It is classed as a personality disorder and is considered as a heterogeneous syndrome with diverse aetiologies. It manifests itself in impaired cognitive processes, personality disintegration and affective disturbances.
In 1896, Emil Kraeplin came up with the term dementia praecox to explain manifestations of schizophrenia. According to him the 3 major sub groups were the hebephrenic, dp- catatonic/ dp and the paranoid type. Hallucinations (auditory or visual), delusions and intellectual deterioration were the main characteristics of the syndrome and it usually occurred in young people but also later in life.
Eugene Bleuer, 1950 disagreed with the time of occurrence and coined the term schizophrenia which had the same characteristics as mentioned above with the inclusion of emotional flattening or numbness to emotions one should normally react to and secondary symptoms.
For Kurt Schneider, 1959 the diagnosis of schizophrenia had to be based on abnormal experiences or disturbances in perceptions, sensations, feelings and volition. These experiences were considered as “first rank symptoms” and were pathognomonic of the disorder.
Does Schizophrenia exist?
Theories of “not schizophrenia” vary from those of Laing and Esterson (1964), Scheff (1966) and Szaz (1971).
Szaz’s idea of abnormal behaviour was that it was a labelling that was only of use to a society which did not want to have to deal with people acting differently from the norm. The hostile social climate during the 1960’s and the advance of biological thinking in psychiatry was according to Szaz the beginning of the un- necessary labelling. Psychiatric illness was social, political and legal in nature and not medical. He believed that labelling someone as schizophrenic deprived one of their liberty by institutionalizing them.
Laing, 1964 stressed on the socio- cultural relevance of medicalization of behaviour patterns. Patients had to be examined with their social environment in mind. Based on existential views from Sartre’s notion of being- in- the- world or how an individual relates to his/her surrounding world. This relation secures the person as validated and accepted but this self-consciousness carries anxiety with it and at a threatened state one retreats to schizophrenia. There is then a sense of being alone in the world.
According to Boyle, 1990 early diagnosis of schizophrenia lacked scientific technique and this caused it to be unreliable and clinically useless.
The early DSM is said to have misdiagnosed 50% of mental illness according to WHO. So the DSM- III and IV- TR narrowed the description of signs of schizophrenia. The former was more based on the broad Kraeplarian description which included characteristics such as response to somatic therapy, familial patterns an onset in early adult life and a functional impairment. The DSM- IV TR was instead influenced by Bleuer’s definition and included delusions, auditory hallucinations, disturbing in thinking, affect or speech, functional impairments and recurrence for 6 months. Responses to semi- structured assessments were also a way of diagnosing schiz.
The major symptoms a part from the above-mentioned were lack of insight, disorders of perception and attention and motor symptoms.
These symptoms are divided in positive (psychotic &disorganization; disordered thoughts, hallucinations and delusions e.g. Capgra’s Syndrome- doubles co-existing) and negative symptoms (behavioural deficits e.g. flattened effect)
The problems with such diagnosis are that there is a poor correlation between symptoms and diagnosis and also some symptoms are found in other disorders such as manic depression.
Types of schizophrenia are: the paranoid, disorganised/ hebephrenic type, the catatonic, undifferentiated and residual types
Multiple genes are responsible for making some individuals vulnerable to schiz. Kallman’s 1938 study examined over 1000 people