In modern psychopathology there are many discrepancies between the symptoms of mental illnesses and the diagnosis. In this article, I have tried to systematize the symptoms of schizophrenia types to the corresponding diagnosis.
According to the type of flow, there are three forms: continuous, periodic and prolonged-progressive schizophrenia.
- Continuously running is characterized by a relatively slow flow and subsequent development of neurosis, wrong judgments, hallucinations, and the “staying” of the patient in one posture. Exit in this form, especially in malignant variants, is the most severe form of schizophrenia. It is characterized by stormy seizure, no affective states (depressive or manic / syndromes), fantastic false thoughts or consciousness. Changes in personality in this form precede the ultimate symptom. Continuous schizophrenia is divided into an overflowing, paranoid and malignant
- Recurrent / periodic / schizophrenia belongs to the relatively favorable forms of the disease, since it does not bring about severe changes in the personality of the ongoing schizophrenia. This pattern is more common in women. It runs with well-defined seizures, followed by sharp and deep remissions. The probability of new outbreaks of the disease is very high (hence called recurrent, recurrent type). The clinical picture of most seizures is varied / as with all acute psychoses. It has a variety of symptoms: affective / depressive and obsessive / obsessive-compulsive. Seizures can occur with the prevalence of one of these symptoms, but often the symptoms change during the course of the attack. In relapses, the clinical picture may be identical to the first,
The typical seizure of periodic schizophrenia unfolds in a certain sequence / stereotype of the onset of the attack. (Initially there are emotional fluctuations, headaches, painful and uncomfortable physical sensations, sleep disorders.
Later there is anxiety, fear, a sense of change in the individual’s personality and the environment. Later recollections, unusual heart excitements, a sense of incomprehension that is happening about the patient, are happening.
Then come fantastic, wrong judgments. Then there may also be a “frost” of the body. The world begins to be considered as unreal, as the feeling that the patient is not a person and has no individuality. Recovery can be progressive or fast. Emotional disorders remain longer. The critique of disease experiences is gradually recovering. For some time there may be remnant misconceptions.
- Progressive-progression schizophreniaas an individual in its disease manifests it occupies an intermediate place between the continuously flowing and the recurrent form, gravitating according to its signs to one and the other. For the para-progressionary form it is characteristic the combination of the ones belonging to the continuous course of neurotic syndromes, ideas for persecution. Emotional and sinister judgments are articulated, coupled with the body’s “pocketing” in one posture. Observations show that personality changes usually precede the emergence of outlined seizures and increase leapfrog after each attack. The beginning of this form is at an early age. Attacks are characterized by the presence of emotional disorders, as well as more complicated syndromes: compulsions, persecution ideas, hallucinations, and “staging” of the body in one posture.
- Febrile schizophrenia. The feverish nature can get acute or abrupt exacerbations, reaching foolish judgments with a fantastic character. The temperature response is not related to somatic reasons. At the highest rise in temperature, hypertonic arousal is observed. The attack passes after the temperature has passed, and then the clinical picture becomes typical of the recurrent or protruding form.
- Paranoid schizophrenia Gradually, the misconceptions of the patient are gradually formed and expanded. In the later stages of psychosis, they get abducted, implausible and ridiculous. This form develops in people with pre-existing features of activity, insistence, arrogance, acute intolerance to injustice. There is no intellectual decline and there is no complete healing.
- Worrying schizophrenia. It is characterized by slow progress, gradual development of personality change, which does not lead to deep emotional devastation. Clinical manifestations are from the circle of neurotic, vegetative, intrusive, phobic, manic fear for one’s own health, lack of conscience, and inability to understand what good or whatever. Typical are mood disorders and a poorly expressed lack of connection with reality.
A third line of classification of forms of schizophrenia can also be separated, according to age . This is already in the field of comparative psychiatry.
In the late age, schizophrenia may not be a first attack, but an exacerbation of a disease already in the past. Attacks are characterized by erroneous judgments, lack of connection with reality, emotional disorders, hallucinations – hearing and visual
- The simple form of schizophrenia is characterized by gradual onset, progressively increasing personality change. It usually occurs in teens and youngsters. Reflective psychotic production is not perceived or very poorly identified. Changes in behavior that are continually deepening are at the forefront.
- Hyperfrenal forms most often affect teenage age. It is expressed in stupid behavior, manners, coquettions, grimaces and euphoric moods. False judgments are in stages and not well shaped. There is an unfavorable flow, and it often comes to baseline for a few years.
- Hebloid syndrome. Characteristic is the preservation of the intellect, but gross abnormalities in behavior are revealed: distortions and perversions of primitive tendencies, associal and antisocial acts, terrorized by relatives, conflict, wandering, excessive stubbornness, aggression, unceremoneness, immorality, insufficient criticality. The patient lacks conscience with him. Missing judgments and hallucinations are missing.
- Schizophreniform Disorder. Characteristic symptoms of two or more of the following, each occurring over a significant part of the time for a period of one month or shorter on successful treatment:
- Wrong judgments;
- Broken speech (for example, often slip or inconsistency)
- Roughly disorganized behavior or “frost” of the body in one posture
- Negative symptoms, i. alignment, unification, deprivation of opinions, ideas, tastes, poverty of speech or frustration and inability to make decisions
If misconceptions are ridiculous or hallucinations consist of commenting on the behavior or thoughts of the diseased voice, only one of the symptoms is sufficient to make the diagnosis.
The episode of the disorder (including pre-existing, active and residual phases) lasts for at least one month but less than six months. The onset of pronounced psychotic symptoms is within 4 weeks of the first noticeable change in normal behavior or functioning. There is confusion or perplexity at the tip of the psychotic episode. He may have a good pre-health condition, with success in social and professional functioning. There is no blunt alignment, unification, deprivation of opinions, ideas, tastes.
- Schizoaffective Disorder . There is a continuous illness during which there is a severe depressive episode, a manic episode, or a mixed episode at times, which coexist with symptoms that last for one month and less good treatment. Characteristic are again wrong judgments, hallucinations, torn speech, grossly disorganized behavior, or “frost” of the body in one posture and the already negative symptoms that are characteristic of schizophrenia.
- Cold Disorder –Jokes with no ridiculous content (that is, situations that can occur in real life, such as some being persecuted, poisoned, infected, loved by a distance, deceit from a marriage or sexual partner, or becoming ill) and are with a duration of at least one month. Tactile and olfactory hallucinations may be present in the delusional disorder if they are related to a lunatic subject. Outside of the effects of delusions (delusions) and their (their) consequences, the functioning is not significantly disturbed and the behavior is not obviously odd or ridiculous. Along with delusions, accompanying affective episodes also appeared, their overall duration was relatively short compared to those of predominantly delusional periods. The disorder is not due to the direct physiological effect of a psychoactive substance (eg drug abuse or medication) or general medical condition. The following types are based on the predominantly lunatic theme:
- Erotomanian type : delusions that someone, usually with a higher social standing, is in love with the individual.
- Grand-type : delusions of increased self-worth, power, knowledge, identity, or special relationship with a deity or a known person.
- Angry type: delusions that the individual’s sexual partner cheats on.
- Transcriptional type: delusions that the individual (or his or her close) has some malicious attitude.
- Somatic type : delusions that the individual has some body defect or is affected by a general medical condition.
- Mixed type: delusions typical of more than one of the types listed above, but none predominate.
The analysis I have tried to make from different sources points to the following issues that are looking for their solution:
In the International Classification of Diseases (ICD-10) the hallucinations and delusions described in the literature I read are under code F22.0 and this is the diagnosis of a delusional disorder. Schizophrenia, schizotype and delusional disorders are from F20 to F29 and the symptoms of these diseases are described.
Psychopathology textbooks include the symptoms of schizophrenia as the first degree of psychosis (without explaining what psychosis actually is), and no mention of other schizophrenic and schizotypic disorders, but writing about psychosis as a general notion. Is that really true? Is the International Classification of Diseases / ICD-10 / true and accurate?
In ICD-10, manic depressive psychosis has dropped out of classification, and in DSM-IV affective disorders are diffected as affective episodes: severe depressive episode, manic episode, mixed episode, and hypomanic episode.
Often, bipolar-affective disorder is spoken, and symptoms of manic-depressive psychosis are included in the symptoms of the disorder. Is there really a diagnosis of bipolar-affective disorder (BAR) and, if so, how is it treated?
In the books he writes about melancholy as the last degree of psychosis, and such a disease does not exist in ICD-10 and DSM-IV. Is there a psychosis called melancholy? Surely there is melancholic temperament, and the temperament is almost unchanging throughout man’s life.
And in what society do we live in the literature as the treatment of schizophrenia? If there are so many prejudices about this disease, people seem to have no knowledge of it. Interesting are the explanations regarding the connection of the patient with schizophrenia with the mother and with the relatives as a whole. Maybe the “root of evil” can be discovered and explained with the help of psychoanalysis?
Which psychoses can be induced? Are strong believers absolutely sick?
It is traditionally assumed that thinking and speech are interrelated. Speech is a physical, physical process that results in the sounds of speech. The combination of sounds formed speech. The combination of sounds forms the tongue. Language is an abstract system of signs and meanings. ie words / and structural rules for their combination. And all this is in certain centers in the brain.
After saying that schizophrenia is a “great simulant” like hysteria, is there really a disability in brain centers in schizophrenia where thinking and speech is localized, or all is due to chemical imbalance? Or if there is a disability in brain centers, can we talk only about the aphasia of Broke and aphasia of Wernicke?
The terminology of emotional experiences is not well defined and the meaning of different terms overlaps. For example, the terms “bad mood” or “good mood” are variants of the norm, but on the other hand, the mood can be judged to be broken and a disease category.
In addition, in common clinical practice, the terms emotions, feelings and affections are commonly used as synonyms, although psychologically and psychopathologically there are differences between them. For this reason, is there a “mismatch” in the classification of affective disorders in ICD-10, DSM-IV and the grouping of disorders in the books.
The last question may also be about paranoia … There is a distinction between true delusions that are the result of primary delusional experiences and which can not be attributed to another disease phenomenon, while the mischievous ideas are secondary and can be extracted from other disease phenomena, which is why they are called secondary delusions. There is also another hypothesis where normal beliefs and delusions are at the ends of a continent, and the mundane ideas take up some central place in this spectrum.
As a conclusion, it can be said that in the field of psychopathology there is still much to be learned that a classification of diseases should be used that is accurate and clear.