Schizophrenia: Psychiatric Significance, Etiology, Classification, Diagnosis And Course Of Disease
Psychiatric Presentation Of schizophrenia
Schizophrenia denotes a group of psychotic illnesses characterized by specific psychological symptoms. These symptoms interfere with the thinking, mood and behaviour of the patient. Often, the illness produces a disintegration of personality. A precise definition of schizophrenia is not available. Earlier, schizophrenia was considered as an illness among adolescents which caused severe intellectual deterioration. Hence it was termed dementia praecox. But later on, splitting of the various functions from one another was realized to be the essential feature of the illness. Hence the term schizophrenia (schizo- split; phrenum- mind) became widely accepted.
Schizoid Personality Trait
The exact etiology is not clear, but several factors play their roles.
Heredity: Genetic factors play a major role in the etiology. About 5% of the parents, 8% of the siblings and 12% of the children of the schizophrenic are seen to be affected by the disorder. In twin studies, the concordance rate is 57% for monozygotic twins whereas it is only 12% for dizygotic twins. The mode of transmission may be through a single recessive gene, a dominant gene; or by polygenes.
Personality: Many schizophrenic patients show a schizoid personality trait. These individuals are very shy, sensitive and are largely unsocial.
Family: In many instances, there may be disturbances of family background. These include faulty parental attitudes, irrational and incoherent family atmosphere, defects in family communication, broken homes, etc.
Social: Schizophrenia is largely found among people belonging to low social class and these schizophrenics tend to drift to slum areas in the cities.
Biochemical: Several biochemical abnormalities have been described. Increased retention of nitrogen have been found in some catatonic schizophrenics. Drugs such as L-dopa which stimulate dopaminergic neurons are known to produce schizophrenic symptoms. Metabolites containing indole nucleus may play a role in the production of schizophrenic symptoms. The platelet monoamine oxidase content is reduced in schizophrenia. Immunoglobulins such as IgM, IgA and IgG are found to be raised in some cases of paranoid schizophrenia.
Stress: Schizophrenia may be precipitated by physical stress like infections, injury, general debility, child birth, etc, or psychological stress.
Diagnosis Of Schizophrenia
Classification Of Schizophrenia
Classically, schizophrenia is divided into four types. These are the catatonic, paranoid, hebephrenic and simple schizophrenias. This classification is made on the basis of the dominant clinical features. In catatonic schizophrenia, motor disturbances are very prominent. In the paranoid form, delusions and hallucinations are the prominent features. In hebephrenia, florid thinking disturbances and marked mood changes are predominant. In simple schizophrenia, an insidious onset, lack of interest and initiative and gradual social withdrawal are the characteristic features. In addition to these classical forms many other special varieties have been described.
Diagnosis: Schizophrenia is diagnosed on the basis of clinical features. Psychometric tests may be helpful. It should be differentiated from physical disorders like uremia and other organic mental disorders such as mashed depression, hysteria etc.
Some cases of schizophrenia may recover fully. Others show remissions and exacerbations, while a few deteriorate gradually and progressively.
© 2014 Funom Theophilus Makama