Learning About Schizophrenia, Part II

Which symptoms are associated with a schizophrenia diagnosis, and how is schizophrenia treated? Here's some of what we've learned about diagnosing and treating schizophrenia.

In the previous blog post, we covered how the presence of anosognosia in a patient greatly complicates a clinician's ability to diagnose schizophrenia: "The difficulty of diagnosing this illness is compounded by the fact that many people who are diagnosed do not believe they have it" (NAMI). Diagnosing schizophrenia doesn't rely on a single lab or physical exam, and can entail doctors monitoring a patient's symptoms over six months (NAMI).

A patient who meets the diagnostic criteria for schizophrenia must have two or more of the following symptoms that are both present and persistent in the context of their reduced functioning:

• Delusions

• Hallucinations

• Disorganized Speech

• Disorganized or Catatonic Behavior

• Negative Symptoms (e.g. Flat affect, lack of follow-through, anhedonia, etc.)

Identifying and diagnosing schizophrenia as early as possible can greatly improve a patient's chances of managing their illness, reducing psychotic episodes, and achieving recovery (NAMI). Conversely, those who don't receive treatment soon after experiencing their first psychotic episode may require more time to control their symptoms. Some related conditions/common comorbidities with schizophrenia include substance use disorder, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and major depressive disorder.

In her article "Understanding Schizophrenia," published on NAMI's website, Katherine Ponte, JD, MBA, CPRP, outlines the following stages characterizing schizophrenia's onset and progression*:

1. Early Symptoms

   1. Early detection and treatment improve the potential to avoid schizophrenia's full manifestation.

2. First Episode Psychosis

   1. Early intervention after the first psychotic episode may improve the effectiveness of treatment and enhance patients' outcomes. It can also help prevent patients from developing unhealthy coping mechanisms.

3. Acute Episode

   1. Usually characterized by psychosis, sometimes aggressive behavior, or suicidal thoughts. This may require hospitalizing the patient.

4. Remission

   1. Indicating a patient's symptoms are at a low level of intensity.

5. Chronic or Unremitting

   1. Sustained or periodic elevated intensity of a patient's symptoms.

6. Recovery

   1. A patient's ability to function in their community, socially and vocationally, in addition to being relatively symptom-free. The maintenance of a patient's treatment plan is key here.

7. Relapse

   1. Signs of relapse include changes in sleep, increased anxiety, agitation, suspiciousness, and/or hostility, lack of insight about symptoms (anosognosia), and increased severity of usual symptoms.

      
      

   *It's worth noting that the above stages of schizophrenia can have acute or subtle onset, continuous or episodic psychosis, and be with or without clinical deterioration.

As of 2025, there is still no definitive cure for schizophrenia. Some of the treatment methods for schizophrenia include the following:

• Antipsychotic Medications

• Psychosocial Intervention

• Cognitive Therapy

• Self-Management Strategies and Education

• Institutionalization

• Relapse Prevention Plan

According to Ponte, it is more difficult to treat schizophrenia's negative symptoms and cognitive impairments versus its positive symptoms (like psychosis). However, both negative and positive symptoms may reflect major unmet therapeutic or medical needs in the schizophrenic patients' lives. This underscores how treating schizophrenia's negative symptoms and cognitive impairment is vital to a patient's long-term functioning.

There is no 'one-size-fits-all' treatment plan for schizophrenia patients because no two cases of schizophrenia are exactly alike. The perceived success of anti-psychotic medication used to treat schizophrenia is somewhat contended by its significant (and sometimes irreversible) side effects, such as tardive dyskinesia (TD) and, most commonly, weight gain. Psychotherapy can provide an outlet for schizophrenia patients to explore their personal history, identify recurring triggers, and develop effective coping strategies with a mental health practitioner. But achieving a positive outcome in therapy can take years of continual and ongoing therapeutic support, which may be inaccessible for schizophrenia patients.

Some mental health experts attest that a community's investment in resources for those with severe mental illnesses may provide better support than state mental healthcare resources:

"Hospitalizing a person with a serious mental illness costs three to five times as much as providing comprehensive community services...Many relapses could be prevented by such intervention. It makes no sense that clinicians are not translating 25 years of

documented PACT* success into daily practice. Don't they believe in recovery?"

-Former NAMI Executive Director Laurie Flynn

PACT*: Program For Assertive Community Treatment

Stay tuned for our next blog post, "Learning About Schizophrenia, Part III," which will explore some of the potential causes of schizophrenia.