Schizophrenia Health Article

Definition

Schizophrenia is a psychotic disorder (or a group of disorders) marked by severely impaired thinking, emotions, and behaviors. Schizophrenic persons are typically unable to filter sensory stimuli and may have enhanced perceptions of sounds, colors, and other features of their environment. Most schizophrenics, if untreated, gradually withdraw from interactions with other people, and lose their ability to take care of personal needs and grooming.

Description

The course of schizophrenia in adults can be divided into three phases or stages. In the acute phase, a person has an overt loss of contact with reality (psychotic episode) that requires intervention and treatment. In the second or stabilization phase, the initial psychotic symptoms have been brought under control but the person is at risk for relapse if treatment is interrupted. In the third or maintenance phase, an individual is relatively stable and can be kept indefinitely on antipsychotic medications. Even in the maintenance phase, however, relapses are not unusual and people do not always return to full functioning.

The term schizophrenia comes from two Greek words that mean split mind. It was first used by a Swiss doctor named Eugen Bleuler in 1908 to describe the splitting apart of mental functions that he regarded as the central characteristic of schizophrenia.

Recently, some psychotherapists have begun to use a classification of schizophrenia based on two main types. People with Type I, or positive schizophrenia, have a rapid (acute) onset of symptoms and tend to respond well to drugs. They also tend to suffer more from so-called positive symptoms, such as delusions and hallucinations. People with Type II, or negative schizophrenia, are usually described as poorly adjusted before their schizophrenia slowly overtakes them. They have predominantly negative symptoms, such as withdrawal from others and a slowing of mental and physical reactions (psychomotor retardation).

The fourth (1994) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) specifies five subtypes of schizophrenia.

PARANOID. The key feature of this subtype of schizophrenia is the combination of false beliefs (delusions) and hearing voices (auditory hallucinations), with more nearly normal emotions and cognitive functioning (cognitive functions include reasoning, judgment, and memory). The delusions of paranoid schizophrenics usually involve thoughts of being persecuted or harmed by others or exaggerated opinions of their own importance, but may also reflect feelings of jealousy or excessive religiosity. The delusions are typically organized into a coherent framework. Paranoid schizophrenics function at a higher level than other subtypes, but are at risk for suicidal or violent behavior under the influence of their delusions.

DISORGANIZED. Disorganized schizophrenia (formerly called hebephrenic schizophrenia) is marked by disorganized speech, thinking, and behavior by an affected person, coupled with flat or inappropriate emotional responses to a situation (affect). An individual may act silly or withdraw socially to an extreme extent. Most people in this category have weak personality structures prior to their initial acute psychotic episode.

CATATONIC. Catatonic schizophrenia is characterized by disturbances of movement that may include rigidity, stupor, agitation, bizarre posturing, and repetitive imitations of the movements or speech of other people. These people are at risk for malnutrition, exhaustion, or self-injury. This subtype is presently uncommon in Europe and the United States. Catatonia as a symptom is most commonly associated with mood disorders.

UNDIFFERENTIATED. Persons in this category have the characteristic positive and negative symptoms of schizophrenia but do not meet the specific criteria for the paranoid, disorganized, or catatonic subtypes.

RESIDUAL. This category is used for persons who have had at least one acute schizophrenic episode but do not presently have strong positive psychotic symptoms, such as delusions and hallucinations. They may have negative symptoms, such as withdrawal from others, or mild forms of positive symptoms, which indicate that the disorder has not completely resolved.

Genetic profile

The risk of schizophrenia among first-degree biological relatives is 10 times greater than that observed in the general population. Furthermore the presence of the same disorder is higher in monozygotic (identical) twins than in dizygotic (non-identical) twins. Research concerning adoption studies and identical twins also supports the notion that environmental factors are important, because not all relatives have the disorder or express it. There are several chromosomes and loci (specific areas on chromosomes that contain mutated genes) that have been identified. Research is ongoing to elucidate the causes, types and variations of these mutations.