The term schizophrenia has been misused (in lay terms) for years. This misuse is the result of the dramatic license taken in movies and in the media as well as general ignorance on the part of the average lay person. The word schizophrenia literally means- split mind. Eugene Bleuler coined this term in 1911 as a replacement for Dementia Praecox (which means premature dementia). In common usage, schizophrenia became “split personality” and was used to mean “of two minds” or “ two personalities.” This usage has been used to describe everything from Dissociative Personality Disorder to simply feeling extreme ambivalence. In fact, Bleuler coined the term to describe the cleavage between cognitive and emotional functions in the mind (previously described as the primary autonomous ego function). He was really describing the “fragmentation” of the ego functions that causes one to lose touch with reality. More recently, common usage of the term schizophrenia bring with it concerns of very dangerous or murderous behavior. In fact, most people diagnosed with schizophrenia are much more dangerous to themselves, due to the lack of self-care and poor judgment, than they are dangerous to others.
Schizophrenic individuals (especially during acute psychosis) may display a variety of emotions in a short period. This “affective lability” may be quite intense and may appear inappropriate for the situation or subject of discussion (the thoughts or speech of the individual). Labile emotions are more characteristic of acute psychosis, whereas blunted or flat affect is more likely seen in the residual or chronic phases of the illness. However, this is not a hard and fast rule.
Disturbance of behavior was mentioned previously. Behavioral anomalies such as generally bizarre or strange behavior, grimacing and posturing, ritual behavior (sometime similar to OCD symptoms), excessive “stony” stillness, as well as some aggressiveness and inappropriate sexual behavior.
If the onset of acute symptoms is shorter (less than 4 weeks after noticeable behavior change) and there is good premorbid functioning, this indicates the use of the DSM-IV specifier “With Good Prognostic Features.” Other considerations for the “Good Prognostic Features” specifier is a lack of blunted affect and the presence of confusion at the height of the episode. On the other hand, the “Without Good Prognostic Features” specifier is used if less than two of these are indicators are present. (Research has also shown that a later than average age of onset of the illness is indicative of better prognosis while earlier onset is a poor prognostic indicator. However, do not confuse this with the use of the DSM specifier, which does not include “age of onset”).
In the next installment, we will try to pull together the assortment of issues covered thus far in the diagnosis of schizophrenia. A closer look at the differential diagnosis of schizophrenia will give some important clues as to conducting a good mental status exam. The mental status examination is important for assessing the current functioning (in the office) of the individual being assessed. Combining the mental status exam with a good history is the core of a diagnostic assessment. However, I feel that the best assessment occurs over time when you are able to experience an individuals patterns of relating- both to themselves and to others (including the therapist).
http://schoolpsychologyexam.com
