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HISTORY OF THE CONCEPT OF SCHIZOPREHNIA Early descriptions  Concept of s by kraeplin and blueler. Kreplain= dementia praecox; the early term for s in 1898. he diff btwn manic depressive illness and dementia praecox. Dementia praecox included several diagnostic concepts- dementia paranoids, catatonia and hebephrenia. These disorders were symptomatically diverse bit but Kraeplin believed they shared a common core  Bleuler wanted to define the core of the disorder and move away from K emphasis on age of onset and course in the def of s. Bleuler broke with K on two major points: he believed that the dis did not have an early onset and it did not inevitably progress toward dementia. Therefore he thought the name was no longer good and changed it to s. from Greek work schizein meaning to split and phren meaning mind  But he faced a conceptual problem cuz symptoms could vary w/ each person  The concept B adopted was the “breaking of associative threads”  For b associative threads joined not only words but thoughts. Thus goal oriented efficient thinking and communication were possible only when these hypothetical structures were intact.  Blocking- an apparently total loss of a train or thought – as a complete disruption of the persons associate threads The historical prevalence of schizophrenia  Suggests that rates of s have fallen sharply since the 1960  There was a substantial decrease in inpatient prevalence rates of s between 1986 and 1996 with no corresponding increase in outpatient prevalence rates  At the NY state psychiatric institute 20% of the patients were diagnosed with s in the 1930s. the #s increased through the 1940s and in 1952 peaked at 80%. In contrast the concept of s prevalent in Europe remained narrower. The % of patients diagnosed with s at maudsley hospital in London for ex; stayed relatively constant at 20% for a 40 yr period  The concept of s was further broadened by three additional diagnostic practises:  1) U.S clinicians tended to diagnose s whenever delusions or hallucinations were present. Cuz these symptoms particularly delusions, occur also in mood disorders, may patients with a DSM-II diagnosis of s may actually have had a mood disorder  2) patients whom we could now diagnose as having a personality disorder and were diagnosed as s according to DSM-II criteria.  3) patients with an acute onset of s symptoms and a rapid recovery were diagnosed as having s The DSM-IV-TR Diagnosis  the US concept of s shifted from broad def to a def that narrows the range of patients diagnosed as s in 5 ways:  1) the diagnostic criteria are presented in explicit and considerable detail  2) patients with symptoms of a mood disorder are specifically excluded. Scizoaffective disorder comprises a mixture of symp of s and mood disorders.  3) DSM-IV-TR requires at least 6 months of disturbances for the diagnosis. The 6 month period must include at least one month of the active phase, which is defined by the presence of at least two of the following: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic beh and negative symp  the remaining time required within the minimum six months can be either a prodormal (before the active phase) or a residual (after the active phase) period. Problems during the prodormal and residual phases include social withdrawal, impaired role functioning, blunted or inappropriate affect, lack of initiative, vague and circumstantial speech, impairment in hygiene and grooming, odd beliefs or magical thinking and unusual perceptual experiences. These criteria eliminate patients who have a brief psychotic episode which is often stress related and then recover quickly. The symp of s dis are the same as those of s but last only from one to six months. Brief psychotic dis lasts from one day to one month and is often brought on by extreme stress such as bereavement  4) some of what DSM-II regarded as mild forms of s are now diagnosed as personality dis  5) DSM-IV-TR differentiates between paranoid s and delusional disorder. A person with delusional disorder is troubled by persistent persecutory delusions or by delusional jealousy, which is the unfounded conviction that a spouse or lover is unfaithful. There are also delusions of being followed, somatic delusions and delusions of erotomania (believing that one is loved by some other person, usually a complete stranger with a higher social status).  Unlike person with paranoid s the person with delusional dis does not have disorganized speech or hallucinations. Delusional dis is quite rare and typically begins later on in life than s. in most families it appears to be related to s perhaps genetically Categories of s in DSM-IV-TR  Three types of s included are disorganized (hebephrenic) catato
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