The Diagnostic Criteria of Schizophrenia
Before the demonstration of diagnostic criteria of schizophrenia there are certain notes that must be put in mind.1-Under stimulation increase the negative symptoms like poverty of speech, apathy, catatonia, while over stimulation induce positive symptoms like hallucination, delusion, restlessness...etc.
2-Highly expressed emotional families are considered as an over stimulant leading to relapse and this is the cause that make those persons prefer hotels rather home.
3-The prevalence of schizophrenia is higher than the incidence because some of the patients become chronic cases.
4-Multifactorial inheritance is responsible for schizophrenia, this mean that the disorder is or may be transmitted from parents to children through the genetic material but need certain environmental factors to be expressed.
It does not always appear especially when the environmental factors has not been provided during the life of person.
5-what are the first rank symptoms and 2nd by Schneider?
a-though echo, running commentary, 3rd person, disorder of possession (insertion , withdrawal, broad casting), passivity delusion of emotion thinking &action, somatic passivity and delusional perception.
b-2nd rank symptoms involve:
paranoid delusion, auditory hallucination in a form off noises, 2nd person(the voices talk directly with him rather than commenting his behavior such as running commentary, others…
6-It has been found that schizophrenia is more common among people born in the winter months .this can be explained by the greater risks of maternal viral infection in autumn and winter with the probability that such infection could interfere with brain development.
7-Bleuler considered schizophrenia as a psychogenic disorder and said that the delusions and hallucinations are secondary symptoms of this disorder, but they are primary and main symptoms of schizophrenia{this was his mistake}
8-While Kraepelin considered schizophrenia to be organic in nature (not psychogenic) so he differed from Freud and Bleuler who did not confirm the organic nature of schizophrenia .
Lastly Schneider considered hallucination and delusion as the main symptoms
The diagnostic criteria of schizophrenia;
The following are criteria depending on the (DSM-IV)
1-Characteristic symptoms:
-delusions
-hallucination
-disorganized behavior (catatonia)
-disorganized speech
-negative symptoms
Note/at least two or more must be found to say that the characteristic symptoms are present but the presence of 3rd person, running commentary, hallucination, or bizarre delusion is enough to say that the characteristic symptoms are present.(according to Schneider).
Bizarre; strange, cannot be explained by other people
2-social and occupational deterioration (dysfunction).
3-The symptoms of patient must continue for six months or more.
Note/if the symptom last less than 6 months then the disorder is either brief psychotic disorder (1 day----1 month) or schizophreniform disorder(1-6 month).
4-The disturbance is not due to the effect of substance (drug abuse, medication, general medical condition).
5-Exclusion of effective disorder symptoms (bipolar and unipolar affective disorder)
6-Relationship to pervasive developmental disorder like autistic disorder.
Here the additional diagnosis of schizophrenia is made on if prominant hallucination and delusions are present.
Note/autistic is derived from autism refer to psychosis of children. here the child is characterized by various abnormal behavior.
Differential DX:
Schizophreniform disorder
Schizoaffective disorder
Delusional disorde
Brief psychotic disorder
Shared psychotic disorder
Substance induced psychosis
Psychosis due to medical conditions
Psychosis not other wise specified