In simple language, schizophrenia may be described as a group of psychotic disorders characterized by withdrawal from reality, illogical thinking, delusions and hallucinations, with concomitant emotional, behavioral, or intellectual disturbances.
Criteria for diagnosis
According to DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) three diagnostic criteria must be met in order to diagnose the patient with schizophrenia.
1. Characteristic symptoms
Two or more of the following:
c. disorganized behavior (e.g., dressing inappropriately, laughing or crying without a reason, etc.) or catatonic behavior characterized by periods of physical rigidity, negativism, or stupor
d. Disorganized speech
e. Negative symptoms such as restriction of emotional expression (blunted affect), inability or decline in speech (alogia), or lack or decline in motivation (avolition).
2. Social or occupational dysfunction
Marked decrease in functioning in social and occupational area such as work, interpersonal skills, or self-care for a significant period of time.
3. Significant duration
Continuation of the above disturbance and impairment for at least six months.
Signs and symptoms
Signs and symptoms of schizophrenia are associated with disturbances in the following areas:
1. Language and communication
The most prominent symptom in a schizophrenic patient is difficulty in communication. He seems to be unable to maintain a consistent train of thoughts and shifts from one idea or topic to another; and at times uses his own words or phrases. In severe cases complete incoherence of speech may be present.
2. Content of thought
Thoughts are severely distorted from reality. The patient often has fixed beliefs about people or things (delusions). He thinks that people are against him or going to harm him or poison him. Also, he thinks that certain things are related to him, e.g., he might think that a television program has a special message for him or is conveying something about him.
3. Disturbance of perception
Disturbance of perception are collectively called hallucinations. They have following subtypes
a. Auditory hallucinations, e.g., hearing voices speaking to him or about him.
b. Visual hallucinations, e.g., seeing people or things which are not there.
c. Tactile hallucinations (false perception of movement or sensation), e.g., feeling electric impulses or animals crawling on skin.
d. Olfactory hallucinations, e.g., smelling poison or gas in the room.
4. Disturbance in impulse control
Such patients have little voluntary control over their activity in acutely ill state. They often show highly impulsive behavior, e.g., throwing things without any provocation, or even display suicidal or homicidal acts.
5. Disturbances of mood
In the early stages, mood may be very labile, shifting rapidly from joyfulness to sorrow for no obvious reason. But later on, invariably the mood is inappropriate to actual situation. More characteristically, the mood progressively becomes blunted or flat, i.e. there is a markedly reduced responsiveness or the patient does not show any emotional expression.
The DSM-IV-TR classified schizophrenia into five sub-types.
1. Disorganized type
Previously called hebephrenic schizophrenia, it is characterized by marked incoherence with blunted affect, like laughing or giggling without any reason. It has an early age of onset in a shy, withdrawn person. The course is progressive with a poor outcome. It represents a more severe disintegration of the personality.
2. Catatonic type
This is characterized by alternative periods of marked excitement and impulsive behavior and extreme withdrawal with stupor or mutism. These patients generally show negativism, rigidity, and posturing.
3. Paranoid type
This is characterized by marked persecutory delusions and occasionally grandiose delusions or delusion of jealousy. They often have auditory or visual hallucinations. Patients are generally very sensitive, fearful, argumentative, and easily provoked to anger.
4. Undifferentiated type
The patients of this type of schizophrenia do not fit into any other type because they have a mixed clinical picture. Features include grossly disordered behavior, delusions, hallucinations, thought disorders, and bizarre behavior characteristic of schizophrenic illness.
5. Residual type
These patients have a definite history of a schizophrenic illness in the past, but have no or very little positive symptoms at present. In practice, it is very difficult to diagnose the schizophrenia. It is not possible to come to the diagnosis in one meeting; instead, it may take months or even years to see if the pattern of illness fits into schizophrenia..