SchizophreniaThe diagnosis of Schizophrenia according to the DSM-IV the individual must:
Have at least 6 months of significant impairment in occupational, interpersonal, and self-supportive functioning. The individual must have experienced a period of actively psychotic symptoms without the presence of a major mood disorder, autism, or organic condition.
The course or the illness is classified as continuous or episodic, with or without intereposidic residual symptoms, or single episode in partial or full remission. There are also five subtypes, which describe the most frequently observed behavioral manifestations observed during the illness. While schizophrenia is a well-defined and stable diagnosis, the subtypes are relatively inadequate and ill defined. Often, individuals tend to overlap in symptoms pattern and the diagnosis can shift from one time to another. Further, as time passes, the symptoms of the illness tend to converge toward general social withdrawal, idiosyncratic thinking, and flattened affect. The course of the illness also tends to be more stable with less acute episodes or symptoms.
Neuroleptic medications are used to treat the symptoms of schizophrenia. The newer antipsychotic drugs tend to have fewer side effects and better efficacy. However, medication tends to treat only the positive symptoms and appears to have little impact on negative symptoms. (Just to clarify, positive symptoms are just that, symptoms that are active- delusions, hallucinations and bizarre behavior. Negative symptoms are the “lack” of behavior- withdrawal, flat affect, and thought blocking.)
Let’s look at a case to help get a sense of diagnosis:
Billy Jean has been acting strangely for several months now. She reports that her neighbors are trying to poison her. They are trying to give her poisoned food and have attempted to pump poisoned gas into her apartment through the air conditioning vents. She states that her mother is in collusion with the “group” that is after her- as are the neighbors. Billy Jean appears very nervous and has pressured speech. She appears confused and frightened.
This is not even a close call. The likely diagnosis is delusional disorder for the following reasons: First, the delusions are non-bizarre. In schizophrenia, the delusions are usually bizarre (e.g. aliens are projecting thoughts into my mind). The duration is too short for schizophrenia (but are sufficient for Brief Psychotic or Schizophreniform Disorder). While there may be an absence of hallucinations in Schizophrenia, this is relatively rare. (Auditory hallucinations in the form of voices are most common, visual are the next common and olfactory and kinesthetic are rare. Olfactory hallucinations are suggestive of organicity). A patient might have a residual or prodromal presentation that could look similar to the above case. However, the residual phase must (by definition) be preceded by an acute phase. In this case, the course and duration do not fit. The Prodromal phase (Prodromal: the period between the first appearance of symptoms and the acute state) is usually characterized by odd behavior and thinking, not clearly define delusions.
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