal from society, lack of personal hygiene, and diminished affection.  Cognitive symptoms include difficulty in processing information, lapses in memory, and issues with concentration.  According to the Mayo Clinic website, it is cognitive symptoms that are often the most disabling because they interfere with a person’s ability to perform daily tasks, however small or routine.
Bipolar disorder, a mood disorder that may affect as many 8 million adult Americans, is the mental disorder most often misdiagnosed as schizophrenia.  People with bipolar disorder are much more likely to live functional lives, hold down regular jobs, and form successful and even intimate relationships.  However, a number of symptoms attributed to bipolar disorder are similar to those found in cases of schizophrenia; thus leading to confusion when attempting a diagnosis.  Substantial overlap exists between the manic symptoms in bipolar disorder and the positive symptoms in schizophrenia (including but not limited to: delusions, hallucinations, paranoia, and disorganized speech). Overlap also occurs concerning depressive episodes in bipolar disorder and negative symptoms attributed to schizophrenia (including but not limited to: apathy, emotional withdrawal, and social isolation).   A useful concept in avoiding a misdiagnosis is awareness of the origination of these different symptoms in the patient.
According to a survey produced by the Depression and Bipolar Support Alliance, one third of patients with bipolar disorder initially report experiencing depressive symptoms; another third of patients initially report experiencing manic symptoms; only 9% report experiencing psychotic symptoms at the outset.  By contrast, psychotic symptoms are primarily the first symptom reported in someone with schizophrenia.  Additionally, symptoms related to bipolar disorder tend to occur rapidly, whereas the symptoms related to schizophrenia occur gradually.  Due to the extreme overlap that exists in symptoms associated with these two disorders, several medications used to treat schizophrenia are also used in treatment of bipolar disorder, particularly the class of drugs known as atypical anti-psychotics.  These include Abilify, Clozaril, Geodon, Risperidal, Seroquel, Invega, and Zyprexa.
Autism is another disorder commonly mistaken for schizophrenia.  According to the Journal of Psychiatry & Neuroscience, autistic individuals possessing symptoms such as delusional thinking, apathy, or diminished affect are most likely to be misdiagnosed as schizophrenic.  However some may be comorbid, suffering from both schizophrenia and   autism or an autism spectrum disorder.  Individuals with both disorders tend to have poor social and communication skills; people with Asperger Syndrome (autism spectrum disorder) tend to be higher functioning than those with autism and/or schizophrenia.  Symptoms of autism tend to appear at a very young age, typically before age 3, while symptoms of schizophrenia may not appear until early adulthood. While there appear to be shared genetic mechanisms in autism and schizophrenia, anti-psychotic medications used to treat schizophrenia are generally ineffective in treating people with autism.
Psychotic symptoms found in people with post-traumatic stress disorder (PTSD) are generally positive symptoms, such as paranoia, delusions, hallucinations (both auditory and visual), as well as hypersensitivity to touch, smell, and sound.  These symptoms can be mistaken for schizophrenia, often leading to misdiagnosis.  While a substantial percentage of people with PTSD experience psychosis, the majority do not.  Dissociative identity disorder (DID), formerly known (and still commonly referred to) as multiple personality disorder, is another mental disorder often misdiagnosed as schizophrenia.  Exhibiting multiple identities can be confused for hallucinations common to schizophrenics; persons afflicted with DID tend to isolate from the outside world (a characteristic common to individuals with schizophrenia).  Treatment for schizophrenia will rarely if ever be effective when applied to people with DID, therefore, correct diagnosis is crucial to developing a successful treatment plan for both disorders.
Types of schizophrenia include paranoid schizophrenia, catatonic schizophrenia, disorganized schizophrenia, and undifferentiated schizophrenia, with paranoid schizophrenia being the most common.  In men, the disorder typically occurs between the ages of 18 and 22.  In women, the age of onset is usually ten years later than in men.
By Greg L.