Types of Disorders
Schizophrenia

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Schizophrenia- A group of disorders characterized by loss of contact with reality, marked disturbances of thought and perception, and bizarre behavior. At some phase delusions or hallucinations almost always occur.1

Schizophrenia is among the most debilitating and and complex of the psychoses. Approximately 1% of the world population is afflicted with this mental illness.


"Emil Kraepelin first identified the illness in 1896 when he distinguished it from the mood disorders. Kraepelin believed that all psychiatric disorders were caused by organic factors, and his experience suggested to him that the onset of the disease occured early in the life of the individual. Hence, he called it dementia praecox, which means a premature deterioration of the brain." 1


Emil's thoughts were later disputed by many psychiatrists. One of these was Eugene Bleuler, an eminent Swiss psychiatrist, who, in 1911 found that the onset of the disease could in fact occur in the later years. He also reported that schizophrenia was not characterized by the progressive deterioration over the life of the patient, but rather that most patients, after an original severe deterioration, tend to stabilize and remain at the same point in their psychosis for extended periods of time. Bleuler also felt that in order to avoid any misunderstanding of the nature of the illness by the now obvious misnomer attached to it, the disease would be much better served if it was referred to as "schizophrenia." Bleuler invented the word by combining two Greek words meaning "split" and "mind." This emphasized a splitting apart of the patient's affective and cognitive functioning, which are heavily affected by the disease.


Types

There are two types of schizophrenia accordingly enumerated Type I (Reactive or Acute Schizophrenia) and Type II (Process Schizophrenia) :



Reactive or Acute Schizophrenia

Reactive schizophrenia is usually sudden and seems to be a reaction to some life crisis. Since the premorbid history is usually good, when the disease does manifest itself, it is in the early phases. Reactive schizophrenia is a more treatable form of the illness than process or chronic schizophrenia.



Process Schizophrenia

Also reffered to as poor premorbid schizophrenia, this type is characterized by lengthy periods of its development with a gradual deterioration and exclusively negative symptoms. It doesn't seem to be related to any major life change or negative event. Usually this type of schizophrenia is associated with "loners" who are rejected by society, tend not to develop social skills and don't excel out of high school.



Symptoms

Positive versus negative

The positive symptoms are things like bizarre behavior, hallucinations, or delusions. Negative symptoms refer to the absence of any adjustive behavior in the important areas of life, a chronic maladaptiveness, flatness of affect, and absence of developed interpersonal relationships (social skills).


Paranoid versus nonparanoid

These symptoms are more easily defined as the presence of heavily paranoid behavior or the absence thereof. The presence of paranoid symptoms early in the disease apparently suggests a good prognosis. There is a relationship between reactive schizophrenia and paranoid thinking.


Content of thought

The principal disturbance in the schizophrenic's thought processes is multiple delusions. This is divided into two sub-categories, persecutory delusions (in which the schizophrenic believes that he/she is being talked about, spied upon, or their death being planned) and delusions of reference (which is when the schizophrenic gives personal importance to completely unrelated incidents, objects, or people. Other common delusions include thought broadcasting (they believe their thoughts are visible to the outside world) and thought insertion, which is what most people perceive schizophrenia as consisting of (their thoughts are not their own and are in truth being inserted into their minds by some outside force). Other delusions, such as believing oneself to be Jesus, may appear in extreme cases.


Form of thought

Either schizophrenics express their thoughts in a loose manner, where ideas shift from one subject to another with seemingly no purpose, or "poverty of content," where communication is so vague, abstract, or repetitive, that it is meaningless to the listener. Made up words or illogically stringed together phrases may appear in writing or speech as well.


Perception

As we well know, the perception of the world is distorted in the experience of a schizophrenic. This may occur with any of the afflicted's senses, but most often appear as auditory, with voices in the patients head or commands from high authorities which are obeyed at high risk to others or the patient themselves. Visual hallucinations happen less often.

Affect

This symptom is easiest described as an excessive lack of corellation between what an individual is saying and what emotion they are expressing (e.g. recounting an experience of serious horror while chuckling).


Volition

Simply the occurence of paralyzation on the patient's will to act out on a decision by their ambivalence.


Sense of self

Schizophrenics generally are not aware of their individuality to an extent that they maintain a perplexity about who they are.


Relationship to the external world

Although obvious, most schizophrenics are so preoccupied with the effects of their illness that they tend to be unavailable to others, which is reffered to as autism. They don't notice the world that is happening before them.



Classes of Schizophrenia

Paranoid Schizophrenia - Patient displays the psychotic symptoms.

Undifferentiated Schizophrenia - Used when the patient's symptoms clearly point to schizophrenia but are so clouded that classification into the different types of schizophrenia is very difficult.

Residual Schizophrenia - Advised when an individual has been through at least one episode of schizophrenia (6 months) but then "recover."

Schizophreniform Disorder - Best understood as a schizophrenic disorder that has lasted for more than two weeks but less than six months. A less serious diagnosis, as it has a likelihood for the patient to return as normal member of society.






Article 1999 Orlando Rojas

HTML 1999 Katrina Spoor