Schizophrenia is a mysterious disease, and although we seem to gain deeper knowledge into its quirks and idiosyncrasies, this only seems to lead to more questions and more mystery.
Considering our lack of knowledge on the cause of this disease, as well as its wide variety of symptoms and levels of severity, it is no surprise that schizophrenia is one of the most commonly misdiagnosed diseases. Symptoms of schizophrenia are very similar to symptoms of other diseases: bipolar disorder, obsessive-compulsive disorder, depression, PTSD, personality disorder, substance abuse, and the list goes on. In many cases individuals with one or a combination of symptoms common to many of these diseases may be wrongly diagnosed with various levels of schizophrenia.
Some additional misdiagnoses of schizophrenia include:
- In many cases, individuals with brain lesions/brain tumors or temporal lobe seizures can be misdiagnosed
- Addison’s disease, a disorder of the adrenal glands, has various symptoms and is commonly misdiagnosed in early stages
- Hypothyroidism
- Cushing’s disease may also have schizophrenia-like symptoms such as paranoia and delusions, leading to a misdiagnosis
- Manic Depressive Disorder
- Epilepsy
- Elderly patients can be misdiagnosed owing to symptoms of paranoia, when the underlying cause is really simple hearing loss. Due to their inability to hear properly what people are saying, elderly patients can become more prone to paranoia, believing that people are “whispering” about them
- Diseases similar to schizophrenia such as schizotypal, schizoid or paranoid personality disorder
While misdiagnoses are understandable on occasion, in regards Schizophrenia, this seems to occur far too often. It’s almost as if Schizophrenia becomes a blanket diagnosis because it could potentially explain so many symptoms.
This misdiagnosis becomes even more severe when we consider the prescription medications that accompany it.
Most often, Schizophrenic patients are treated with antipsychotics, antidepressants, and/or mood stabilizers. All of these can have serious side effects, including but not limited to:
- Sedation
- Hypotension
- Anticholinergic Effects
- Extrapyramidal Symptoms (i.e.Pseudoparkinsinism, Tardive Dyskinesia)
- Hyperprolactinemia
- Sexual Dysfunction
- Agranulocytosis
- Cardiac Arrhythmias
- Seizures
- Metabolic Syndrome Issues
According to the American Academy of Family Physicians, the use of antipsychotic medications entails a difficult trade-off between the benefit of alleviating psychotic symptoms and the risk of troubling, sometimes life-shortening adverse effects.
Perhaps in the case of true Schizophrenic patients, the benefits outweigh the costs of such medications. For some, it is impossible to function or live their lives without them. However, in the case of misdiagnosed patients, we are not only introducing them to these harmful side effects, but we likely are not treating their true symptoms either.
So how do we prevent this misdiagnosis?
Physicians have a difficult line to walk. Early diagnosis of true Schizophrenia is important, and such antipsychotic medications can be highly beneficial for these patients. However, incorrect diagnosis in an attempt to be efficient can do much more harm than good, leaving a misdiagnosed patient untreated and at the mercy of harmful drugs.
To begin with, doctors must consider the patient as human and not a set of symptoms. When is a strongly held belief a full blown “delusion” rather than just a different point of view? Not everyone who is paranoid is necessarily suffering from schizophrenia and it is crucial not to jump to conclusions.
To aid in this, the DSM –IV has several other possible diagnoses listed for paranoid personality types. Additional lists elsewhere have several alternative diagnoses for Schizophrenia. It is important to consider all of these during the diagnostic process. If a patient presents with 85% symptoms that point to Schizophrenia, perhaps it is worth looking into the other 15% before wrongly diagnosing.
Additionally, more emphasis on psychotherapy or “talk therapy” may alleviate some of the severity of a misdiagnosis. While it is never “good” to misdiagnose a patient, at least if such a patient were suggested to psychotherapy rather than prescribed antipsychotics, there would not be such harmful affects.
Is there a point here? No reasonable clinician does any of the behaviors the author expresses concerns about. These are old and insulting accusations that have been around any field of medicine for decades. We can use the same formula to talk about any occupation. Not sure who wrote this or their qualifications but the ignorance of these ideas suggests little to no actual training in medicine, much less psychiatry. No good clinician in any field considers a patient to be a “case of X”.
Any field of medicine always endeavors to make the appropriate diagnosis. A good history, medical evaluation including physical exam and laboratory testing, collateral information, previous treatment records, psychological testing (not routine), family (genetic risk) history, substance use history, and most importantly consistent follow-up are the standard of care for any psychiatric diagnosis. Brain Scans and EEG are not helpful unless the patient has neurologic symptoms or finding on physical examination which includes neurologic screening. There are good clinicians that differ in whether someone has had a “heart attack” (myocardial infarction) or not in spite of very sophisticated technology or whether a particular surgery would be helpful or not. Usually the diagnosis of Schizophrenia is late in the patients course of severe and persistent symptoms. Delusions are well defined as “persistent false beliefs that are not culturally consistent”. Conspiracy theories, unusual religious beliefs and “magical” ideas are not automatically considered to be delusions.
Unfortunately, psychologists and most other mental health providers have little to no experience in their training with people who suffer this devastating illness. Their training does not include much involvement in Mental Health Centers and rarely any training at an inpatient psychiatric unit or a State Hospital. Psychotherapy shows little to no benefits in treatment for Schizophrenia. Multiple studies have demonstrated this.- almost all of these done by psychologists (I wish it did). Case managers are crucial to good care. Focused therapies on issues to support independent living, education, family supports and vocational supports are also important. This is a brain disease that effects real human beings.Many of these brain changes are reasonable well understood but I agree there is much more to be done It is crucial we practice data based and evidence-driven assessments and treatments. The trivializing and denial of psychotic symptoms is dangerous and has contributed significantly to the “street people” phenomena of the last 25 years.
By the way DSM 4 has not been used for several years. There was an update called DSM-IVR and psychiatry has used DSM-5 for the last 1 year.