Evidence-based assessment/Schizophrenia (disorder portfolio)/extended version

What is a "portfolio"?
For background information on what assessment portfolios are, click the link in the heading above.

Does all of this feel like TMI? Click here to go to a condensed version.

Diagnostic Criteria for Schizophrenia
ICD-11 Diagnostic Criteria Changes in DSM-5 The diagnostic criteria for depressive disorders changed slightly from DSM-IV to DSM-5. A summary is available here.
 * Schizophrenia
 * Schizophrenia is characterized by disturbances in multiple mental modalities, including thinking (e.g., delusions, disorganization in the form of thought), perception (e.g., hallucinations), self-experience (e.g., the experience that one's feelings, impulses, thoughts, or behaviour are under the control of an external force), cognition (e.g., impaired attention, verbal memory, and social cognition), volition (e.g., loss of motivation), affect (e.g., blunted emotional expression), and behaviour (e.g.,behaviour that appears bizarre or purposeless, unpredictable or inappropriate emotional responses that interfere with the organization of behaviour). Psychomotor disturbances, including catatonia, may be present. Persistent delusions, persistent hallucinations, thought disorder, and experiences of influence, passivity, or control are considered core symptoms. Symptoms must have persisted for at least one month in order for a diagnosis of schizophrenia to be assigned. The symptoms are not a manifestation of another health condition (e.g., a brain tumour) and are not due to the effect of a substance or medication on the central nervous system (e.g., corticosteroids), including withdrawal (e.g., alcohol withdrawal).
 * Schizophrenia, First Episode
 * Schizophrenia, first episode should be used to identify individuals experiencing symptoms that meet the diagnostic requirements for Schizophrenia (including duration) but who have never before experienced an episode during which diagnostic requirements for Schizophrenia were met.
 * Note: The ICD-11 lists 3 additional subcategories of schizophrenia, first episode. They can be found here.
 * Schizophrenia, Multiple Episodes
 * Schizophrenia, multiple episode should be used to identify individuals experiencing symptoms that meet the diagnostic requirements for Schizophrenia (including duration) and who have also previously experienced episodes during which diagnostic requirements were met, with substantial remission of symptoms between episodes. Some attenuated symptoms may remain during periods of remission, and remissions may have occurred in response to medication or other treatment.
 * Note: The ICD-11 lists 3 additional subcategories of schizophrenia, multiple episodes. They can be found here.

Base rates of schizophrenia in different populations and clinical settings
This section describes the demographic setting of the population(s) sampled, base rates of diagnosis, country/region sampled and the diagnostic method that was used. Using this information, clinicians will be able to anchor the rate of schizophrenia they are likely to see in their clinical practice.


 * To find prevalence rates across multiple disorders, click here.

†Rates reflect schizophrenia spectrum disorders. Note: DIS = Diagnostic Interview Schedule, CIDI = Composite International Diagnostic Interview, SCID = Structured Diagnostic Interview for DSM, BASIC-32 = Behavior and Symptoms Identification Scale

Search terms: [Schizophrenia] AND [prevalence OR incidence], [Schizophrenia] AND [Prevalence] AND [Outpatient OR inpatient] in PsycINFO, Medline, and PubMed

Screening instruments for schizophrenia
The following section contains a list of screening and diagnostic instruments for schizophrenia. The section includes administration information, psychometric data, and PDFs or links to the screenings. Screenings are used as part of the prediction phase of assessment; for more information on interpretation of this data, or how screenings fit in to the assessment process, click here.

Likelihood ratios and AUCs of screening measures for schizophrenia

 * For a list of the likelihood ratios for more broadly reaching screening instruments, click here.

Note: ‡ Used the SCID administered by trained raters. • Used Present State Examination 9 and psychiatrist diagnosis. (*) Cutoff score for all clusters was 15% of symptoms in that cluster present (for cluster 1= 5/35 symptoms)


 * “LR+” refers to the change in likelihood ratio associated with a positive test score, and “LR-” is the likelihood ratio for a low score. Likelihood ratios of 1 indicate that the test result did not change impressions at all. LRs larger than 10 or smaller than .10 are frequently clinically decisive; 5 or .20 are helpful, and between 2.0 and .5 are small enough that they rarely result in clinically meaningful changes of formulation (Sackett et al., 2000).

Search terms: [schizophrenia] AND [sensitivity OR specificity] AND [differential diagnosis] AND [ prodrome] in MedLine and PsycINFO

Interpreting schizophrenia screening measure scores

 * For information on interpreting screening measure scores, click here.

Gold standard diagnostic interviews
For a list of broad reaching diagnostic interviews sortable by disorder with PDFs (if applicable), click here.

Process phase
The following section contains a list of process and outcome measures for schizophrenia. The section includes benchmarks based on published norms and on mood samples for several outcome and severity measures, as well as information about commonly used process measures. Process and outcome measures are used as part of the process phase of assessment. For more information of differences between process and outcome measures, see the page on the process phase of assessment.

Clinically significant change benchmarks with common instruments for schizophrenia
Note: “A” = Away from the clinical range, “B” = Back into the nonclinical range, “C” = Closer to the nonclinical than clinical mean.

Note: Clinical significance may be limited for use in schizophrenia as the disorder is currently incurable and the extent to which a return to normal functioning may be less common. For this reason, some investigators have used methods other than those proposed by Jacobson and Truax (1991) to develop cut-off points (Jacobson et al. 1999).
 * Example: Positive and Negative Syndrome Scale (PANSS) cut-off scores of 40, 45 and 50 have been mentioned for clinically significant change for schizophrenia patients in hospital settings (Schennach et al. 2015).

Search terms: [schizophrenia] AND [clinical significance OR outcomes OR change] AND [PANSS OR SWLS] in MedLine and PsycINFO

Treatment
Cognitive behavioral therapy to routine care has shown limited evidence of an average effect size on psychosis symptoms. However, individual CBT is not widely available in the US, and group CBT is likely more cost-efficient. Other general treatment information can be found here.

External Resources

 * 1) ICD-11 diagnostic criteria
 * 2) Find-a-Therapist (a curated list of find-a-therapist websites where you can find a provider)
 * 3) NIMH (information about schizophrenia)
 * 4) OMIM (Online Mendelian Inheritance in Man)
 * 5) 181500

Web-based resources
Online Support Group for Family Members & Individuals with Schizophrenia

Website

Chatrooms for Individuals with Schizophrenia:
 * http://www.schizophrenia-online.com/
 * http://theircvillage.com/chat/

General Information about Schizophrenia