How Is Schizophrenia Diagnosed?
Mental Health ConditionsSchizophrenia
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Schizophrenia Diagnosis

While there’s no single test for diagnosing schizophrenia, mental health professionals can diagnose schizophrenia in a number of ways.
Schizophrenia Diagnosis
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Published on March 28, 2025
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Schizophrenia is a chronic, disabling psychiatric condition that causes symptoms like hallucinations and delusions. Early diagnosis and treatment are very important for managing symptoms before major complications arise and for a better long-term prognosis.

But diagnosing schizophrenia can be challenging for several reasons.

No single test can diagnose schizophrenia. Instead, it’s diagnosed by evaluating a person’s symptoms over several months and ruling out other possible health conditions. Use of certain drugs like methamphetamine or LSD can cause symptoms resembling schizophrenia. Schizophrenia also can have similar symptoms to other psychiatric conditions, such as bipolar disorder. This can result in misdiagnosis and inappropriate treatment in some cases.

Diagnosing and treating schizophrenia is further complicated by the fact that many with schizophrenia aren’t aware they have it. This symptom, called anosognosia or “lack of insight,” can make helping people with the condition more difficult.

Factors like these can lead to delays in proper diagnosis and treatment, which can cause worsened symptoms, physical health problems, or early death. But a timely and correct diagnosis significantly boosts a person’s odds of managing their symptoms and recovering.

Illustrative graphic titled How Is Schizophrenia Diagnosed? shows The following can help diagnose schizophrenia: Mental Health Exam, Physical Health Exam, Lab Tests and Screenings. Everyday Health logo
Your mental health provider will use this information to determine a diagnosis.Everyday Health

How Is Schizophrenia Diagnosed?

Schizophrenia is usually diagnosed by a mental health professional, such as a psychiatrist.

The condition usually follows a progression. Schizophrenia often starts with a prodrome, or early, mild symptoms indicating the onset of the condition, such as changes in behavior including cognitive difficulties, social withdrawal, paranoid or suspicious thoughts, or sleep disturbances. A diagnosis is usually made once the condition progresses to first-episode psychosis, a symptom of schizophrenia that involves hallucinations (seeing or hearing things that aren’t there) and delusions (steadfast false beliefs that are clearly untrue to everyone around them).

Getting a correct schizophrenia diagnosis typically involves the following steps:

Mental Health Evaluation

Your healthcare provider will perform a mental health evaluation to assess your symptoms. They do this by asking you or your loved ones questions about your health, observing your behavior, and noting your reported symptoms. Some of their questions will be aimed at ruling out other conditions that could be causing your symptoms. They will then compare this information to established criteria for a schizophrenia diagnosis.

The criteria are outlined in the Diagnostic and Statistical Manual of Disorders, Fifth Edition (DSM-5), which is a guide used by professionals to diagnose mental health conditions. The criteria needed to be diagnosed with schizophrenia are:

  • You have at least two of the five main symptoms of schizophrenia.
  • You’ve had symptoms for one month or more.
  • Your symptoms affect your ability to work or maintain relationships.
The five main symptoms of schizophrenia are:

  • Delusions Strongly held false beliefs that are clearly untrue, such as believing that someone is controlling your thoughts.
  • Hallucinations Seeing, smelling, hearing, feeling, or tasting things that don’t actually exist. This can include hearing voices, for example.
  • Disorganized or Incoherent Speech Having problems organizing your thoughts when you speak, making it difficult for others to understand what you are saying.
  • Disorganized or Unusual Movements You move in ways that are unusual to others, such as moving excessively for no apparent reason or not moving much at all.
  • Negative Symptoms Negative symptoms refer to the absence of expected ways of interacting with your surroundings. Examples include having little facial expression or speaking without any emotion in your voice.

Physical Evaluation

A physical exam for schizophrenia includes assessing your general appearance, such as hygiene and grooming. This gives your doctor a picture of your self-care habits. It also includes obtaining a set of vital signs, such as blood pressure and heart rate, to screen for any underlying health problems.

Your doctor may also take your height, weight, and body mass index (BMI) as part of your physical examination.

Lab Tests and Screenings

Your mental health provider may also order laboratory or imaging tests to help rule out other conditions with similar symptoms. These tests may include:

  • Drug and Alcohol Screening This helps confirm or rule out the use of alcohol or drugs like LSD or methamphetamines, which can cause schizophrenia-like symptoms.

  • Blood Tests Blood tests help assess your kidney function, liver function, electrolyte levels, and other clinical data.

  • Magnetic Resonance Imaging (MRI) or Computerized Tomography (CT) These imaging scans are used to gather detailed images of the brain.

Creating a Care Team for Your Loved One Living With Schizophrenia

Creating a Care Team for Your Loved One Living With Schizophrenia

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Other Conditions That Can Resemble Schizophrenia

As mentioned, healthcare providers need to rule out other conditions that can cause symptoms resembling schizophrenia. These include:

  • Schizoaffective Disorder Schizoaffective disorder is a psychiatric condition that shares some symptoms of schizophrenia, such as delusions and hallucinations, but also involves mood symptoms, such as mania or depression.

  • Bipolar Disorder With Psychotic Features Bipolar disorder is a mood disorder involving alternating manic, hypomanic, or depressive mood episodes (periods of intense emotional states). Like schizophrenia, bipolar disorder can also involve episodes of psychosis.

  • Major Depressive Disorder With Psychotic Features Major depressive disorder (aka depression) is a mood disorder involving persistent depressed mood, loss of interest or pleasure in activities once enjoyed, and other symptoms. In some cases, major depressive disorder can involve episodes of psychosis.
  • Delusional Disorder Delusional disorder is a psychiatric condition that involves delusions, but doesn’t involve other typical symptoms of schizophrenia like hallucinations or disorganized speech.
  • Substance-Induced Psychotic Disorder Substance-induced psychotic disorder is a form of psychosis caused by starting or stopping drug or alcohol use, especially during periods of intoxication or withdrawal.

     As mentioned, using drugs such as methamphetamines or LSD can cause symptoms similar to schizophrenia. Methamphetamine use can cause hallucinations and paranoia.

     LSD can cause hallucinations and a disconnect from reality.

The Takeaway

  • Diagnosing schizophrenia can be challenging, as its symptoms can resemble those of other mental health conditions, and many with schizophrenia aren’t aware they have it.
  • Delays in diagnosis can lead to worsened symptoms, physical health issues, or early death, but early diagnosis and treatment can improve prognosis.
  • A physical exam, mental health exam, lab tests, and sometimes imaging tests are needed to get an accurate diagnosis.

Resources We Trust

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Schizophrenia: Symptoms & causes. Mayo Clinic. October 16, 2024.
  2. Schizophrenia. National Alliance on Mental Illness.
  3. Ayano G et al. Misdiagnosis, detection rate, and associated factors of severe psychiatric disorders in specialized psychiatry centers in Ethiopia. Annals of General Psychiatry. February 2021.
  4. Schizophrenia: Diagnosis & treatment. Mayo Clinic. October 16, 2024.
  5. Diagnosing Schizophrenia. New York University Langone Health.
  6. Schizophrenia. Cleveland Clinic. December 11, 2024.
  7. DSM-IV to DSM-5 Schizophrenia Comparison. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health. June 2016.
  8. Hany M et al. Schizophrenia. StatPearls. March 6, 2025.
  9. Fochtmann LJ et al. Performance in Practice: Practice Assessment Tool for the Care of Patients With Schizophrenia. Focus. November 6, 2020.
  10. Schizoaffective Disorder: Symptoms & causes. Mayo Clinic. June 5, 2024.
  11. Bipolar Disorder. National Institute of Mental Health. December 2024.
  12. Substance-Induced Psychotic Disorder. Sheppard Pratt.
  13. Substance use - LSD. Mount Sinai.
  14. Matta N. Meth Addiction: Signs, Effects, and Treatment. American Addiction Center. November 21, 2024.
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Angela-Harper-bio

Angela D. Harper, MD

Medical Reviewer
Castle Connolly Top Doctor

Angela D. Harper, MD, is in private practice at Columbia Psychiatric Associates in South Carolina, where she provides evaluations, medication management, and psychotherapy for adults.  

A distinguished fellow of the American Psychiatric Association, Dr. Harper has worked as a psychiatrist throughout her career, serving a large number of patients in various settings, including a psychiatric hospital on the inpatient psychiatric and addiction units, a community mental health center, and a 350-bed nursing home and rehab facility. She has provided legal case consultation for a number of attorneys.

Harper graduated magna cum laude from Furman University with a bachelor's degree and cum laude from the University of South Carolina School of Medicine, where she also completed her residency in adult psychiatry. During residency, she won numerous awards, including the Laughlin Fellowship from the American College of Psychiatrists, the Ginsberg Fellowship from the American Association of Directors of Psychiatric Residency Training, and resident of the year and resident medical student teacher of the year. She was also the member-in-training trustee to the American Psychiatric Association board of trustees during her last two years of residency training.

Harper volunteered for a five-year term on her medical school's admission committee, has given numerous presentations, and has taught medical students and residents. She currently supervises a nurse practitioner. She is passionate about volunteering for the state medical board's medical disciplinary commission, on which she has served since 2015.

She and her husband are avid travelers and have been to over 55 countries and territories.

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Shelby House, RN, BSN

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Shelby House, RN, BSN, has been a registered nurse for almost 10 years. She currently serves as a nursing director for a program that provides healthcare services to underserved Missourians, specifically aiding those with mental health disorders in achieving their best state of physical health.

She received her bachelor's degree in nursing from Maryville University in Missouri. She has worked in the specialty areas of medical-surgical nursing, cardiopulmonary rehabilitation nursing, mental health nursing, and nursing leadership.

Outside of the office, Shelby enjoys spending time with her husband and two young children, volunteering in her local community, and soaking up the countryside scenery of rural America where she lives.

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