Several questions regarding differential diagnosis

I am sorry for the length of this post. It's just that I have many questions which I absolutely could not find anywhere else:

1. I heard that there is a subtype of schizophrenia called the residual type when the patient suffers negative symptoms alone. What is the difference between the negative symptoms of schizophrenia and clinic depression? How can a therapist distinguish one from the other?

2. If a patient develops symptoms of the "Alice in wonderland" syndrome - i.e distorted sense of body image and objects, however the patient is not a child, doesn't suffer of Epstein Barr virus nor do the symptoms occur in accompaniment to headaches, could these account as psychotic symptoms?

3. Can post traumatic stress disorder show vivid psychotic clinical picture?

4. Is it possible for a schizophrenic to have periods of normal functioning during the course of his illness, assuming the illness is not treated?

5. If so, is it possible for him to sense by himself that something is wrong with him?

6. If a person holds a job and works long hours (12-14 hours daily) BUT is psychotic, doesn't take care of himself and fails to function on social level could this qualify as SZ or should any other mental disorder be condsidered?

7. Is self-awareness usually damaged in schizophrenia? For example, if a person was very self consciouss by means of identifying and sensing his personality changes, small as they may be, and generally sensing every internal process occuring in his mind - before the disease will  he maintain the same self consciousness when ill? If so, may this self consciousness make him realize he is ill?

8. Can a schizophrenic person identify the symptoms of an  illness in himself by reading the disease definition and by reading life stories of schizophrenics and understanding they are similar to his own life story?

Thank you for your patience, you reply and your time

You are a great help to all of us

Naomi.

[HFHS MD - RG]

Dear Naomi,

Here are the answers to your questions in the same format.

1. To diagnose schizophrenia, residual type  there should be an absence of prominent delusions, hallucinations, disorganized speech, grossly disorganized behavior. But the individual should have continuing evidence of the disturbance as indicated by the presence of negative symptoms or two or more of symptoms as listed above in an attenuated form (e.g. odd beliefs, unusual perceptual experiences).  If the individual lacks the above symptoms and only presents with depressive symptoms - flat affect, poor interest in pleasure things, etc. clinicians would deter diagnosing schizophrenia.

2. Depersonalization refers to the experience of feeling detached from one