eMedicine Specialties > Emergency Medicine > Psychosocial

Schizophrenia: Differential Diagnoses & Workup

Author: Paul S Gerstein, MD, Attending Physician, Baystate Mary Lane Hospital Emergency Department
Contributor Information and Disclosures

Updated: Aug 18, 2009

Differential Diagnoses

Delirium, Dementia, and Amnesia
Toxicity, Acetaminophen
Depression and Suicide
Toxicity, Hallucinogen
Encephalitis
Toxicity, Mushroom - Hallucinogens
Neuroleptic Malignant Syndrome
Toxicity, Neuroleptic Agents
Panic Disorders
Toxicity, Phencyclidine
Personality Disorders
Toxicity, Sympathomimetic

Workup

Laboratory Studies

  • No specific laboratory findings are diagnostic of schizophrenia. However, performing some studies may be necessary to rule out possible organic etiologies for psychosis or to uncover complications of schizophrenia and its treatment (see Delirium, Dementia, and Amnesia).
    • Blood levels of certain psychiatric drugs, specifically lithium and the mood-stabilizing antiseizure medications (eg, valproic acid, carbamazepine), can be used to confirm compliance or rule out toxicity.
    • Serum alcohol levels and drugs-of-abuse screening can be useful when substance abuse is suspected.
    • Interpreting the results of a fingerstick blood glucose determination is a rapid and inexpensive method of ruling out a diabetic emergency masquerading as an exacerbation of a psychotic illness; similarly, measuring oxygen saturation levels can help disclose hypoxia resulting in behavioral or CNS disturbance.
    • Electrolyte measurements may reveal hyponatremia secondary to water intoxication (ie, psychogenic polydipsia). This is common in undertreated or refractory schizophrenia.
    • Laboratory abnormalities observed in neuroleptic malignant syndrome (NMS) may include leukocytosis with left shift and elevated skeletal muscle creatinine kinase (CK) and aldolase levels.

Imaging Studies

  • CT, MRI, and positron emission tomography (PET) scanning can disclose abnormalities of brain structure and function in schizophrenia. Although these studies are of interest for research, they have limited clinical relevance.

Other Tests

  • Various psychological and neurobiological tests, such as absence of smooth eye-tracking, may be helpful in studying schizophrenia but are not useful in the ED setting.

More on Schizophrenia

Overview: Schizophrenia
Differential Diagnoses & Workup: Schizophrenia
Treatment & Medication: Schizophrenia
Follow-up: Schizophrenia
References
Further Reading
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References

  1. Kaplan HI, Sadock BJ, eds. Schizophrenia. In: Comprehensive Textbook of Psychiatry. Williams & Wilkins; 1995:889-997.

  2. Wu EQ, Birnbaum HG, Shi L, Ball DE, Kessler RC, Moulis M, et al. The economic burden of schizophrenia in the United States in 2002. J Clin Psychiatry. Sep 2005;66(9):1122-9. [Medline].

  3. Malaspina D, Harlap S, Fennig S, et al. Advancing paternal age and the risk of schizophrenia. Arch Gen Psychiatry. Apr 2001;58(4):361-7. [Medline].

  4. [Guideline] American Psychiatric Association. Practice guideline for the treatment of patients with schizophrenia. 2nd ed. Feb 2004;114.

  5. Zammit S, Allebeck P, Dalman C, et al. Paternal age and risk for schizophrenia. Br J Psychiatry. Nov 2003;183:405-8. [Medline].

  6. Andreasen NC, Arndt S, Alliger R, et al. Symptoms of schizophrenia. Methods, meanings, and mechanisms. Arch Gen Psychiatry. May 1995;52(5):341-51. [Medline].

  7. APA Task Force. Schizophrenia and other psychotic disorders. In: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). American Psychiatric Association; 1994:273-315.

  8. Braff DL. Schizophrenic disorders. In: Harrison's Principles of Internal Medicine. 17th ed. McGraw-Hill; 1996:2414-17.

  9. Carpenter WT Jr, Buchanan RW. Schizophrenia. N Engl J Med. Mar 10 1994;330(10):681-90. [Medline].

  10. Chambers RA, Druss BG. Droperidol: efficacy and side effects in psychiatric emergencies. J Clin Psychiatry. Oct 1999;60(10):664-7. [Medline].

  11. Freedman R. Schizophrenia. N Engl J Med. Oct 30 2003;349(18):1738-49. [Medline].

  12. Gabbard GO, ed. Schizophrenia and other psychotic disorders. In: Treatments of Psychiatric Disorders. 2nd ed. American Psychiatric Press; 1995:944-1089.

  13. Kane JM. Schizophrenia. N Engl J Med. Jan 4 1996;334(1):34-41. [Medline].

  14. Lagomasino I, Daly R, Stoudemire A. Medical assessment of patients presenting with psychiatric symptoms in the emergency setting. Psychiatr Clin North Am. Dec 1999;22(4):819-50, viii-ix. [Medline].

  15. [Best Evidence] Lieberman JA, Stroup TS, McEvoy JP, Swartz MS, Rosenheck RA, Perkins DO, et al. Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. N Engl J Med. Sep 22 2005;353(12):1209-23. [Medline].

  16. Lucke WC. Thought and affective disorders. In: Emergency Medicine - Concepts and Clinical Practice. Mosby-Year Book; 1992:2073-80.

  17. Marder SR, Ames D, Wirshing WC, Van Putten T. Schizophrenia. Psychiatr Clin North Am. Sep 1993;16(3):567-87. [Medline].

  18. Powchik P, Schulz SC, eds. Schizophrenia. Psychiatr Clin North Am;1993.

  19. Reus VI. Schizophrenia. In: Harrison's Principles of Internal Medicine. 18th ed. McGraw-Hill; 1998:2499-2501.

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Further Reading

Clinical guidelines

 Practice guideline for the treatment of patients with schizophrenia. Second edition. American Psychiatric Association. Arlington (VA): American Psychiatric Association; 2004 Feb. 114 p. [1391 references]

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Keywords

schizophrenia, schizophrenia symptoms, schizophrenia treatment, hallucinations, schizophrenia drugs, delusions, psychosis, psychotic disorder, psychotic disorders, acute psychiatric emergencies, insanity, madness, dementia praecox, schizophrenic disorder, delusive disorder, thought disorder, chronic psychotic disorder, schizophrenia-related disorders, schizophrenia spectrum disorder

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Contributor Information and Disclosures

Author

Paul S Gerstein, MD, Attending Physician, Baystate Mary Lane Hospital Emergency Department
Paul S Gerstein, MD is a member of the following medical societies: American Academy of Emergency Medicine and Massachusetts Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Joseph A Salomone III, MD, EMS Medical Director, Kansas City, Missouri; Associate Professor and Staff Physician, Truman Medical Centers/UMKC School of Medicine
Joseph A Salomone III, MD is a member of the following medical societies: American Academy of Emergency Medicine, National Association of EMS Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Robert Harwood, MD, MPH, FACEP, FAAEM, Program Director, Department of Emergency Medicine, Advocate Christ Medical Center; Assistant Professor, Department of Emergency Medicine, University of Illinois at Chicago College of Medicine
Robert Harwood, MD, MPH, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Council of Emergency Medicine Residency Directors, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD, Professor of Clinical Medicine/Emergency Medicine, David Geffen School of Medicine at UCLA; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center
Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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