Olguera, Pauline Anne G. BSCP III-3ABNORMAL PSYCHOLOGYDr. Serafina Maxino

DSM III

Place great diagnostic significance on what it terms characteristic delusions and hallucinations. The symptom lists in DSM-III for a diagnosis of a schizophrenic disorder include six items. Three are delusional in nature, two are hallucinatory, and the last item is thought disorder accompanied by affective disorder, delusions or hallucinations, disorganized behavior, or catatonic symptoms. DSM-III reflects the idea that the category of schizophrenia includes a group of disorders, and specifies the following as essential characteristics: disorganization from the previous level of daily functioning in at least two areas, such as work, social relations, and self-care; the presence of at least one symptom from a least of six during the active phase of the illness; at least a 6-month duration of illness, during which the symptom or symptoms necessary for making the diagnosis are present

ICD-9 list the four basic types, but comments on simple schizophrenia that is schizophrenic symptoms are not clear-cut and that should, therefore, be diagnose sparingly, if at all. Other schizophrenic subtypes in ICD-9 include acute schizophrenic episode, latent schizophrenia, schizoaffective type, other, and – to be used only as a five resort – unspecified. DSM-III lists only five types under schizophrenic disorders: Disorganized (Hebephrenic), catatonic, paranoid, undifferentiated, and residual

Schizophrenia

Is sometimes considered the most devastating of the mental illnesses because its onset is early in a patient’s life and its symptoms can be destructive to the patient’s family and friends. Although schizophrenia is discussed as a single disease, the category can include a variety of disorders that present with somewhat similar behavioral symptoms.

Schizophrenia is probably comprises a group of disorders with heterogeneous causes and definitely includes patients whose clinical presentations, treatment responses, and courses of illness are varied.

Essential Features of Various Diagnostic Criteria for Schizophrenia KURT SCHNEIDER

1. First-rank symptomsa. Audible thoughtsb. Voices arguing or discussing or bothc. Voices commentingd. Somatic passivity experiences

e. Thought withdrawal and other experiences of influenced thoughtf. Thought broadcastingg. Delusional perceptionsh. All other experiences involving volition, made affects, and made impulses

2. Second-rank symptomsa. Other disorders of perceptionb. Sudden delusional ideasc. Perplexityd. Depressive and euphoric mood changese. Feelings of emotional impoverishmentf. “…and several others as well”

GABRIEL LANGFELDT

1. Symptom criteriaSignificant clues to a diagnosis of schizophrenia are (if no sign of organic mental disorder, infection, or intoxication can be demonstrated):a. Changes in personality, which manifest as a special type of emotional blunting

following by lack of initiative, and altered, frequently peculiar behavior. (In hebephrenia, especially, these change are quite characteristic and are a principal clue to the diagnosis.)

b. In catatonic types, the history and the typical signs in periods of restlessness and stupor (with negativism, oily faces, catalepsy, special vegetative symptoms, etc.)

c. In paranoid psychoses, essential symptoms of split personality (or depersonalization symptoms) and a loss or reality feeling (derealization symptoms) or primary delusions

d. Chronic hallucinations2. Course criterion A final decision about diagnosis cannot be made before a follow-up of at least five years has shown a chronic course of disease.

NEW HAVEN SCHIZOPHRENIA INDEX 1. a. Delusions: not specified or other-than-depressive: 2 points

b. Auditory hallucinationsc. Visual hallucinationsd. other hallucinations

2. a. bizarre thoughtsb. Autism or grossly unrealistic private thoughtsc. looseness of associations, illogical thinking, overinclusiond. Blocking

e. concretenessf. Derealizationg. Depersonalization

3. Inappropriate affect: 1 point4. Confusion: 1 point5. Paranoid ideation (self-referential thinking, suspiciousness): 1 point6. Catatonic behavior

a. Excitementb. Stuporc. Waxy flexibilityd. Negativisme. Mutismf. Echolaliag. Stereotyped motor activity

Scoring: To be considered part of the schizophrenic group, the patient must score on item 1 or item 2a, 2b, or 2c, and must receive a total score of at least 4 points. FLEXIBLE SYSTEM

Minimum number of symptoms required can be four to eight, depending on investigator’s choice.1. Restricted affect2. Poor insight3. Thoughts aloud4. Poor rapport5. Wide spread delusions6. Incoherent speech7. Unreliable information8. Bizarre delusions9. Nihilistic delusions10. Absence of early awakening (one to three hours)11. Absence of depressed facies12. Absence of elation

RESEARCH DIAGNOSTIC CRITERIA Criteria 1 through 3 required for diagnosis.1. At least of the following for definite illness, and one for probable (not couting those occurring during period of drug or alcohol abuse or withdrawal):a. Thought broadcasting, insertion, or withdrawalb. Delusions of being controlled or influenced, other bizarre delusions, or multiple delusions

c. Delusions other than persecution or jealousy lasting at least one weeke. Auditory hallucinations in which either a voice keeps up running commentary on subject’s behaviors or thoughts as they occur or two or more voices converse with each otherf. Nonaffective verbal hallucinations spoken to subjectg. Hallucinations of any type throughout day for several days or intermittently for at least one monthh. Definite instances of marked formal thought disorders accompanied by blunted or inappropriate affect, delusions or hallucinations of any type, grossly disorganized behavior2. One of the following:a. Current period of illness lasted at least two weeks from onset of noticeable change in subject’s usual conditionb. Subject has has a previous period of illness lasting at least two weeks, during which he or she met criteria, and residual signs of illness have remained (e.g. extreme social withdrawal, blunted or inappropriate affect, formal thought disorder, or unusual thoughts or perceptual experiences)3. At no time during active period of illness being considered did subject meet criteria for probable or definite manic or depressive syndrome to the degree that it was a prominent part of illness.

ST. LOUIS CRITERIA 1. Both necessary:a. Chronic illness at least six months of symptoms before index evaluation, without return to premorbid level of psychosocial adjustment.b. Absence of period of depressive or manic symptoms sufficient to qualify for moog (affective) disorder or probable mood (affective) disorder.2. At least one of the following:a. Delusions or hallucinations without significant perplexity or disorientationb. Verbal production that makes communication difficult owing to lack of logical or understandable organization (in presence of muteness, diagnostic decision must be deferred)3. At least three for definite, two for probable, illness:a. Never marriedb. Poor premorbid social adjustment or work historyc. Family history of schizophreniad. Absence of alcoholism or drug abuse within one year of onsete. Onset before age 40

TAYLOR AND ABRAMS’ CRITERIA All criteria must be met for diagnosis.1. Duration of episode greater than six months2. Clear consciousness3. Presence of delusions, hallucinations, or formal thought disorder (variegation, non sequiturs, word approximations, neologisms, blocking, and derailment)4. Absence of broad affect5. Absence signs and symptoms insufficient to kae diagnosis of affective disease6. No alcoholism or drug abuse within one year of index episode7. Absence of focal signs and symptoms of coarse brain disease or major medical illness known to produce significant behavioral changes

Signs and Symptoms

The presence of some key symptoms, for schizophrenic weighs heavily in favor of a diagnosis of schizophrenia.

1. Loosening of Associations- the specific thought disorder of the schizophrenic- is perhaps the most valuable diagnostic criteria. But a good knowledge of psychopathology is required to be sure of its presence, and to avoid confusing it with other forms of disturbed thinking, such as manic flight of ideas, disintegration of thought process due to clouding of consciousness, and impaired reasoning due to fatigue or distraction.

2. Bizarre Behavior – The patient’s behavior may furnish a significant clue for the diagnosis. Bizarre postures and grimacing are the certainly characteristic of schizophrenic conditions, but what constitutes a bizarre posture is not always easy to establish unequivocally. Religious rituals and special positions for meditation or rock-and-roll dancing with which the observer is not familiar may be called bizarre.

3. Hallucinations – sensory experiences or perception without corresponding external stimuli are common without symptoms of schizophrenia. Most common are auditory hallucinations, or the hearing of voices. Most characteristically, two or more voices talk about the patient, discussing him in the third person.

4. Dream content – studies of the dream content of schizophrenia patients have shown that dreams of schizophrenia are less coherent and less complex also less bizarre than are the dreams of normal persons. Unpleasant emotions are the common in the dreams of schizophrenics than in the dreams of normals.

5. Disturbances of thinking- the schizophrenic disturbance of thinking and conceptualization is one of the most characteristics features of the disease.

6. Delusion- by definition, delusion is false ideas that cannot be corrected by reasoning, and that are idiosyncratic for the patient that is not part of his cultural environment. they are the most common symptoms of schizophrenia.7. Incoherence- for the schizophrenic, language is primarily a means of self expression, rather than a means of communication. His verbal and graphic productions are often either empty or obscure.

8. Neologisms- occasionally, the schizophrenic creates a completely new expression, a neologism, when he needs to express a concept for which no ordinary word exits.

9. Mutism- this function inhibition of speech and vocalization may last for hours or days, but, before the area of modern treatment methods, it often used to last for years in chronic schizophrenics of the catatonic type. Many schizophrenics tend to be monosyllabic and to answer question as briefly as possible.

10. echolalia- occasionally, the schizophrenic patient exhibit echolalia, repeating in his answers to the interviewer’s question’s many of the same words the questioner has used.

11. Verbigeration- this rare symptom is found almost exclusively in chronic and very regressed schizophrenia. It consists of senseless repetition of the same words or phrases, and it may, at the times, go on for days.

12. Stilted language- some schizophrenics make extraordinary efforts to maintain their social relations in order to maintain their relatively stable adjustment. But they may betray their rigidity and artificiality in their interpersonal relations by a peculiarly stilted and grotesquely quaint language.

13. Stuporous states- these states used to be common in the catatonic subtype of schizophrenia. Today, a modern physical treatment method permits therapists to interrupt stupors.

14. Echopraxia- this motor symptom is analogous to echolalia in the verbal sphere – imitation of movements and gestures of a person the schizophrenic is observing.

15. Automatic Obedience- Another symptoms sometimes observed in catatonic patients is automatic obedience, a patient may, without hesitation and in robot like fashion, carry out most simple commands given to him.

16. Negativism- the term negativism refers to a patient’s failure to cooperate, without any apparent reason for that failure. The patient does not appear to be fatigued, depressed, suspicious, or angry. He is obviously capable of physical movement.

17. Stereotyped Behavior- this behavior is occasionally seen in chronic schizophrenics, and not only in the back wards of old time mental hospitals. It may present itself as repetitive patterns of moving or walking or perhaps pacing the same circle day in and day out.

18. Deteriorated appearance and manners- schizophrenic patients tend to deteriorate in their appearance. Their efforts at grooming and self care may become minimal and they may have to be reminded to wash, bathe, shave, change their underwear, and so on.

19. Reduced Emotional responses- the quantitative change invariably consists of reduction in the intensity of emotional response. Many schizophrenics seems to be different or, at times, totally apathetic.

20. Anhedonia- anhedonia is a particularly distressing symptom of many schizophrenics. The anhedonia person is incapable of experiencing or even imagining any unpleasant emotionally barren.

21. Inappropriate Responses- a typical emotional reaction of schizophrenic is an incongruous or inappropriate response to life situations.