How to get a psychiatrist’s diagnosis for schizophrenia

Schizophrenia is a lifelong mental health condition. As a psychotic disorder, it’s known to involve disruptive hallucinations and delusions. Hallucinations occur when a person sees or hears something that isn’t really there. Delusions are entrenched ideas that most people wouldn’t believe to be true. Left untreated, schizophrenia can severely impact daily functioning. It can also increase the risk of other health concerns. But, fortunately, it can be managed with the right support. 

The first step in accessing care for schizophrenia is to seek an evaluation. Psychiatrists are medical doctors, while psychiatric mental health nurse practitioners (PMHNPs) are nurse practitioners who specialize in mental health. To diagnose schizophrenia, psychiatric providers rely on a clinical assessment. This often starts with a review of a person’s medical, mental health, family, and social history. They also reference the diagnostic criteria for schizophrenia. 

Psychiatric providers diagnose schizophrenia using their observations, rating scales, patient feedback, and history. From there, they can move into treatment planning. This often starts with helping patients achieve safety and stability. Then, they can engage with other aspects of care.

Diagnostic criteria a psychiatrist looks for

To diagnose schizophrenia, a person must exhibit two (or more) of the following. Continuous disturbance must be present for six months with at least one month of below symptoms present unless successfully treated. There’s also additional diagnostic criteria to be considered that your psychiatric provider can discuss with you. 

Number one, two, or three must be present.

1. Delusions: Objectively false beliefs, like, “The government is controlling me through the TV” 

2. Hallucinations: Seeing, hearing, tasting, feeling, or smelling something that isn’t there 

3. Disorganized speech: Speaking confusingly or incoherently

4. Highly disorganized or catatonic behavior: Unpredictable bizarre behavior as well as a lack of response or unusual movements 

5. Negative symptoms: Flat emotional expression and/or a major decline in self-directed behavior

6. Significant interruption in daily functioning: Like a person’s ability to work, attend school, or maintain relationships

Before they can confirm a diagnosis, psychiatric providers must also rule out conditions that share similar features. In the case of suspected schizophrenia, providers will want to ensure that a person’s psychosis isn’t being caused by a different condition, like:

• Major depressive disorder (MDD)

• Bipolar disorder with psychotic or catatonic features

• Schizoaffective disorder

• Schizophreniform

• Brief psychotic disorder

• Delusional disorder 

• Schizotypal personality disorder 

• Obsessive-compulsive disorder (OCD) 

• Body dysmorphic disorder

• Post-traumatic stress disorder (PTSD)  

• Autism spectrum and communication disorders

• Other mental health conditions with psychotic episodes

Tests psychiatrists use to diagnose schizophrenia

While there’s no definitive test that can determine whether someone has schizophrenia, there are some helpful tools available. Some psychiatric providers use schizophrenia rating scales to help them better understand a patient’s experiences. The most commonly used scale is the Positive and Negative Syndrome Scale (PANSS). 

The goal of these scales is to help clinicians assess the severity of a patient’s symptoms and track how well treatment is working. The scale your provider uses may depend on where you’re receiving care, the amount of time they have to make an assessment, and other factors.

How to set up a psychiatric evaluation

When it comes to living with schizophrenia, early intervention is key. Getting help sooner can help prevent symptoms from getting worse and make the condition easier to manage. In other words, if you think that you or someone you care about may have schizophrenia, don’t hesitate to ask for help. 

Here’s how to set up a schizophrenia evaluation with a psychiatric provider:

• Get a referral. Talk to one of your current healthcare providers. Be specific about your concerns and your symptoms. Ask if they can provide a referral for a psychiatric provider who can evaluate you for schizophrenia.

• Consider telepsychiatry. If you’re unable to secure a referral for a psychiatric provider in your area, you may be able to connect with one online. While you may need to see them in person at some point, you can use technology to expand your provider search. 

• Take some notes. To prepare for your appointment, try to write down when your symptoms started, how often they occur, how they affect your life, and what seems to make them better or worse. It’s OK to ask a loved one for help with this step if you’re having trouble remembering everything.

• Have patience. As you gear up for a first appointment with a psychiatrist, know that getting diagnosed with schizophrenia is a multi-step process. It may take more than one meeting for your provider to confirm your diagnosis. They may also ask you to take some extra steps, like seeing a doctor or doing some blood work.

What to do if you’re diagnosed with schizophrenia

Being diagnosed with schizophrenia can be a challenging experience. It can bring up a wide range of thoughts and emotions. Just try to take it one day at a time, and remember that you’re not alone. 

Therapies, medications, lifestyle changes, and other supports can help you live a full life with schizophrenia. Staying engaged with care, taking your medication as directed, and following your providers’ recommendations can help you maintain your mental health and improve your quality of life.

Clinician's take

Being evaluated for schizophrenia can be an emotional experience. People can have a lot of apprehension regarding discussing symptoms because they may feel like they’re being judged. However, it’s important to remember that psychiatric providers are there to provide support. And talking honestly about what you’re experiencing is an important first step.

Halee Fullerton, PMHNP-BC

Clinical reviewer

Find care with Rula

Schizophrenia is a serious mental health concern. It’s characterized by a break from reality called psychosis. This typically comes in the form of hallucinations (seeing or hearing things that aren’t there) and/or delusions (false beliefs). Left untreated, schizophrenia can severely impact a person’s mental health and daily functioning. But, fortunately, it can be managed with the help of a psychiatrist and other providers. 

If you’re concerned that you or someone you care about may have schizophrenia, one of the best things you can do is seek an evaluation. A psychiatric provider can conduct a clinical assessment, issue an official diagnosis, and create a personalized schizophrenia treatment plan.

At Rula, we’re committed to delivering a comprehensive behavioral health experience that helps people feel seen and understood so they can get back to feeling their best. 

Rula makes it easier to find a licensed therapist or psychiatric provider who accepts your insurance so you don’t have to choose between affordable care and excellent care. With a diverse network of more than 15,000 providers, 24/7 crisis support, and appointments available as soon as tomorrow, we're here to help you make progress — wherever you are on your mental health journey.