What are the screening questions to diagnose schizophrenia in an adult?

Screening Questions for Diagnosing Schizophrenia in Adults

The diagnosis of schizophrenia requires structured screening questions that assess both positive and negative symptoms, with at least two psychotic symptoms present for a significant portion of time during a 1-month period and overall disturbance persisting for at least 6 months. 1

Core Screening Questions for Positive Symptoms

Hallucinations

• "Do you ever hear voices or sounds that other people don't seem to hear?" 1
• "Do these voices comment on what you're doing or thinking?" 1
• "Do you hear two or more voices conversing with each other?" 1
• "Do you see things that others don't see?"
• "Do you experience unusual sensations in your body?"

Delusions

• "Do you feel that others are trying to harm you or plotting against you?"
• "Do you believe you have special powers or abilities that others don't have?"
• "Do you feel that your thoughts are being broadcast so others can hear them?"
• "Do you believe someone or something is controlling your thoughts or actions?"
• "Do you feel that certain events or people have special meanings intended specifically for you?"

Disorganized Speech/Thought

• Observe for tangentiality, loose associations, and incoherence during the interview 1
• "Do you sometimes find it difficult to keep your thoughts organized?"
• "Do others tell you that they have trouble following what you're saying?"

Disorganized or Catatonic Behavior

• Observe for bizarre behavior, inappropriate affect, or catatonic features
• "Do you sometimes find yourself unable to move or stuck in one position?"
• "Have others commented that your behavior seems unusual or inappropriate?"

Core Screening Questions for Negative Symptoms

• "Have you lost interest in activities you used to enjoy?" 1
• "Do you find it difficult to get motivated to do things?" 1
• "Do you prefer being alone rather than with friends or family?"
• "Do you feel emotionally numb or that your emotions are blunted?"
• "Do you have difficulty expressing your feelings?"

Functional Impairment Assessment

• "Has your performance at work/school declined?"
• "Have you withdrawn from relationships with family or friends?"
• "Are you having trouble taking care of yourself (hygiene, meals, etc.)?"
• "How has your ability to function in daily life changed over time?"

Duration and Course

• "When did you first notice these experiences?"
• "Have these symptoms been present continuously or do they come and go?"
• "Were there early signs before the full symptoms appeared?" (assessing prodromal phase)
• "Have you had periods where symptoms improved or worsened?"

Important Diagnostic Considerations

1. Symptom Duration: The disturbance must persist for at least 6 months, including at least 1 month of active-phase symptoms 1

2. Functional Decline: Must demonstrate marked deterioration in social, occupational, or self-care functioning below previous achievement levels 1

3. Differential Diagnosis: Always rule out:

   • Mood disorders with psychotic features (especially bipolar disorder) 1
   • Substance-induced psychosis 1
   • Medical conditions causing psychotic symptoms 1
   • Post-traumatic stress disorder 1
   • Developmental disorders 1

4. Medical Clearance: A thorough physical examination, laboratory tests, and toxicology screens are necessary to rule out medical causes of psychotic symptoms 2, 1

Diagnostic Accuracy Considerations

• Periodic reassessment is essential to ensure diagnostic accuracy, particularly as the clinical picture may evolve over time 1
• Using standardized assessment tools like the Positive and Negative Syndrome Scale (PANSS) can help confirm the presence of required symptoms 1
• Diagnostic criteria are met when at least two psychotic symptoms are present for a significant portion of time during a 1-month period, with overall disturbance persisting for at least 6 months 1
• Only one symptom is required if delusions are bizarre, hallucinations involve a voice providing running commentary, or two or more voices converse with each other 1

The screening process should be comprehensive, involving both the patient and family members when possible, as insight may be impaired in individuals with schizophrenia. Remember that early diagnosis and intervention can significantly improve outcomes in terms of morbidity, mortality, and quality of life.