Schizophrenia – Diagnostic Interview

• Tell me what symptoms of schizophrenia you have? (If patient tells you diagnosis. It also gives an understanding of insight)
• It is not unusual/Sometimes when people are stressed they can have strange experiences. Have you ever experienced this?
• Can you give me some examples?

1. Assessment of Hallucinations

• Have you ever heard voices/people talking about you when no-one else is around/you are on your own? (Auditory hallucinations)
• Where do they come from – from inside your head or through your ears?
• Do they talk directly to you or about you? (2nd or 3rd person)
• How often do you hear them?
• How do they affect you?
• If I were to hear them what would I hear?
• Can you tell me exactly what they say?
• Do they ever comment on your actions? (Running Commentary is a First Rank Symptom)
• Do they ever tell you to harm yourself or others? (Important: Risk, Command hallucinations)
• Have you had any strange tastes, smells or visions, lately? (Hallucinations in other modalities)

2. Assessment of Thought

• Have you ever felt/Do you feel like your thoughts are being interfered with….. (pause)…… like thoughts being put into your head? (Thought insertion)
• Thoughts being taken out of your head (Thought withdrawal)
• Thoughts broadcasted to other people so that they know what you are thinking (Thought broadcasting)
• Have you ever felt under the control of someone else other than yourself?
• Have you ever felt like your actions, feelings or urges are being controlled by some external force? (Passivity phenomenon)
• Have you felt any strange sensations in your body? (Somatic passivity)
• Have you felt that people on the radio or TV. were talking about you in their reports, or giving you special messages? (Ideas or Delusions of Reference)
• Do you ever receive any special messages from books, radio or TV that are specifically meant for you? (Paranoid bizarre delusions)
• Do you ever feel like you are being spied upon like someone is following you or conspiring against you? (Persecutory Delusions)
• Do you ever feel like you are being watched by cameras or special devices? (Persecutory Delusions)
• How did it start? (To establish delusional perception)

Relevant resource: Understanding Schizophrenia – Linking Neurobiology to Clinical Symptoms

• Olfactory, Visual and Tactile Hallucinations can signal an organic cause. Temporal lobe epilepsy can occur with such hallucinations and is an important differential diagnosis for Schizophrenia.Read more: 
  1. How to Diagnose Schizophrenia? 
  2. Understanding the Neurobiology of Schizophrenia – Linking neurobiology to clinical symptoms
  3. Management of Schizophrenia
  4. Simplified Guide to Oral Antipsychotics 
• Negative symptoms are difficult to assess from direct questioning. Ask “Take me through a normal day”. Anhedonia and amotivation can be inferred from this answer. Collateral and MSE may be required for other features of alogia (reduced speech), abulia (lack of initiative), asociality and blunted affect.
• Physical examination is a must as Extrapyramidal side effects (EPSE) can result in secondary depression or negative symptoms.