Schizophrenia

Schizophrenia is a mental disorder that Encarta (2001) describes as an illness that results in delusional thought patterns, hallucinations, and inappropriate effect. It literally means "split-mind', but is not a multiple personality disorder. According to DSM-IV (1996) schizophrenia is categorized under the diagnostic code, ICD-9-CM or International Classification of Diseases, Ninth Revision, Clinical Modification of 295.xx. Symptoms of schizophrenia can be positive, which occur during the active phase, and negative, which are present before the onset of the disorder. Positive symptoms of the disease include delusions of grandeur (a belief that one is a famous admired individual), delusion of control (when they believe something wants to control them), delusions of broadcasting (belief that another can read their minds or their thoughts are being aired on the radio), delusions of persecution, and thought withdrawal (belief that their thoughts have been removed from their brain). Negative symptoms include anhedonia (the inability to feel pleasure), alogia (disorganized speech), and flat affect (when the individual does not show any emotion even in situations that strong reactions are expected).

According to the DSM-IV (1996) one must fall under these explicit categories in order to be diagnosed with schizophrenia:

A. Characteristic Symptoms: Two (or more) of the following, each present for a significant portion of time during a one-month period (or less if successfully treated):

1. Delusions

2. Hallucinations

3. Disorganized speech (e.g.. Frequent derailment or incoherence)

4. Grossly disorganized or catatonic behavior

5. Negative symptoms, i.e., affective flattening, alogia, or avolition

Note: Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person's behavior or thoughts, or two or more voices conversing with each other.

B. Social/occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement).

C. Duration: Continuous signs of the disturbance persist for at least six months. This six month period must include at least one month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms- and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

D. Schizoaffective and Mood Disorder exclusion: Schizoaffective Disorder and Mood Disorder With Psychotic Features have been ruled out because either (1) no major depressive, manic, or mixed episodes have occurred concurrently with the active-phase symptoms; or (2) if mood episodes have occurred during active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods.

E. Substance/general medical condition exclusion: The disturbance is not due to the direct physiological effects of a substance (e.g., a drug abuse, a medication) or a general medical condition.

F. Relationship to a Pervasive Developmental Disorder: If there is a history of autistic disorder or another pervasive developmental disorder, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations are also present for at least a month (or less if successfully treated).

Once an individual is diagnosed with schizophrenia they are placed into a subtype that is defined by the predominant symptomatology at the time of evaluation. These subtypes are DSM-IV classified as 295.xx.

A. 295.30 Paranoid Type: A type of schizophrenia in which the following criteria are met:

* Preoccupation with one or more delusions or frequent auditory hallucinations.

* None of the following is prominent: disorganized speech, disorganized or catatonic behavior, or flat or inappropriate affect.

B. 295.10 Disorganized Type: A type of schizophrenia in which the following criteria are met:

* All of the following are prominent: disorganized speech, disorganized behavior, and flat or inappropriate affect.

* The criteria are not met for Catatonic Type.

C. 295.20 Catatonic Type: A type of schizophrenia in which the clinical picture is dominated by at least two of the following:

* Motoric immobility as evidenced by catalepsy (including waxy flexibility) or stupor.

* Excessive motor activity (that is apparently purposeless and not influenced by external stimuli).

* Extreme negativism (an apparently motiveless resistance to all instructions or maintenance of a rigid posture against attempts to be moved) or mutism.

* Peculiarities of voluntary movement as evidenced by posturing (voluntary assumption of inappropriate or bizarre postures), stereotyped movements, prominent mannerisms, or prominent grimacing.

* Echolalia or echopraxia

NIMH (1999) reports that people with this disease are prone to perceive reality in a manner that fluctuates from the way a healthy human being perceives it. The ill individual can be one of the two extremes: catatonic or hyperactive. Furthermore, NIMH and Encarta (2001) agree that this illness is a frightening and lonely experience because of the various hallucinations, illusions, delusions, disordered thinking, and emotional expressions that plague the individual. Hallucinations are acuities that occur without the presence of a valid source. The most common hallucination schizophrenics encounter is hearing voices that others are not privy to. Although it has been documented that hallucinations can occur in any of one's five senses. An illusion is when a schizophrenic misinterprets a sensory stimulus. Delusions are a misconception of schizophrenics that vary from the norm of the culture concepts and logical reasoning, for example a schizophrenic may have delusions of grandeur,

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