Thursday, March 17, 2005


(I mainly used the DSM-IV, but also checked some web pages. Here and here)

I recently gave a presentation in which I briefly introduced the topic of Schizophrenia. As I was relatively ignorant before I did some research, I thought I’d share what I learned in case others are in the same place.

Schizophrenia, coined by Bleuler in 1911, literally means ‘splitting of the mind.’ It is largely because of this etymology that the disease is quite misunderstood. Those suffering from Schizophrenia do not have a split personality, nor do they have a dissociative identity disorder. Rather, the term was meant to convey a ‘split’ between the subjective feeling experienced and accompanying thoughts.

As there is no known cause of Schizophrenia, the condition is diagnosed by observing a constellation of symptoms/behaviours that occur for a certain amount of time. The characteristic symptoms span a range of cognitive and emotional dysfunctions. Examples are the areas of perception, inferential thinking, language and communication, affect, behavioural monitoring, fluency and production of thought and speech… and attention.

The symptoms can be divided into two main categories: positive and negative. For the clinically uninitiated like myself, that does not mean good and bad, but an excess or distortion of normal cognitive function and a diminution or loss of normal cognitive functioning, respectively.

Positive symptoms usually consist of delusions, hallucinations and disorganized speech. Negative symptoms usually consist of a restriction in range of emotions (affective flattening), fluency and productivity of speech (alogia), and goal-directed behaviour (avolition).

Diagnostic Criteria
• Characteristic Symptoms (such as those mentioned above, demonstrate 2 for about 1-month)
• Social/Occupational dysfunction (the level of functioning in social, professional or personal functioning is below normal for that individual)
• Duration (There must be continuous signs for at least 6 months)
• Mood Disorder exclusion (making sure it isn’t something else)
• Substance/general exclusion (making sure it isn’t something else)
• Pervasive developmental disorder (making sure it isn’t something else)

Some general facts:
• Prevalence among adults is usually 0.5-1.5%, worldwide.
• Median age of onset is mid-late 20s, but usually develops around late teens to mid 30s. Men onset earlier than woman (18-25 vs. 25-mid30s)
• The later the age of onset, the better the outcome for an individual.
There exists great variability in the course of the disease across suffers. Some may show exacerbations and remissions, others will be chronic.
• Those with Schizophrenia will often have a shorter life expectancy because 10% will successfully commit suicide and at least 20 percent will make an attempt. Additionally, those with Schizophrenia often have substance abuse problems, with over 80% having Nicotine Dependence.

Schizophrenia Subtypes

I just thought I would mention that there are subtypes. (The names indicate the type)
• Catatonic Type
• Disorganized Type
• Paranoid Type
• Undifferentiated Type
• Residual Type

There were two main things that became prominent in my mind while researching Schizophrenia.

(1) Are things in the world continuous or discrete?
Ever since Plato we in the Western world have suffered with the idea of ‘the essential object.’ He proposed that things have an ‘essence:’ a particular quality that defines the object. I think that divisions of reality into discrete variables is very useful as a communicative technique but does little to accurately represent what is important in the world. It leads to silly philosophical questions such as “Would you still be you if your hair was different?” “Are you really you if someone has replace your heart with another’s even if you don’t know about it?” See also any of the Twin Earth stuff.

The notion of what is and what is not a particular medical condition is especially relevant if there is not particular cause. Is it still Schizophrenia if the suffer has only had it for 5 months instead of 6? What about if they show 90 percent of the symptoms but not enough for a full diagnosis? Some think classifiation by subtype should be discontinued in favour of examining the degree of positive and negative symptoms. These are the issues that medial health professionals deal with (and if they aren’t, they should be). Is it a mood disorder with Schizophrenic tendencies or a Schizoaffective disorder that is confounded by medication?

I don’t want to give the impression that designations and classifications don’t matter, because there are actual differences in disorders and those differences are important for treatment. It is just something to keep in mind when making judgments. I chose the word assessments instead of diagnosis, because while the latter connotes the medical field the former allows the average person to be included. The notion of continua is a very important one and is worth your consideration. Making things black and white is a easy (lazy) method of interpreting the world, but you’ll likely find that things won't make as much sense if you don’t adopt the idea of shades of grey.

(2) Beliefs and Reality
In the main diagnostic manual of the medical and psychiatric profession, it made a point to urge caution in the diagnosis of Schizophrenia regarding cultural differences. Basically, one culture’s religious practices are another culture’s delusions. I laughed out loud. I don’t think we should discriminate… call them all delusions. The fact that it is in a manual makes the utter illogicality of some religious practices palpable. I’ll probably write more on this topic another time, but people are generally very inconsistent. Humans live and breathe empiricism, but then deny its power beauty when examining a ‘cognitive plane.’ I have my own ideas, but I want to hear people's thoughts. Why are you so afraid?


Anonymous Anonymous said...

1. I'm a firm believer in a continuum rather than discrete categories with regards to psychiatric disorders. It's ridiculous to think that people can be divided into categories and if you don't meet arbitrary cut offs than you don't have a mental illness. The DSM really needs to get with the times.

2. I read a few articles on how schizophrenic patients recover in North America vs Europe and apparently it is viewed as a much more serious and with a poorer prognosis in NA and consequently, these patients don't recover as well as those in Europe.

3. I work in a psychiatric hospital right now and I can see where that attitude comes from. The majority of cases I see are a revolving door pattern: The patient commits a crime, has a 30 day assessment, found not criminally responsible, spends a few months in the hospital and gets released into the community. Repeat 20 times. It's really quite sad. I'm not sure if I could work with this population in the future.


1:24 AM  
Blogger Unknown said...

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4:23 AM  

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