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Ask the Experts

Question:

Is there a test for schizophrenia? Also, if someone does have schizophrenia, how can you predict how serious the disorder will be and how it will progress?

Answered by: L. Fredrick Jarskog

Unfortunately, there is no test (such as a genetic or biochemical blood test or an MRI scan)that can be used to diagnose schizophrenia. The illness is diagnosed based on the duration, type, and severity of clinical symptoms. Sometimes the diagnosis is quite clear from onset; sometimes it may take longer to establish the diagnosis.

Similarly, it is difficult to accurately predict the course of the illness in a given individual. Certain features tend to predict a better long term course. These include 1) female gender, 2) high level of functioning prior to the onset of symptoms (such as successful participation in school, job, or other meaningful activities), 3) later onset of psychosis (mid to late twenties as compared to adolescence), and 4) abrupt first onset of symptoms (weeks to a few months) as compared to gradual onset with substantial social withdrawal and pronounced lack of motivation.

Regardless of the severity of the presenting symptoms, it is widely agreed that long term outcome is better for patients who take their antipsychotic medication consistently. When medications are not taken consistently, symptoms will usually return and worsen with time, and when medications are eventually restarted they will be less effective than had the patient remained compliant with the treatment from the start. It is critical for a patient to work with his or her psychiatrist to find a medication that is both effective and that has a side-effect profile that is acceptable. This may take some trial and error with several different antipsychotic medications.