Monday, June 11, 2007

concept of schizophrenia

19th century 2 views

1. Wilhelm Griesinger’s unitary psychosis (einheitpsychose).

he thought that all mental illnesses are the same illness but in different sevirity.

2. Benedict A.Morel in 1852 coined demence precoce (early dementia) to describe a disorder that start in adolescence and leading to withdrawal, odd mannerisms, self neglect and finally to
intellectual deterioration.

Karl Kahlbaum (1863) described the syndrome of catatonia.

Ewald Hecker (1871) described what he called as hebephrenia.

Emil Kraeplin

Division of severe mental disorders into 2: dementia praecox (partial improvement) and manic depressive psychosis (full recovery).

13% of his patients did recover.

3 subtypes: catatonic, hebephrenic, and paranoid.
. Described dementia praecox: “a series of states, the common characteristic of which is a peculiar destruction of the internal connections of the psychic personality”(1919)

Kraepelin believed that dementia praecox was primarily a disease of the brain, and particularly a form of dementia

Coined the name paraphrenia for a condition that start in middle life with no changes in emotions and volition.

Later Bleuler added the 4th as: simple.
Eugen Bleuler, Swiss psychiatrist, coined the term schizophrenia, did not consider delusions, hallucinations, and catatonic symptoms to be necessary for Dx. Leading to the idea that we could Dx. Schizophrenia without the presence of psychotic symptoms (simple schizophrenia).
4As : Association
Ambivalence (apathy)

Bleuler realized the illness was not a dementia (it did not always lead to mental deterioration) and could sometimes occur late as well as early in life and was therefore misnamed.
Bleuler believed that dementia praecox subsumed multiple disorders that differed in etiology and pathogenesis but certain clinical features in common.

Conflict between Kraeplin & Bleuler views reached its peak in 1950s leading to the International Pilot Study of Schizophrenia which showed that USA and URSS got broader concepts of schizophrenia than Colombia, Czechoslovakia, Denmark, India, Nigeria, Taiwan, and the UK “WHO 1973”.
Norwegian psychiatrist Langfeldt differentiate between schizophrenia and schizophreniform psychosis. In that they got different outcome and in that ECT and insulin coma therapy were ineffective in schizophrenia (1960).
DSM-IV term schizophreniform disorder is used in a different way than that meant by Langfeldt. According to modern diagnostic criteria, most of Langfeldt’ schizophreniform stated would be classified as mood disorder (Bergen et al.,1990)
Clinical psychologists in USA developed series of rating scales – the Elgin, Phillips, and Kantor scales- to differentiate between process and non-process schizophrenia mainly on the basis of premorbid personality and psychosexual adjustment
Both Langfeldt and the American psychologists assumed that true process schizophrenia was endogenous and hereditary, and that schizophreniform or non-process (“reactive”) psychosis were psychogenic, but neither succeeded in demonstrating a clear demarcation between the two.

Kurt schneider (1887-1967)
the first rank symptoms.
Pseudoneurotic schizophrenia (Hoch and Polatin 1949):
patient had a wide range of neurotic symptoms, such as phobias, obsessions, and depersonalization, often associated with severe anxiety and attacks of psychotic disturbance lasting days, hours or perhaps only minutes.
Some authorities, like Kleist and Leonard in Germany and Langfeldt in Norway, insisted that the term should be restricted to illnesses resulting in permanent damage to the personality; others used it freely regardless of outcome.
Some insisted on the presence of certain key symptoms; others were prepared to make a confident dx. on the basis of indefinable subjective impressions, the so-called “praecox feeling”.
Leonard distinguished schizophrenia from the cycloid psychosis, a group of non-affective psychosis of good outcome (1957).

Adolf Meyer saw schizophrenia as a reaction to life events. However, he recognized the importance of biological predisposition.

Some authors say that anyone, if had enough of the right stresses, will develop schizophrenia.
DSM-I was heavily influenced by Meyer’s thoughts and referred to schizophrenic reactions.
DSM-II moved toward a disease entity.
DSM-III & IV attempted to be atheoretical.
Presently, the stress-diathesis model for schizophrenia reigns supreme, but as developmental neurobiology evolves, other more sophisticated models may prove useful
In Denmark and Norway, cases of psychosis arising after stressful events have received much attention. The term reactive psychosis, or psychogenic psychosis are commonly applied to conditions which appear to be ppt. by stress and have good prognosis.
In current dx. Schemes such disorders would be classified as brief psychotic disorder or schizophreniform disorder.
Studies examining the diagnosis of schizophrenia have typically shown relatively low, or inconsistent levels of diagnostic reliability. Most famously, David Rosenhan's 1972 study, published as On being sane in insane places, demonstrated that the diagnosis of schizophrenia was (at least at the time) often subjective and unreliable. More recent studies have found agreement between any two psychiatrists when diagnosing schizophrenia tends to reach about 65% at best33. This, and the results of earlier studies of diagnostic reliability (which typically reported even lower levels of agreement) have led some critics to argue that the diagnosis of schizophrenia should be abandoned34.
They pointed to Japan, where the category schizophrenia was replaced with "integrated disorder" in 2004, as a possible model

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