SCHIZOPHRENIA

Schizophrenia

Schizophrenia

Introduction

Schizophrenia is perhaps the most complex, severe, and devastating of all mental illnesses. It can manifest in many different ways and forms. People with schizophrenia can exhibit, for example, a wide combination of psychotic symptoms, behavioral disorganization, and deficits in motivation and affective expression. Schizophrenic individuals may also show a variety of cognitive impairments. All of these symptoms interfere with the person's day-to-day social and occupational functioning. Schizophrenic signs and symptoms typically wax and wane across time and circumstances. Some people with schizophrenia, for example, have periods of time when they think clearly and can function in the community, and other times when their thinking and speech become unclear, and they may lose touch with reality and require psychiatric hospitalization. In other cases, symptoms are refractory and severe enough to result in chronic impairment and major life disruption (Shean, 2004).

Diagnostic Origins

In 1883, German psychiatrist Emil Kraepelin developed what is often considered the most comprehensive description of schizophrenia. He used the term dementia praecox to describe two important aspects of the disorder: an early onset, typically between 16 and 25 years old (praecox) and a progressive deteriorating course (dementia). Eugen Bleuer, a contemporary of Kraepelin, greatly broadened the definition of dementia praecox and renamed it schizophrenia, from the Greek words schizein, which means “to split,” and phrenos, which means “mind.” Bleuer believed that in schizophrenia, one's mental associations, thoughts, and emotions, which are usually integrated with one another, are loosened or split. Today, our conceptualization of the disorder (e.g., in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 4th edition, or in the World Health Organization's International Statistical Classification of Diseases and Related Health Problems, 10th revision) is research based, more reliable and valid than in the past, and much closer to Kraepelin's description of dementia praecox even though the term schizophrenia was retained.

Descriptive Features

No single symptom is characteristic of schizophrenia. The diagnosis requires the presence of a number of behavioral and social deficits that significantly impact the functioning of the individual. Characteristic symptoms fall into three broad categories: positive symptoms, disorganized symptoms, and negative signs and symptoms. Positive symptoms reflect an excess of normal functions, such as delusions and hallucinations.

Delusions are defined as beliefs that are both untrue and uncharacteristic of the individual's culture. They can be categorized as persecutory, somatic, referential, or grandiose. Hallucinations are sensory perceptions in the absence of an external stimulus, and can occur in any sensory modality—auditory, visual, tactile, olfactory, and gustatory. Auditory hallucinations are the most commonly experienced type of hallucination in schizophrenia and are perceived as one or more voices distinct from one's own thought (Suddath, 2000).

Disorganized symptoms include speech that is hard to follow and confused motor behavior. Speech may become so disorganized that the individual is almost incoherent and communication is severely impaired. Disorganized or catatonic motor behavior is exhibited in problems with goal-directed behavior, which lead to declining maintenance of activities of daily living as well as inappropriate and/or unpredictable ...