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There are both good and bad sides to being diagnosed with schizophrenia. You might feel relieved to have a name for what is happening to you. And it's a first step towards getting the right treatment to help you cope with your illness. On the other hand, being diagnosed with a serious long-term mental illness can be a shock. You might not be happy at having a "label" that some people associate with being crazy or dangerous.

Doctors are usually very cautious about diagnosing someone with schizophrenia. Usually, they will carry out several different assessments over a period of weeks or months, to make certain you don't get diagnosed incorrectly. You'll see a specialist mental health doctor (a psychiatrist) before you are diagnosed.¹

Your doctor may do some of the things below to help work out if you have schizophrenia.²

If your primary care provider thinks that you may have schizophrenia, he or she will probably refer you to a hospital or clinic, to see a psychiatrist. The psychiatrist will want to hear the history of any problems you've had. He or she may ask you:²

• What sort of symptoms have you been getting?
• When did you first start having these problems (such as hearing voices)?
• If you do hear voices, what do they say?
• Do you know that the delusions or hallucinations you have are part of an illness, or do you think they are real experiences?
• Do your problems come and go or do you get them all the time?
• How have your problems affected your life (such as your studies or your work)?

The psychiatrist will probably ask about any other mental or physical health problems you have had, and whether anybody else in your family has had mental health problems.

If a friend or relative has come with you to the hospital or the clinic, your doctor may ask them what they have noticed about your condition. This may be particularly important if your symptoms are making it hard for you to speak or for people to understand what you are saying.

During the interview, the psychiatrist will look at you carefully and see how you react to things. This is called a mental state examination. This is to find out if you have schizophrenia symptoms at the time of the interview. The psychiatrist will:

• Look at your appearance and behavior
• Listen carefully to the way you speak and what you say
• See how you move and how much energy you seem to have
• Ask about how you are thinking: whether your thoughts are racing or coming slowly
• Try to work out whether you are having abnormal thoughts (delusions) or abnormal experiences (hallucinations)
• Ask about your mood and how you feel about yourself
• If you are having delusions or hallucinations, try to figure out whether you know your experiences are not real.

There aren't any blood tests or scans that can show if you have schizophrenia. But you may need to have blood or urine tests, to make certain you don't have another condition that can cause mood problems.

Your doctor will always check for any other conditions that could be causing your symptoms, before making a diagnosis of schizophrenia. For more information, see What else might it be?

When the psychiatrist has gathered up all the information about your symptoms, he or she will compare this with the standard descriptions of schizophrenia.³ Before making the diagnosis, the psychiatrist will consider how much your symptoms have affected your life, and whether you have had problems for at least six months.

Your psychiatrist will be looking to see if you've had two or more of the following symptoms, each of which have lasted for about a month at a time:

• Delusions
• Hallucinations
• Disorganized speech (such as suddenly switching topics or not making sense). This may show you have thinking or memory problems.
• Disorganized behavior (such as dressing or behaving strangely or being unable to look after yourself). This may also show you have thinking or memory problems.
• Negative symptoms (such as a completely flat mood, not speaking very much or not wanting to begin or finish things). (They are called negative symptoms because they take things away from your normal personality.)

If you have had two or more of these, your doctor will probably diagnose schizophrenia. But if the delusions are obviously false (they are bizarre), or the hallucinations affect you a lot, the doctor will diagnose you with schizophrenia, even if you haven't had any other symptoms.

This information is for educational use only, and is not a substitute for prompt professional medical advice. Readers should always consult a physician or other professional for advice and treatment. ©BMJ Publishing Group Limited 2008. All rights reserved.