Tips for Differentiating Schizophrenia From Underlying Mood Disorders
When a patient’s symptoms may fit the profile of several disorders, how can clinicians ensure they are accurately diagnosing schizophrenia? Filmed at the 2025 Psych Congress NP Institute in Orlando, Hara Oyedeji, APRN, PMHNP-BC, MSEd, offers practical tips for differentiating schizophrenia from underlying mood disorders, medication side effects, or other under-treated conditions. With a focus on acting swiftly to prevent treatment-resistant disease, Oyedeji encourages clinicians to use all of the clinical tools at their disposal to best understand the symptoms presented before them.
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Read the Transcript
Hara Oyedeji, APRN, PMHNP-BC, MSEd: Hello, my name is Hara Oyedeji. I am a psychiatric nurse practitioner out of Baltimore, Maryland, and I have my Master of Science in Nursing and also a Master of Science in Education, so I am an educator first and foremost. I have my own group practice, Fortitude Wellness Group, and I absolutely love being able to interact, teach, and work with fellow nurse practitioners.
Psych Congress Network: How can clinicians differentiate whether their patient’s symptoms are part of an underlying mood disorder, a side effect, or related to inadequately treated psychosis—and how does that influence treatment decisions?
Oyedeji: It's really important that we understand what's presented before us. We have a duty to understand the symptomology for different disorders, and it makes a difference in terms of the history that you're obtaining. One of the things that nurse practitioners, physicians assistants (PAs), advanced practice providers (APPs), it's important that we understand we're not just prescribers, as clinicians, we're also private investigators. We have to utilize different tools and resources to get the information that we need because that history is going to be such a huge piece in terms of where we think this diagnosis may lie. There isn't always a black and white when you're looking at mental health psychiatry. There is a lot of gray. Oftentimes our patients are not the best historians or informants of collateral information, so we have a duty to what is the history, what are the symptoms that are there, and the differentiation is really understanding the differences.
It's very possible that patients might really be with a mood disorder instead of schizophrenia. We understand psychotic symptoms can present themselves during episodes of mania. So having a full scope and better context as much as we can, as much as possible, helps us so that we can help our patients. It can also help us not provide incorrect medications. If you have a more accurate diagnosis, it allows you to tailor your medication management appropriately.
Furthermore, it's important because we talk about time lost. You run the risk of having treatment-resistant disease every time a patient is experiencing another episode, and oftentimes patients experience those because they're not getting the right medications for the right diagnosis. So screenings are huge. I would encourage you to get to know and make sure you're providing a Patient Health Questionnaire-9 (PHQ-9) and that you're screening for mood disorders, especially when you're suspecting that you could be seeing schizophrenia. That may very well be the case, so make sure you're utilizing your actual evidence-based tools and instruments as part of your assessment.
Hara Oyedeji, APRN, PMHNP-BC, MSEd, is a board-certified psychiatric nurse practitioner currently working in outpatient care with experience in inpatient and psychiatric hospital settings. She serves as owner, clinician and clinical preceptor in her private group practice, Fortitude Wellness Group, and is the Chief Operating Officer and Medical Director of a CARF accredited Outpatient Mental Health Clinic, Greater Chesapeake Health and Wellness in Baltimore City. Hara completed her undergraduate degree at Rutgers University and her Master’s degree in education from Monmouth University in New Jersey. She completed her Master’s degree in nursing from the University of Maryland with her Post-Master's training as a psychiatric mental health nurse practitioner from Drexel University.
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