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Schizophrenia Workup

  • Author: Frances R Frankenburg, MD; Chief Editor: Glen L Xiong, MD  more...
Updated: Jun 24, 2016

Approach Considerations

Information about the medical and psychiatric history of the family, details about pregnancy and early childhood, history of travel, and history of medications and substance abuse all are important. This information is helpful in ruling out other causes of psychotic symptoms.

The findings from a general physical examination are usually noncontributory. This examination is necessary to rule out other illnesses.

It is sometimes helpful to perform a neurologic examination as a baseline before initiating antipsychotic medications, because these drugs themselves can cause some neurological signs. Some patients with schizophrenia have motor disturbances before exposure to antipsychotic agents. Schizophrenia has been associated with left and mixed handedness, minor physical anomalies, and soft neurologic signs.

Schizophrenia is not associated with any characteristic laboratory results. The following should be performed on all patients, both at the beginning of the illness and periodically afterward, to rule out other or concomitant illnesses:

  • Complete blood cell (CBC) count
  • Liver, thyroid, and renal function tests
  • Electrolyte, glucose, vitamin B-12, serum methylmalonic acid, folate, and calcium levels
  • Pregnancy testing (if the patient is a woman of childbearing age)
  • Urine testing for drugs of abuse, such as alcohol, cocaine, opioids, cannabis
  • Urine for culture and sensitivity (to look for urinary tract infection)
  • Brain imaging to rule out subdural hematomas, vasculitis, cerebral abscesses, and tumors

Other tests to consider, if the history provides any reason for suspicion (see Differentials), are as follows:

  • Urine and serum copper and ceruloplasmin - If a strong suspicion of Wilson disease exists, consider a liver biopsy (or multiple biopsies)
  • Twenty-four-hour urine collections for porphyrins, copper, or heavy metals
  • Dexamethasone suppression test for hypercortisolism; corticotropin stimulation test for hypocortisolism, morning cortisol
  • Rapid plasma reagin (RPR) - If a strong suspicion of neurosyphilis exists, specific treponemal tests may be helpful
  • HIV antibodies
  • Lyme antibodies
  • Antinuclear antibody (ANA) for systemic lupus erythematosus
  • Chest radiography to rule out pulmonary illness or occult malignancy
  • Electroencephalography (EEG)

Some experts suggest that a lumbar puncture be performed to examine cerebrospinal fluid, especially to rule out inflammatory and infectious CNS disorders. 

Neuropsychological testing may be considered; determination of the patient’s cognitive weaknesses and strengths can be helpful in treatment planning. Common findings in patients with schizophrenia are as follows:

  • Poor executive functioning (ie, poor planning, organizing, or initiation of activities)
  • Impaired memory
  • Difficulty in abstraction and recognizing social cues
  • Easy distractibility
Contributor Information and Disclosures

Frances R Frankenburg, MD Professor, Department of Psychiatry, Boston University School of Medicine; Chief of Inpatient Psychiatry and Consulting Psychiatrist, Edith Nourse Rogers Memorial Veterans Administration Medical Center; Associate Psychiatrist, McLean Hospital

Frances R Frankenburg, MD is a member of the following medical societies: Alpha Omega Alpha, American Psychiatric Association

Disclosure: Nothing to disclose.

Chief Editor

Glen L Xiong, MD Associate Clinical Professor, Department of Psychiatry and Behavioral Sciences, Department of Internal Medicine, University of California, Davis, School of Medicine; Medical Director, Sacramento County Mental Health Treatment Center

Glen L Xiong, MD is a member of the following medical societies: AMDA - The Society for Post-Acute and Long-Term Care Medicine, American College of Physicians, American Psychiatric Association, Central California Psychiatric Society

Disclosure: Received royalty from Lippincott Williams & Wilkins for book editor; Received grant/research funds from National Alliance for Research in Schizophrenia and Depression for independent contractor; Received consulting fee from Blue Cross Blue Shield Association for consulting. for: Received book royalty from American Psychiatric Publishing Inc.


Ronald C Albucher, MD Chief Medical Officer, Westside Community Services; Consulting Staff, California Pacific Medical Center

Ronald C Albucher, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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Cortical activation patterns during verbal working memory maintenance. Healthy controls (A), patients with schizophrenia (B), and significantly different activation between groups (subtraction of SZ-CO) (C) are shown. The time series plots in the middle column show activation associated with true memory maintenance (red lines) relative to the baseline activities (blue line). Bright parts in the middle of each plot represent 1-volume (1.5 s) after onset, and offset of the maintenance phase (4.5 secs). All p-values are corrected with false discovery rate of q< 0.005. Image courtesy of Kim J, Matthews NL, and Park S. An event-related fMRI study of phonological verbal working memory in schizophrenia. PLoS One. 2010; 5(8): e12068.
Cortical activation patterns during false memory trials. (A) False memory, baseline in controls (CO). (B) False memory, baseline in schizophrenia (SZ). (C) SZ – CO. All p-values are corrected with a false discovery rate of q< 0.005. The time course plots show false memory-related activities (yellow) and true memory-related activities (red) relative to the baseline (blue). Image courtesy of Kim J, Matthews NL, and Park S. An event-related fMRI study of phonological verbal working memory in schizophrenia. PLoS One. 2010; 5(8): e12068.
Magnetic resonance imaging showing differences in brain ventricle size in twins. The twin on the right has schizophrenia, whereas the twin on the left does not. Image courtesy of Dr. Daniel Weinberger, Clinical Brain Disorders Branch, National Institutes of Health.
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