PSYC496AV Lecture Notes - Dementia Praecox, Pathological Jealousy, Delusional Disorder

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12 Feb 2013
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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
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