Episode 83: This is the second in our series of Gold Standard USMLE Audio Reviews covering the antipsychotic medications.  Let me know if your medical school uses a systems-based curriculum; if so we’ll organize the DVD-ROMs according to your block schedule if you’re interested.

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History of Schizophrenia

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I. Brief History

  • Kahlbaum ———Catatonia
  • Hecker ————-Hebephrenia
  • Sanders————-Paranoia (“absent mind”)
  • Morel ————–Demence Precoce
  • Kraepelin ———Dementia Praecox or Precox (Catatonia + Hebephrenia + Paranoia)
  • Bleuler ————Schizophrenias (” splitting of the mind”)
  • Langfeldt———-Schizophreniform Disorder

II. Essential features of Schizophrenia

Characteristic signs and Sx (+ and -) that have been present during a one-month period or shorter period if successfully treated …………(involves active psychosis w/ delusions & hallucinations)

……with some signs of the disorder persistent for at least 6 months

These signs and symptoms are associated with marked social or occupational dysfunction

The disorder is not obviously related to organic causes (drug-physical illness) or mood d/o (these options must be eliminated)

III. Symptoms at Onset

  • Somatic Manifestations, changes in the ability to work- vague; ie headaches
  • Anxiety
  • Perplexity – “what did you say? I did not hear you.” (they are not mentally there)
  • Abstract ideas (philosophy, occult, religion, etc.)
  • Peculiar Behavior- not bathing; justify it by saying only dirty people bath and kept rationalizing it
  • Trema (fright) – realize that something is wrong
  • Apocalyptic- person falls to pieces
  • Vegetable-like phase- pt had no pain with a horrid abdominal abscess

IV. Diagnostic Criteria (according to the DSM-IV)

  • Characteristic symptoms- 2 or more of the following, each present for a significant portion of time during a one month period (or less, if successfully treated)

– Delusions

– Hallucinations

– Disorganized speech (frequent derailment or incoherance)

– Grossly disorganized or catatonic behavior

– Negative symptoms (affective flattening, alogia, or avolition)

Only one of the above is required if the delusions are bizarre of hallucinations consist of a voice keeping up a running commentary on the person’s behavior or thoughts, or two or more voices conversing with each other

  • Social/occupational dysfunction- significant declining performance at work or in relationships since the onset of symptoms; or when the onset is in childhood, the child fails to achieve the expected levels of interpersonal, academic, or occupational achievement
  • Duration- continuous signs of disturbance persist for at least 6 mos

– 6 mo pd must include at least 1 month (or less is successfully treated) that meet Criterion A (active phase Sx)

– May include pds of prodromal/residual Sx during whichsigns of disturbance are manifested by either

Only negative Sx or

2+ symptoms listed in Criterion A present in the attenuated form (odd beliefs, ususual perceprtions)

  • Schizoaffective and Mood Disorder (w/psychotic features) have been Excluded

– Ruled out b/c either:

1. No major depressive, manic, or mixed episodes have occurred concurrently with acute phase symptoms

2. If mood episodes have occurred during active phase symptoms their total duration has been brief relaitve to the duration of the active and residual periods

  • Substance/General medical condition Exclusion- the disturbance is not due to the direct physiological effects of a substance (eg a drug of abuse, a medication) or a general medical condition
  • Relationship to a Pervasive Developmental Disorder – if there is a history of autistic disorder or another pervasive developmental disorder, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations are also present for at least a month (or less if successfully treated)
  • Kurt Schneider Criteria

 

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