Die Diagnostik bei Verdacht auf Schizophrenie ist recht umfangreich. Die Diagnose „Schizophrenie“ erfolgte auf dem Boden eines sorgfältig erhobenen psychopathologischen Befundes (systematisierte Symptomatik) unter Anwendung entsprechender diagnostischer Leitlinien und Algorithmen moderner, manualisierter Klassifikationssysteme (ICD-10 oder DSM-V). Manchmal ist die Diagnose-Stellung einer Schizophrenie erst nach einer gewissen Verlauf-Zeit möglich.
Wichtige Vorbedingungen für eine saubere (=sichere) Diagnostik der Schizophrenie sind darüber hinaus die Durchführung von Laboruntersuchungen und einer apparative Diagnostik zum Ausschluss von körperlich begründbaren Psychosen!!!
Merke:
- Das Vorliegen von Anhaltspunkten für eine Hirnerkrankung oder einer das Hirn affizierende Allgemeinerkrankung schliesst die Diagnose einer Schizophrenie aus!!!
- In der modernen operationalisierten Diagnostik sind „Zeitkriterien“ eingebaut, die erfüllt sein müssen, damit die Diagnose gestellt werden kann. Ist das Zeitkriterium nicht erfüllt, die anderen Kriterien aber schon, dann muss die Diagnose einer schizophreniformen Psychose gestellt werden!!!
Merke:
- Die ICD-10 verlangt 4 Wochen Mindestzeit einer produktiven Symptomatik
- Das DSM-IV verlangt kontinuierliche Anzeichen über mindestens 6 Monate!! Auch Negativsymptomatik zählt dazu. Zumindest einmal muss produktive Symptomatik in diesem Zeitraum aufgetreten sein.
Differentialdiagnostik
Wie oben bereits erwähnt, müssen zur sicheren Diagnose einer „Schizophrenie“ andere, symptomatisch ähnliche Erkrankungen ausgeschlossen werden. Dazu gehören:
- Körperlich begründbare Psychosen:
- Entzündliche, neoplastische, toxisch und andere (hirn-) organische Prozesse
- Andere Somatosen:
- Porphyrie
- Homozytinurie
- M. Wilson
- Hämochromatose
- Phenylketonurie
- Niemann-Pick
- M. Gaucher
- M. Fahr (Basalganglienverkalkung)
- Schizoaffektive und affektive Erkrankungen
- (Zeitkriterium für Schizophrenie nicht erfüllt)
- (schizotypisch, schizoid, paranoid oder Borderlin-Typ)
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