Schizophrenia: An Altered Health State

Schizophrenia is a chronic, severe and debilitating psychiatric illness. It is a term (replacing older designation "dementia praecox") to indicate a group of psychological disturbances or mental disorder occurring in different combinations and degrees of symptoms but generally having in common disturbances of feeling, thought and relationship to the outside world. It is a severe psychiatric disturbance affecting many areas of an individual's functioning, including thought processes, perceptions, emotional affect, motivation, and even bodily movement1. It is a functional psychosis of uncertain etiology which is often a chronic disorder and, in spite of advancements in treatment, still becomes disabling2. Schizophrenia is not "split personality". The word schizophrenia from "split" (schism) and "mind" (phrenos) has the literal meaning as "splitting of mind" but is different from multiple personality disorder, with another type of diagnosis.

Schizophrenia affects 1% of the world's population. An additional 2% to 3% has a milder form of the disease, called schizotypal personality disorder3.The one-year prevalence of treated schizophrenia (the population proportion in contact with the psychotic services with the diagnosis of schizophrenia at any time during the year) is between 0.2% and 0.4% while the annual inception rate (the rate which new cases occur during a year) is about 0.015%. The prevalence of schizophrenia is greatest in the lowest socio-economic class of the population, because of the effects of the illness lead to a drift down the social welfare for many patients.

There are several types of Schizophrenia. The simple type is marked by insidious reduction of intellectual and emotional life and social attachments. The withdrawal is not related to discernible precipitating events, begins during early adolescence, and represents a quiet and unremarkable withdrawal into autistic fantasy. The hebephrenic type, named after the Greek god Zeus' daughter Hebe, who sipped the wine she was bearing and slipped into a state of silly giggling and exuberance. It is characterized by disorganized thinking and inappropriate affect and regressive behavior. The catatonic type is divided into two parts. The excited type is marked by stupor, autism, uncomfortable postures and automatism. The paranoid type is identified primarily by the presence of persecutory or grandiose delusions. The onset is typically later in life than most other subtypes, with new cases appearing in their thirties and forties. Acute Schizophrenic episode is characterized by acute onset, associated with confusion, perplexity, emotional distress, excitement, and fear. The latent type is referring to individuals who "have clear symptoms of schizophrenia but no history of psychotic schizophrenic episode"4.The residual type is applied to someone who shows signs of the illnesses but due to the limited psychotic schizophrenic period, it is no longer psychotic. The schizo-affective type is referring to individuals who evidence a mixture of schizophrenic symptoms with pronounced elation or depression. The childhood type refers to cases which symptoms of the disease can be observed to patients under the stage of puberty. Signs may include autistic and withdrawn behavior, failure to developmental inadequacy. The chronic undifferentiated type applies to patients who present a mixed picture of definite signs of schizophrenic thought, affect, and behavior not classifiable under the other subtypes, and who have been diagnosed as schizophrenic for several years.

A Swiss researcher Eugen Bleuler5 who published his work, Dementia Praecox or the Group of Schizophrenias, made a study about its origin and manifestation. He also added that the intellectual deterioration characteristic of dementia praecox was not similar to that observed in organic disorders, that many patients were capable of selected areas of highly complex thought and function6. He also added that the heterogeneity of symptoms associated with schizophrenia, and at times suggested that the disorder might be discovered to be caused by a group of closely related diseases rather than a single organic disease process.

The concept is best understood historically. Until German psychiatrists began their careful clinical studies with long term follow up in the 19th century, most of the mentally ill were lumped together as insane'. Many died such illnesses as syphilitic General Paresis or because of lack of care or from concurrent infection; a great many deteriorated; and some recovered. By the end of the 19th century, building the work of omay others, Kraepelin had firmly established two major groups among those who did not die of organic brain disease - Manic Depressive illnesses and Dementia Praecox. They were distinguished essentially by finding that the manic depressives recovered, although they often relapsed; while the Dementia Praecox did not, ending up in a characteristic end state despite rather widely varying patterns of early illness. The essential difference was therefore prognostic7. Late Bleuler suggested the name 'the schizophrenias', and broadened the concept, leading the way to include patients who did not necessarily end up 'demented', but who share some of the characteristic signs and symptoms on the onset. .

Important differences exist among patients with Schizophrenia's characteristic cluster of signs and symptoms, and providing a clear demarcation between this illness and other types of madness has proved difficult. Although schizophrenia had many names (stupidity, foolishness, vesania, idiocy, insanity of puberty, monomania, paranoia, etc) early clinicians described the characteristics of family origin, endogenous cause, early onset, remitting of progressive course, bizarre ideation, dissociation of thought and emotion, and social withdrawal, thus moving toward a useful psychiatric classification by using a criteria of symptomatology, course, and outcome.

There are two types of symptoms in Schizophrenia - the positive symptoms (such as conceptual disorganization, delusions, or hallucinations) or negative symptoms (loss of function, anhedonia, decreased emotional expression, impaired concentration, and diminished social engagement. The two negative symptoms anhedonia and affective flattening were the strongest independent predictors of negative outcome, and patients with the poorest long-term outcome tended to show an increase in negative symptoms during the early years of their illness. Early and progressive negative symptoms may signal a process leading to long-term disability.

Delusions and Hallucinations are also considered as positive symptoms of Schizophrenia. Delusions do occur in psychotic conditions, although much less often than in schizophrenia. They have little diagnostic

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