Schizophrenia
Schizophrenia (sometimes called dementia praecox) is the name for a group of severe psychotic mental illnesses. The name means "shattered mind", referring to the thought disorders that are the characteristic symptoms of schizophrenia.
Although it is commonly confused by the public with multiple personality disorder, schizophrenia has nothing to do with the manifestation of distinct multiple personalities within a person. Instead schizophrenia is a condition manifesting itself in
both "positive" and "negative" symptoms with the mixture of symptoms
different from patient to patient.
"Positive" symptoms include hallucinations (auditory, visual or tactile), delusions (bizarre beliefs which are a departure from the person's previous thought patterns, unresponsive to evidence to the contrary, and outside of the person's culture), disordered speech, and "negative symptoms" (lack of affect, apathy, etc.). Paranoia, withdrawal from social interaction, religious obsessions, and delusions of grandeur and/or persecution are common. Many individuals hear "voices". Voices vary in content, from a running commentary, to warning the person against various people or activities or instructing that person in actions to take. A person can hear multiple distinct voices, and the voices can be people they know or do not know.
"Negative" symptoms impact attention, memory, concentration and learning and consists of social withdrawal, lack of emotional responsiveness, and lack of initiative. Although the "positive" symptoms
are much more dramatic, they are also much more easily treatable with
antipsychotics. Negative symptoms have traditionally been less affected
by antipsychotics although there has been a new class of "atypical antipsychotics" which has been useful in treating these aspect of schizophrenia.
Schizophrenia was first identified as a distinct mental disorder by Emil Kraepelin.
Schizophrenia is the most common form of major psychosis; it is estimated that over 45 million people are affected worldwide. The pathogenesis of schizophrenia is not fully understood but there is some evidence suggesting that the basis of this disease is disruption to the balance of chemical messengers and nerve pathways in the brain, and it appears that a
combination of both genetic and environmental factors are necessary to
cause schizophrenia. In cases where one identical twin has schizophrenia,
there is a 60 percent chance that the other twin will also have the disease.
This illustrates that there is a strong genetic component to the disease, but
that genetics is not the only factor. Psychiatrists generally do not believe
as they once did that the origin of the disease can be tracable to child
rearing practices.
Schizophrenia is said to manifest itself in several types, often four in the West (simple, catatonic, hebephrenic and paranoid -- though there has been some variation and debate on these classifications), and to this, in the former Soviet Union, was added a fifth, sluggishly progressing schizophrenia. Particularly in the RSFSR (Russian Soviet Federated Socialist Republic), political dissidents were diagnosed with sluggishly progressing schizophrenia and confined to psychiatric hospitals for the purpose of silencing them or getting them to recant their ideas. The first four, widely varying, forms of schizophrenia have led some to pose the controversial question, "Is schizophrenia one illness, or different illnesses that have been mistakenly classified under one heading?", and others to speculate that schizophrenia does not exist. They have used the "sluggishly progressing schizophrenia" of the RSFSR, and lower rates of diagnosis for the forms of schizophrenia accepted in the West in Western Europe than in the United States of America, to question whether it is possible that in some cases schizophrenia is not deliberately misdiagnosed in the United States as a means of political or philosophical repression. These questions are only being posed by a small minority and are highly controversial.
Schizophrenia can sometimes be caused by heavy use of hallucinogenic drugs, especially LSD; but it appears that one has to have a predisposition towards developing schizophrenia for this to occur. There is also some evidence suggesting that people suffering schizophrenia but responding to treatment can have an episode as a result of use of LSD. Methamphetamine and PCP also mimic the symptoms of schizophrenia, and can trigger ongoing symptoms of schizophrenia in those who are vulnerable. There is also some evidence that marijuana usage can be a contributing trigger to schizophrenia in vulnerable individuals.
The first schizophrenic episode typically occurs between the ages of fifteen and thirty. Men typically develop the symptoms five to ten years earlier than women. In about a third of the cases, the patient will suffer a psychotic episodes for a few months and then make a complete recovery without treatment.
This characteristic of the disease makes it difficult to distinguish between
effective treatments and non-effective ones.
However, if the condition relapses, the probability of spontaneous recovery
decreases. A rule of thumb is that one
third of persons with a psychotic episode will recover fully with or without
treatment. One third will be able to lead relatively independent lives with
continued treatment, and one third will be unable to live independently even
with medication.
The symptoms of the illness tend to improve later in life corresponding to decreases in the neurotransmitter Dopamine. Schizophrenia is incurable but can be treated with antipsychotic drugs. These drugs can have many unpleasant side effects; many patients may stop taking their medication as a result of extrapyramidal side effects (EPSE), a variety of movement disorders described at [here].
Controlled studies of have shown that "insight-oriented"
psychothreapy in which the patient is asked to understand the causes of their
mental states is useless in the treatment of schizophrenia and tend to make
the symptoms worse. General practice for the treatment of schizophrenia is
to emphasize "supportive psychothreapy" in which the focus of the treatment
is to help the patient deal with the day to day problems that arise as the
result of the disease.
Symptoms of schizophrenia often overlap with other "major mental illnesses", particularly mood disorders or obsessive compulsive disorder. The term "schizoaffective disorder" is used for situations where an individual has the distinct "thought disorder" symptoms of schizophrenia, combined with "mood disorder" symptoms usually associated with Bipolar Disorder or depression. Unlike other major mental illnesses, patients with
schizophrenia do not have periods between attacks of the disease in which they
are able to return to full functioning without medication.
Beginning in the 1960's there was a movement called anti-psychiatry that claimed that psychiatric patients are not ill and that they are just individuals that are misfit in society, and therefore put into asylums. Whilst there may have been some truth to this assessment with regards to mental illness in general, anthropological studies indicate that roughly equivalent percentages of people in a variety of cultures, some very different to modern Western culture, develop a disease recognised by that culture as such, with similar symptoms to schizophrenia, and subsequent medical examination of afflicted individuals show similar physical abnormalities as schizophrenics. (Some who are active in anti-psychiatry have not gone so far as to challenge the illness of psychiatric patients but merely challenged the practice of involuntary commitment from a legal or civil-liberties perspective.)
Researchers into shamanism have speculated that in some cultures schizophrenia or related conditions may predispose an individual to becoming a shaman. This assertion is highly criticized by anthropologists and psychiatrists.
The 1976 book The Origin of Consciousness in the Breakdown of the Bicameral Mind, by psychologist Julian Jaynes proposed that until the beginnings of historic times schizophrenia or a closely similar condition was the normal human consciousness; a "bicameral mind" in which a normal state of low affect suitable for routine activities would be interrupted in moments of crisis by "mysterious voices" giving instructions, which early people characterized as interventions from the gods. This theory was briefly controversial but continued work has not provided additional support.
The classic text on schizophrenia is: Dementia praecox and paraphrenia / by Emil Kraepelin. Translated by R. Mary Barclay. Edited by George M. Robertson. Huntington, N.Y., R. E. Krieger Pub. Co., 1971. xxiv, 331 p. illus., facsims. 23 cm. (Translation of section on the disease from the German: Psychiatrie. 8. Aufl., Bd. 1: Allgemeine Psychiatrie; Bd. 11: Klinische Psychiatrie, 1. Teil. Barth, Leipzig 1909. Bd. 111, 1913; Bd. IV, 1915.)
For a complete bibliography of English translations of Kraepelin's works see: http://www.kraepelin.org/_wsn/page3.html
For a complete bibliography of works by and about Kraepelin's including those in the original German: http://www.med.uni-muenchen.de/psywifo/Kraepelin.htm
For detailed information on Emil Kraepelin who first discovered schizophrenia, manic depression and co-discovered Alzheimers disease including biographical, bibliographical and historical information, as well as contact information for answers to specific questions about the disease and its history, visit the International Kraepelin Society at: http://www.kraepelin.org/