Psychiatry for Physicians - Schizophrenia - 1

Among all the psychiatric disorders the most significant one, from all points of view, is schizophrenia. So far the scientific inference about schizophrenia mentions its best management as medications with various forms of psychosocial care. Recent advancements also suggest integrated approach with genetic, neurochemical, and neuropathological knowledge about the disease.

Emil Kraepelin is the first person who first delineated schizophrenia. Taking it as young age dementia he named it as "Dementia Praecox". It was Eugen Bleuler who later named it as "Schizophrenia". Another significant contribution towards schizophrenia is the introduction of Schneiderian symptoms.

In this article I will discuss the diagnosis of schizophrenia with the support from the DSM of the APA. The following symptoms can be present in cases of schizophrenia -

1. Delusions

2. Hallucinations

3. Disorganized speech

4. Grossly disorganized or catatonic behavior

5. Negative symptoms

6. Social and occupational dysfunction

7. Duration of symptom is at least 6 months

Differential diagnosis of schizophrenia can be as follows -

1. Psychiatric illnesses

a. Psychotic mood disorders

b. Schizoaffective disorders

c. Brief reactive psychosis

d. Schizophreniform disorder

e. Delusional disorder

f. Induced psychotic disorder

g. Panic disorder

h. Depersonalization disorders

i. Factitious disorder with psychological symptoms

j. Malingering

2. General medical illness

a. Temporal lobe epilepsy

b. Tumor, stroke, brain trauma

c. Endocrine/metabolic disorders

d. Vitamin deficiency

e. Infectious

f. Autoimmune

g. Toxic

3. Drugs of abuse

a. Stimulants

b. Hallucinogens

c. Anticholinergics

d. Alcohol withdrawal delirium

e. Barbiturate withdrawal delirium

Laboratory tests are helpful for differentiating schizophrenia from medical illnesses. But confirming schizophrenia does not get any help from such laboratory investigations. In DSM course of schizophrenia is also classified. Schizophrenia can be episodic with interedisope residual symptoms or no such symptoms, or it can be continuous, or single episode with partial or full remission or of other patterns. In the next article I shall discuss about the rest of schizophrenia.