Getting diagnosed with schizophrenia and related conditions

There is no blood test or brain scan that can say "this is schizophrenia." Doctors reach the diagnosis by listening, asking questions, doing a medical check, and watching how symptoms change over time.² That takes patience, and it can feel slow when you are worried about someone you love.

This page explains how a diagnosis is made, what doctors rule out first, and how related conditions differ. The names can be confusing, so we go one at a time. If you are still learning what the symptoms look like, start with signs of schizophrenia and early psychosis.

Who can diagnose it?

A qualified mental health professional makes the diagnosis. This may be a psychiatrist, a psychologist or a clinical social worker.⁴ A primary care doctor is a good first stop. They can do a first check and refer you on.

People with a first episode of psychosis should be seen by a specialist team when possible. In the UK, guidance says that team can include a psychiatrist, a psychologist and a therapist trained in psychosis.¹⁰ In the U.S., early psychosis programs called coordinated specialty care offer this kind of team care.⁴ Read more on therapy and recovery.

Most people are first diagnosed between ages 16 and 30.¹ Men often show symptoms earlier than women. Onset after age 45 is uncommon.^3,11 Later life has its own causes to rule out, covered in psychosis and schizophrenia in later life.

What happens at the evaluation?

An evaluation usually has four parts. It may be spread over more than one visit.

1. A talk about life and symptoms. The doctor asks what you have noticed, when it began and how it affects daily life. They look at thoughts, feelings and behavior, and at mood, anxiety and past trauma.¹⁰
2. A talk about drugs, alcohol and medicines. The doctor asks about alcohol, cannabis, other drugs and all prescribed medicines, because these can cause psychosis on their own.^4,10
3. A physical exam and some tests. This looks for medical causes.^3,10
4. Input from family. A person in the middle of psychosis may not see that something is wrong. With the person's permission, family members can add helpful detail.

What do doctors look for?

Doctors use a standard list of symptoms. A person needs two or more of these, each present for a good part of a one-month period:^2,7

• Delusions (firm false beliefs)
• Hallucinations (such as hearing voices others cannot hear)
• Disorganized speech or thinking
• Very disorganized behavior, or catatonia (a state of odd, rigid or unresponsive movement)
• Negative symptoms (less emotion, speech or motivation)

At least one of the first three must be on the list.⁷ Your daily life also has to drop off, such as in work, school, relationships or self-care.²

The 6-month rule

Signs of the illness have to last at least six months for a diagnosis of schizophrenia. That time can include the early warning stage before the full symptoms and milder leftover symptoms after.^3,7 This rule helps separate schizophrenia from short episodes that clear up.

A "movie," not a "snapshot"

NAMI explains that a long view of a person's life gives a more accurate diagnosis than a single interview.² That is why doctors may follow someone over weeks or months. Records, past hospital stays and family history can all help.

Ruling out other causes

Many things can cause hallucinations, odd beliefs or confusion. Doctors rule these out before they diagnose schizophrenia.^2,4

Drugs, alcohol and medicines

Cannabis, stimulants, alcohol and some prescribed medicines can trigger psychosis.⁴ Sleep loss can too.⁴ A urine drug test is a common part of the first workup.^7,8

If psychosis starts during substance use, doctors may first call it substance-induced psychosis. It often clears when the substance leaves the body. But it can also be an early sign of a longer illness. In one large review, about 1 in 4 people diagnosed with substance-induced psychosis later received a schizophrenia-spectrum diagnosis. In a large Norwegian study over six years, the rate was higher after cannabis, 36%, and lower after alcohol, 13%.⁹ This is why close follow-up matters, even after the first episode settles. Learn more about cannabis on causes and risk factors.

Thyroid and other health problems

Thyroid problems, brain tumors and other medical conditions can look like schizophrenia.² The workup is based mostly on the history and physical exam. Common checks include:^7,8

• Blood counts and basic blood chemistry, including kidney and liver function
• A thyroid test
• A urine drug screen
• Tests for infections such as HIV and syphilis, when the history suggests a need
• Vitamin levels, such as B12 and folate

Doctors tailor the tests to each person's history. Not everyone needs every test.^7,8

Seizures, brain scans and EEG

A brain scan (MRI or CT) is not needed for everyone. Families often ask for one, but it is not a routine part of every workup. Doctors order an MRI when there are signs of a brain problem, such as focal nerve signs (for example, weakness or numbness in one part of the body) or concern about seizures.^7,8 An EEG (a test that records brain waves) may be added when a person has staring spells or loses consciousness, which can point to epilepsy.⁸ A rare cause, autoimmune encephalitis (swelling of the brain caused by the body's own immune system), is considered when psychosis comes on fast with new nerve or brain signs.⁸

Later-life causes

In older adults, psychosis can come from Parkinson's disease, Alzheimer's disease and related dementias, certain medicines, or an illness that causes confusion.⁴ See psychosis and schizophrenia in later life and our dementia section.

Conditions that look similar

The main differences are how long symptoms last and whether a mood episode is part of the picture. Doctors may change a diagnosis as time passes.

Brief psychotic disorder

This is a short episode of psychosis, lasting from a day up to a month. The person then returns to their earlier self.³ It still needs a medical check and follow-up, because it can be the first episode of a longer illness.⁹

Schizophreniform disorder

Think of this as "schizophrenia, with a clock still running." The symptoms match schizophrenia, but they have lasted for less than six months. Social and work decline is not required.³ Some people recover. Others reach the six-month mark and are re-diagnosed with schizophrenia.³ Treatment starts right away either way. You do not have to wait for the label.

Schizoaffective disorder

Here a person has symptoms of schizophrenia and a full mood episode, either depression or mania, at the same time. The mood symptoms are present for most of the illness. There must also be at least two weeks of delusions or hallucinations with no mood episode.³ Experts estimate about 0.3% of people have it at some point, or about 1 in 330.³

The line between schizoaffective disorder and other diagnoses is not always clear. NAMI notes that Black and Latino people are more likely to be misdiagnosed with schizoaffective or other psychotic disorders. Bias and limited access to culturally responsive care may play a part.² If a diagnosis does not fit, it is fair to ask questions or get a second opinion.

Delusional disorder

In delusional disorder, a person holds one or more firm false beliefs for at least a month. They have little other impairment in daily life.³ About 0.2% of people have it in their lifetime, or about 1 in 500.³ As with other psychosis, the person may not feel ill and may not seek care. Gentle, steady support from family can help. See helping a family member with psychosis.

When psychosis is part of a mood disorder

Psychosis does not always mean schizophrenia. It can also happen in severe episodes of mood disorders.

• Bipolar disorder. In severe mania or depression, some people have hallucinations or delusions. The beliefs tend to match the extreme mood. For example, during mania a person may believe they have special powers.⁵
• Psychotic depression. This is a severe form of depression that includes psychosis.⁶

NIMH points out that bipolar disorder with psychosis can be mistaken for schizophrenia. To tell them apart, clinicians review how the illness has moved over time, not just today's symptoms.⁵ The big question is whether psychosis shows up only during mood episodes or also when mood is steady. Read our pages on getting diagnosed with bipolar disorder, types of depression and bipolar disorder.

The right label matters because treatment can differ. Medicine choices for schizophrenia are not always the same as for mood disorders.

When someone does not believe they are ill

Many people with psychosis do not feel that anything is wrong. This is called anosognosia (a lack of insight that comes from the illness itself). It is not stubbornness or denial.² It can delay care and make a diagnosis harder. Family tips are on helping a family member with psychosis.

Myths about diagnosis

Questions to ask the doctor

When to get help

• See a doctor soon if you or someone close has new odd beliefs, voices, deep suspicion, withdrawal from others or a fast drop in school or work. Early care is linked to better recovery.⁴
• Call or text 988 for thoughts of suicide, or if someone seems unable to stay safe.⁴
• Call 911 if someone is in immediate danger, or if they are a danger to others.⁴
• NAMI HelpLine: 1-800-950-6264 (Monday to Friday, 10 a.m. to 10 p.m. ET) or text "HelpLine" to 62640. It offers information and referrals.⁴

You can also use our help page or a safety plan.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.