Questions Doctors Ask to Diagnose Schizophrenia


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Seeing a psychiatrist is a decision that does not come easy. Part of the difficulty is not knowing what to expect. Is the doctor going to ask lots of questions? What sort of questions? This article gives an overview of the questions that are commonly asked during a psychiatric evaluation for schizophrenia. Being informed goes a long way to relieve some of the anxiety often experienced by patients seeing a psychiatrist for the very first time.

How Do Doctors Make a Diagnosis?

Most medical conditions are diagnosed based on a combination of patient’s complaints (symptoms) and abnormal findings from the physical or mental state examination (signs).

Following the history and examination, the doctor might have enough information to make a diagnosis. However, there are cases when the doctor needs to get additional tests to better understand what the problem is.

Most times doctors consider a number of possible medical conditions that might be responsible for a problem. As the physician puts together the information from history, examination, and any additional tests, the panel of the different conditions under consideration (differential diagnosis) is gradually narrowed to the most likely diagnosis.

Getting the History

The doctor will first gather the history, meaning that he will ask about symptoms: how did they start (onset), how did they change over time (course of illness), and what makes things better or worse (modifying factors). The doctor will also inquire about associated problems including medical problems and excessive use of alcohol or drugs. It is good practice to also clarify what medications were prescribed and how your symptoms responded to treatment.

The doctor will also ask about any history of past mental health issues, as well as past medical problems including seizures, head trauma, or prolonged loss of consciousness.

Understanding who the patient is as a person is an essential part of the psychiatric evaluation. So, expect questions about growing up, schooling, relationships with family members and friends, interests and hobbies, strengths, and weaknesses. 

Last but not least, the psychiatrist will ask questions about any family history of significant mental health issues, including drug or alcohol problems.

Collateral History

In order to better understand what is going on it might be important to also talk to others who know the patient well. That means the psychiatrist will likely seek permission to talk to people who spend time with the patient, such as family members or friends.

Mental Status Examination

The doctor will assess the patient's mood, feelings, interest, motivation, and overall thinking. 

Questions about a desire to self-harm or harm others are a standard part of any psychiatric evaluation.

The mental state examination for schizophrenia will always include questions about unusual experiences such hearing voices or noises, seeing visions, feeling like things are crawling on your skin or anything else that might qualify as a strange or bizarre thought or feelings (positive symptoms). Expect questions about how you get along with other people including questions about feeling as if others are giving you a hard time, following you or plotting against you.

Finally, the psychiatrist will want to assess concentration, the ability to pay attention and remember things. To get that, the doctor will ask the patient to do simple calculations, or remember a few words or numbers.

Be Open

It is common to feel uncomfortable when asked many questions. Many people find it hard to trust and be open with someone they just met, doctors included. Some of the doctor’s questions will be about sensitive subjects and talking about embarrassing or very private details is not easy.

And then, to make it even harder, imagine voices telling you "not to trust anybody" or feeling like "they are out to get me" (at times it can feel as the doctor is also part of the plot). Hallucinated voices or paranoia are not imagined but real for patients living with schizophrenia.

It is understandable then that often times patients with schizophrenia choose to not engage or even completely shut down.

Unfortunately, when that happens, the doctor will have very little information to go by. And little information is of little help when it comes to a good diagnosis and treatment plan. In times like this, it is important to remind the patient that doctors cannot read anyone's mind and chances are that they are not out to get them. Reassurance from people they trust can help patients feel more comfortable talking about their experiences, thoughts, and feelings.

Doctors' ability to help is as good as the information they got during the evaluation. Seeing a psychiatrist is no different than seeing any other doctor: the patient's "job" is to try to answer questions the best they can, not misrepresent and not withhold information. As the more open the patient is, the better the doctor’s ability to make the right diagnosis and give the best treatment.

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