Junk

Schizophrenia (DSM-IV-TR #295.1–295.3, 295.90)
Schizophrenia is a chronic, more or less debilitating illness
characterized by perturbations in cognition, affect and
behavior, all of which have a bizarre aspect. Delusions, also
generally bizarre, and hallucinations, generally auditory in
type, also typically occur. The original name for this illness,
“dementia praecox,” was coined by EmilKraepelin, a
German psychiatrist in the late nineteenth and early twentieth
century, whose description of the illness remains a guiding
force for modern investigators.
Schizophrenia is a relatively common disorder, with a
lifetime prevalence of about 1%. Although the overall sex
ratio is almost equal, males tend to have an earlier onset than
females, a finding accounted for by the later ageof onset in
those females who lack a family history of the disease.
ONSET
Although most patients fall ill in late teenage or early adult
years, the range of age of onset is wide: childhood onset may
occur, and in some instances symptoms may not appear until
the sixties.
There may or may not be a prodrome before the actual onset
of symptoms. In some cases the “pre-morbid personality”appears completely normal. In others, however, peculiarities
may have been apparent for years or even decades before the
onset. In cases where the prodrome began in childhood, the
history may reveal introversion and peculiar interests. In
cases where the prodrome began later, after the patient’s
personality was formed, family members may recall a stretch
of time wherein the patient “changed” andwas no longer “the
same.” Prior interests and habits may have been abandoned
and replaced by a certain irritable seclusiveness, or perhaps
suspiciousness.
The onset of symptoms per se may be acute or insidious.
Acute onsets tend to span a matter of weeks or months and
may be characterized by confusion or at times by depressive
symptoms. Patients may recognize that something is wrong,
andthey may make some desperate attempts to bring some
order into the fragmenting experience of life. By contrast, in
cases with an insidious onset the patient may not be
particularly troubled at all. Over many months or a year or
more, evanescent changes may occur: fleeting whispers,
vague intimations, or strange occurrences.
CLINICAL FEATURES
Although the clinical presentation of schizophreniavaries
widely among patients, certain signs and symptoms, though
present to different degrees, are consistently present, and
these include hallucinations, delusions, disorganized speech
and catatonic or bizarre behavior. “Negative” symptoms
(e.g., flattening of affect) are often also seen but in some
cases are quite mild. Generally, based on the constellation of
symptoms present, one mayclassify any given case of
schizophrenia into one of several subtypes, namely the
paranoid, catatonic, hebephrenic (“disorganized”) and

simple subtypes, with a large proportion of patients, however,
failing to clearly fit any subtype and being characterized as
having “undifferentiated” schizophrenia.
Hallucinations are very common in schizophrenia. Patients
may hear things, often voices,or they may see things;
hallucinations of taste, touch, and smell may also occur. But
of all these, the hearing of voices is most characteristic of
schizophrenia.
The voices may come from anywhere. They come from the
air; God or angels send them. They may come from the
television or radio; wiring may emanate the voices. Special
devices may be planted in the walls or furniture. Sometimesthey are in clothing; often they are localized to certain parts
of the body. They come from the bowels, the liver, from “just
behind the ear.” They may be male or female; the patient
may or may not be able to recognize the identity of the
speaker. It is a sibling, or a dead parent. Most often, though,
the voices are not recognized as belonging to anyone; they
are from strangers. They may be...