Schizophrenia Health Article

Definition

Schizophrenia is a psychotic disorder (or group of disorders) marked by severely impaired thinking, emotions, and behaviors. The term schizophrenia comes from two Greek words that mean "split mind." It was coined around 1908 by a Swiss doctor named Eugen Bleuler to describe the splitting apart of mental functions that he regarded as the central characteristic of schizophrenia. (Note that the splitting apart of mental functions in schizophrenia differs from the split personality of people with multiple personality disorder.) Schizophrenic patients 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.

Although schizophrenia was described by doctors as far back as Hippocrates (500 B.C.), it is difficult to classify. Many writers prefer the plural terms schizophrenias or schizophrenic disorders to the singular schizophrenia because of the lack of agreement in classification, as well as the possibility that different subtypes may eventually be shown to have different causes.

Description

The schizophrenic disorders are a major social tragedy because of the large number of persons affected and the severity of their impairment. It is estimated that people who suffer from schizophrenia fill 50% of the hospital beds in psychiatric units and 25% of all hospital beds. A number of studies indicate that about 1% of the world's population is affected by schizophrenia, without regard to race, social class, level of education, or cultural influences. (However, outcome may vary from culture to culture, depending on the familial support of the patient.) Most patients are diagnosed in their late teens or early 20s, but the symptoms of schizophrenia can emerge at any point in the life cycle. The male/female ratio in adults is about 1.2:1. Males typically have their first acute episode in their late teens or early 20s, while females are usually well into their 20s when diagnosed.

Schizophrenia is rarely diagnosed in preadolescent children, although patients as young as five or six have been reported. Childhood schizophrenia is at the upper end of the spectrum of severity and shows a greater gender disparity. It affects one or two children in every 10,000; the male/female ratio is 2:1.

The course of schizophrenia in adults can be divided into three phases or stages. In the acute phase, the patient 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 patient is at risk for relapse if treatment is interrupted. In the third or maintenance phase, the patient is relatively stable and can be kept indefinitely on antipsychotic medications. Even in the maintenance phase, however, relapses are not unusual and patients do not always return to full functioning.

Recently, some psychiatrists 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 the 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 revised (2000) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) specifies five subtypes of schizophrenia: