Telehealth Support for Schizophrenia: A Clinical Guide

Understanding Schizophrenia Through Telehealth: A Clinical Perspective

Schizophrenia is a complex psychiatric disorder characterized by a wide range of often-disruptive symptoms. The official criteria for diagnosing schizophrenia are outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). This article explores the DSM-5 criteria for diagnosing schizophrenia and examines how telehealth platforms like ReachLink can provide accessible support for individuals navigating this challenging condition.

The DSM-5: A Foundation for Understanding Schizophrenia

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition is the official handbook healthcare professionals use to define and diagnose mental health disorders. While the DSM was established in the United States, it is referenced worldwide. Along with detailed descriptions of mental health disorders, symptoms, and other diagnostic criteria, the DSM provides a common language for ease of communication between patients and providers.

The DSM-5 establishes consistent diagnoses that can be used in research on mental disorders. This consistency aids in the development of medications and other methods of treatment. As mental health disorders are being continuously researched, the DSM is continuously updated. Since the DSM-5 was published in 2013, the DSM-5-TR is a text revision that includes fully revised text, new references, clarifications to diagnostic criteria, and updates to medical codes.

Along with schizophrenia, the DSM-5 includes outlines and information on conditions and symptoms like depressive disorders, bipolar disorder, schizoaffective disorder, and psychotic disorders. To learn more about the DSM-5, the American Psychiatric Association offers resources for clients and clinicians on its official website.

Understanding Schizophrenia as a Psychiatric Disorder

Schizophrenia is a psychiatric disorder that significantly impacts physical and mental health. This disorder disturbs the standard functioning of the brain, affecting cognition, memory, sensory perceptions, and behaviors. Schizophrenia can severely disrupt an individual’s ability to function in everyday life and can lead to risky behavior, as well as challenges in organizing thoughts.

Individuals with schizophrenia may not recognize their symptoms, but those around them might. The five primary symptoms of schizophrenia are as follows:

• Delusions: False beliefs persist despite evidence to the contrary. For instance, you may believe that someone is controlling your thoughts, words, or actions.
• Hallucinations: Hallucinations cause sensory perceptions of seeing, hearing, smelling, touching, or tasting stimuli that do not exist, such as auditory hallucinations like hearing voices.
• Disorganized or incoherent speech: Disorganized speech involves difficulty organizing thoughts while speaking, resulting in trouble staying on topic or expressing ideas clearly.
• Disorganized or unusual movements: Behaviors that deviate from expected norms, such as frequent random movements or a lack of movement altogether, may characterize disorganized movements.
• Negative symptoms: These symptoms involve a decrease or loss of expected behaviors, including reduced facial expressions, disorganized or catatonic behavior, flat or emotionless speech, and diminished motivation, particularly in socializing or engaging in enjoyable activities.

Impact of Schizophrenia on Daily Life

As a result of these symptoms, individuals with schizophrenia may:

• Experience suspicion, paranoia, or fear
• Neglect personal hygiene and appearance
• Experience symptoms of depression and anxiety
• Experience suicidal thoughts
• Turn to substances like alcohol, nicotine, prescription medications, or recreational drugs in attempts to alleviate symptoms

Schizophrenia has two main phases: active and residual periods. During the active phase, symptoms like hearing voices, having unusual thoughts, or seeing what is not present can be intense and challenging.

The residual phase comes after the active phase. The symptoms might not be as severe in this phase but can still linger. People in this phase may continue to experience some effects of schizophrenia, like difficulty thinking clearly or being less motivated than usual.

The Official DSM-5 Criteria for Schizophrenia

The schizophrenia DSM-5 criteria are as follows.

Primary symptoms under the schizophrenia DSM-5 criteria

Two (or more) of the following symptoms must be present for a significant portion of time during a one-month period (or less if successfully treated). At least one of these must be delusions, hallucinations, or disorganized speech:

• Delusions
• Hallucinations
• Disorganized speech (e.g., frequent derailment or incoherence)
• Grossly disorganized or catatonic behavior
• Negative symptoms (i.e., diminished emotional expression or avolition)

Functional impairments

For a significant portion of the time since the onset of the disturbance, one’s level of functioning in one or more significant areas, such as work, interpersonal relations, or self-care, must have been markedly below the level achieved before the onset. When the onset is in childhood or adolescence, one must experience difficulty achieving the expected level of interpersonal, academic, or occupational functioning.

Persistence

Continuous signs of the disturbance must persist for at least six months. This six-month period must include at least one month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

Differential diagnosis

Schizoaffective disorder and depressive or bipolar disorder with psychotic features must be ruled out because either no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or, if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.

The disturbance is not attributable to the physiological effects of a substance (e.g., a misused drug, a medication) or another medical condition. (Consult a medical doctor before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis.)

If there is a history of autism spectrum disorder (ASD) or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least one month (or less if successfully treated).

Course Specifiers

The diagnostic professional must specify if the following course specifiers are only to be used after a one-year duration of the disorder and are not in contradiction to the diagnostic course criteria:

• First episode, currently in acute episode: First manifestation of the disorder meeting the defining diagnostic symptom and time criteria. An acute episode is a period in which the symptom criteria are fulfilled.
• First