1. What is the decision or change (e.g., clinical topic, practice guideline, system design, delivery of care) you are facing or struggling with where a summary of the evidence would be helpful?
Develop evidence and criteria for diagnostic testing for paranoid schizophrenia by compiling data from existing imaging and possibly lab results from validated sources. Persons with paranoid schizophrenia have a highly unique and unusual condition often compounded by anosognosia, devastating every aspect of ordinary life, and a medical and legal system based on the DSM-5 and decades old observation-based diagnostic criteria. Development of any diagnostic criteria based on physical test results would be free from the high-risk of observation-based diagnosis as evidenced in the many persons who receive multiple and disparate diagnosis. In the last 10 to 20 years, never before available advances in technology has generated data from multiple valid sources. The data is waiting to be compiled, analyzed, and to possibly reveal never considered patterns and nuances for development into much more reliable diagnostic criteria.
Focusing on the one diagnosis of paranoid schizophrenia, within the spectrum of psychotic disorders, could help diagnostic indicators be discerned from the already vast amounts of existing study and clinical data from the use of FMRI, SPECT and PET scans. Possibly a review of newer atypical anti-psychotics and possible measurable changes in brain neurotransmitters/biochemistry could reveal potential measures for laboratory testing. There may be reliable data from sleep studies or other forms of remote monitoring. Some current researchers are searching for genetic origins or other causes of schizophrenia, but this report’s focus should be on diagnosis of patients with paranoid schizophrenia.
2. Why are you struggling with this issue?
Diagnostic criteria for paranoid schizophrenia has not developed in decades, and may be held back that by the current standard which is still observation based. Limitations of observation and eye witness accounts are confirmed to be high-risk for all manner of important decision making. Observation based diagnosis requires the patient to be actively exhibiting, over multiple occasions and extended time, outwardly visible positive symptoms so acute and alarming as to cause a response an observer, who must also be in a position of authority (such as a licensed medical person or police officer). Identifying any physical marker for paranoid schizophrenia would accomplish reduced delays and increased accuracy as a diagnostic tool. Gathering the data from physical testing could reveal information to transform schizophrenia into a physical disorder with psychiatric symptoms, much like what has changed for all aspects of Alzheimers and dementia care.
Even with or without recognizable and fixed symptoms of anosognosia, persons with paranoid schizophrenia are caught in a terrible catch 22 of being legally responsible to choose, plan and guide their own medical care, while also being utterly incapable of choosing and guiding their own medical care. Confirming the useful validity of diagnostic tools which already exist, is the only path to relieve the extreme consequences of anosognosia, visual and auditory hallucinations, and utterly debilitating delusions which require high levels of costly care (not profitable). Whether by accident or design, many persons with paranoid schizophrenia are excluded from any system of care to remain untreated, undiagnosed, no family, no friends, no home, and often not even able to access services available for persons dumped to the streets. Any identified physical indicator, whether specific or a range of probability, would utterly redefine diagnosis, treatment, care, courts, incarceration, stigma, SAMSHA text, policy, and every other aspect of schizophrenia care.
Many people with paranoid schizophrenia are not diagnosed unless and until that person becomes an actual danger to self or others. Then that person may still not be correctly diagnosed if not enough evidence and observation through time had been documented for the current observation-based diagnostic criteria of 6 months or more of positive symptoms. The person with a future diagnosis of paranoid schizophrenia must live in continuous catastrophe waiting for an observation-based diagnosis. If imaging or other physical testing could be used for diagnosis, whether definitive or probable, diagnosis could be accomplished at the first intervention involving danger, or even at early indications of severe disorder in a person’s life. Diagnosis would be available in an emergency departments, by an order from a pediatrician or primary care provider, or any other healthcare provider or authority a struggling person or family may approach for help.
3. What do you want to see changed? How will you know that your issue is improving or has been addressed?
Many people with paranoid schizophrenia are not diagnosed unless and until that person becomes an actual danger to self or others. Then that person may still not be correctly diagnosed if not enough evidence and observation through time had been documented for the current observation-based diagnostic criteria of 6 months or more of positive symptoms. The person with a future diagnosis of paranoid schizophrenia must live in continuous catastrophe waiting for an observation-based diagnosis. If imaging or other physical testing could be used for diagnosis, whether definitive or probable, diagnosis could be accomplished at the first intervention involving danger, or even at early indications of severe disorder in a person’s life. Diagnosis would be available in an emergency departments, by an order from a pediatrician or primary care provider, or any other healthcare provider or authority a struggling person or family may approach for help.
Most persons diagnosed with paranoid schizophrenia are only treated intermittently, not through the medical system, but through reluctant intervention of law enforcement and the courts. Identification of useful imaging, or lab tests (beyond urinalysis), and corresponding diagnostic criteria, could even become part of screening for persons exhibiting certain maladaptive behaviors, offering early identification and intervention, all before the worst happens. Currently the system still requires collapse into the worst and years of suffering before diagnosis, and still more years if effective care is ever rendered. Persons with paranoid schizophrenia are some of the world’s most perfect victims of other people’s and institution’s discrimination, fear, forced homelessness, avoidance, isolation, diminishment, victim-blaming and are often left to become targets of crime. This focus on diagnosing a single type of schizophrenia could remake current systems of diagnosis, care, and legal status for all DSM-5 disorders that include psychosis.
4. When do you need the evidence report?
Tue, 03/31/2026
5. What will you do with the evidence report?
An analysis report of current data could be distributed using ordinary existing processes available within AHRQ, NIH, CMS, etc. and be distributed and used by all physician associations, government policy makers, clinical and practice guidelines, coverage policy, advocacy organizations and every other entity or person looking for current and valid information. The report would be useful in decision making for caregivers, medical treatment, origin or cause of schizophrenia, onset of schizophrenia, healthcare payers, insurance coverage, program planners, housing planners, facility commitment, legal status, disability status, and in evaluation of danger to self and others. This report could also help protect patients and their community from the consequences of undiagnosed and undertreated paranoid schizophrenia.
Optional Information About You
What is your role or perspective? Caregiver, and employee of a healthcare payer.
May we contact you if we have questions about your nomination? Yes
