Schizophrenia Introduction

Psychiatry

Psychiatric disorders;
It is a clinically significant behavior or psychological syndrome that causes significant distress or disability and loss of freedom.. etc.
There are a lot of types and varieties of psychiatric disorders like disorders of thinking, disorders of cognition.
Note/ we have learned that a physical disorder is a deviation from normal physiology, also the disorders of mind is a deviation from normal physiology.
Psychiatric illnesses are classified to make them easier and understandable. While the classification of diseases in medicine is depending on etiology, it is not possible in psychiatry, except in certain organic disorders (eg. Delirium…), so the classification of psychiatric illnesses is depending on the dominant observable features of the disease or syndrome.
While this method of classification has some disadvantages, it is inevitable at the present time.
In general, the two main classification systems currently used in clinical practice are “ Diagnostic and statistical manual- DSM-IV” used by the American psychiatric association and the WHO classification named “ International classification of diseases- ICD-10”
Classification of mental disorders: Traditional classification
Mental illnesses;
Mental illnesses are better circumscribed than mental disorders because an illness has its own etiology, onset, course and lines of treatment, while a disorder is a common term. However, mental illnesses are either:

1-Orgenic:- Delirium, Dementia, Amnestic syndrome

2-Functional:- These have no specific lesions or obvious pathology in the CNS and are of two types»» Psychosis and Neurosis.
Psychosis: the patient is not aware of reality and he or she may affect other people, the patient has no insight.. eg. Schizophrenia, affective mood disorders including mania, depression.. etc.
Neurosis: the patient is aware of reality and he or she does not affect other people, the patient has insight and keeps his feelings within himself so that nobody knows about them... eg. Anxiety, Obsessive compulsive disorder, reaction to stress, somatoform disorders…etc.

Mental disorders; They include;

Alcoholism and drug dependence (substance misuse)
Personality disorders
Psychosexual disorders
Mental impairment
Disorders of childhood and adolescence
Behavioral syndromes associated with physiological disturbances and medical conditions such as »» Anorexia nervosa (feeding disorder) and sleeping disturbance.


Schizophrenia
The following is a list of schizophrenia and its related conditions:
Schizophrenia
Schizophreniform disorders
Schizoaffective disorders
Delusional disorders
Brief Psychotic disorders
Shared psychotic disorders
Substance induced psychosis
Psychosis due to medical condition
Psychosis not otherwise specified or unclassified.

The first psychiatrist who used the term schizophrenia was Bleuler in 1912.

In fact, schizophrenia is regarded as the heart of psychiatry and the core of its clinical practice while all other psychiatric disorders are regarded to be secondary.
It is a very grave disease because it is prevalent more than the other psychiatric disorders and it affects young people ( at the productive age) with economic consequences.
The patient who is by schizophrenia continues in his life consuming the same services of any other member in the society, in fact, the patient consumes without production. In addition, the patient causes also sever distress on the members of his family or his relatives and friends.
It has been found that 10% of the hospitals beds in G.B. were occupied by schizophrenic patients.
Another study was made on the gross national product of America, the result was that about 2% of the (GNP of America= 400 trillion Dollars) goes to the Schizophrenic patients.
It occurs before the age of 45 and affects young clever people, the patient has his own inner life dominated by fantastic ideas, delusions, hallucinations,…etc, and he is usually cut off from his fellows and from the reality as a whole.
This disorder develops gradually in the patient leading ultimately to fragmentation of personality.
Certain changes in life can precipitate schizophrenia, there are persons who are susceptible to be affected (Schizoid personality)»»» reclusive, abnormal, shy, hypochondriasis, emotional coolness, …etc. Also it can occur in normal individuals (not schizoid personality)
Writing about schizophrenia begun in the 19th century and the first one who talked about schizophrenia was (Morel) in 1856 when a young brilliant and clever student with deterioration of personality came to him seeking help (advice), Morel called that condition ((Dementia Praecox)).
Later on, Kalhbum used the term katatonia( catatonia) for the first time.
After that, Kehler used the term hebephrenia for the first time, while in 1896 Kraepelin used the term paranoid for the first time, in fact, Kraepelin believed that the condition was organic in nature and occurs due to long term deterioration that leads to the disorder of personality. In addition to that he regarded all types of this condition that had been described by other psychiatrists (catatonia, paranoid, hebephrenia…etc) as one disease.
Note/ Kraepelin described the condition and illustrated it under the neme of dementia praecox, and he divided psychosis into= manic depressive insanity and dementia praecox.
Then, Bleuler came and he was the first who used the term schizophrenia. This psychiatrist confirmed Freud in his belief and regarded this condition ((schizophrenia)) as a psychogenic illness »»» loose association and imbalance in psychic functions like thinking, taking decisions…etc.


The Fundamental Symptoms of Schizophrenia as described by Bleuler:
1-Association loosening
2-Affective incongruity
3-Ambivalance
4-Autism

While the secondary symptoms are;

1-Dellusions
2-Halucination

After Bleuler, the psychiatrist Schneider illustrated that the first rank symptoms that are pathognomonic for schizophrenia in the absence of organic brain disorder.

1st rank Symptoms:

1-Thought echo; Voice repeating the person's thought aloud.
2-Running commentary on the patient's action; the patient hears one voice commenting continuously on his actions and behavior.
3-Third person; two voices are heard by the patient talking with each other about his behavior, the patient is considered the 3rd person.
4-Delusion concerning the possession of thought (insertion).
5_Delusion concerning the possession of thought (withdrawal or deprivation).
6_Delusion concerning the possession of thought (broad casting).
7-Delusion of perception.
8-Somatic passivity; the patient feels that his internal sensations are affected by external forces.
9-Primary delusion (sudden delusion ideas coming without preceding events …eg.. hallucination etc…)
10-Passivity delusion of emotion; Outside agencies causing the person's feeling (emotion).
11-Passivity delusion of action; Outside agencies causing the person's action (acts).


Types of schizophrenia
1-Simple schizophrenia, the patient has poverty in activity, thinking, volition,…etc. and this condition is confused sometimes with mental subnormality.
2-Hebephrenia, this is seen in younger age group (disorganized schizophrenia)
3- Paranoid schizophrenia, it is seen in older age group and characterized by paranoid delusion.
4-Catatonic schizophrenia
5-Residual schizophrenia
6-Undifferentiated schizophrenia, there is no delusion nor hallucinations and the disease is not diagnosed well.

Epidemiology

The prevalence of schizophrenia is 1%, while the incidence is 15/100000 per year.
The onset of schizophrenia is usually insidious but may be acute in certain occasions.
Male to female ratio is equal but males are usually affected 4-5 earlier than females, so if females are affected at 30 years of age then males may be affected at 25 years old.
It usually occurs more in low socioeconomic groups and in centers of cities more than in rural areas. It is more prevalent in immigrants.
The winter borne infants are more liable to be affected by schizophrenia than others, but this relationship between seasonal births and the disease occurrence is not necessarily true, or it may be due to hidden factors like;
1-Influenza 2-poor diet 3-viral infections 4-birth trauma 5-others.
Schizophrenics are with low fertility.