What observations on a mental status exam indicate schizophrenia?

Updated: Mar 16, 2018
  • Author: Frances R Frankenburg, MD; Chief Editor: Glen L Xiong, MD  more...
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On a detailed mental status examination (MSE), the following observations may be made in a severely ill patient with schizophrenia:

  • The patient may be unduly suspicious of the examiner or be socially awkward

  • The patient may express a variety of odd beliefs or delusions

  • The patient often has a flat affect (ie, little range of expressed emotion)

  • The patient may admit to hallucinations or respond to auditory or visual stimuli that are not apparent to the examiner

  • The patient may show thought blocking, in which long pauses occur before he or she answers a question

  • The patient’s speech may be difficult to follow because of the looseness of his or her associations; the sequence of thoughts follows a logic that is clear to the patient but not to the interviewer

  • The patient has difficulty with abstract thinking, demonstrated by inability to understand common proverbs or idiosyncratic interpretation of them

  • The speech may be circumstantial (ie, the patient takes a long time and uses many words in answering a question) or tangential (ie, the patient speaks at length but never actually answers the question)

  • The patient’s thoughts may be disorganized, stereotyped, or perseverative

  • The patient may make odd movements (which may elated to neuroleptic medication)

  • The patient may have little insight into his or her problems (ie, anosognosia)

  • Orientation is usually intact (ie, patients know who and where they are and what time it is)

Persons with schizophrenia may display strange and poorly understood behaviors. These include drinking water to the point of intoxication, staring at themselves in the mirror, performing stereotyped activities, hoarding useless objects, and mutilating themselves. Their wake-sleep cycle may be disturbed.

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