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The Essence of Schizophrenia

The Essence of Schizophrenia. Originally called “dementia praecox” Produces severe incapacity – “dementia” Typically begins in adolescence – “praecox”. The Tragedy of Schizophrenia. A catastrophic illness Tends to persist chronically 10% suicide rate Very common -- 0.5-1% of population

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The Essence of Schizophrenia

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  1. The Essence of Schizophrenia Originally called “dementia praecox” Produces severe incapacity – “dementia” Typically begins in adolescence – “praecox”

  2. The Tragedy of Schizophrenia • A catastrophic illness • Tends to persist chronically • 10% suicide rate • Very common -- 0.5-1% of population • The “cancer of mental illness”

  3. The Complexity of Schizophrenia • No single defining feature • Multiple characteristic symptoms • Symptoms from multiple domains • Emotion • Personality • Cognition • Motor Activity • Probably a multisystem disorder, analogous to syphilis

  4. Simplifying the Complexity of Schizophrenia • Division of symptoms into two broad groups • Positive: distortions or exaggerations of normal functions • Negative: diminution of normal functions

  5. Hughlings-Jackson: Positive and Negative Symptoms • Disease that is said to “cause the symptoms of insanity.” I submit that disease only produces negative mental symptoms answering to the dissolution, and that all elaborate positive mental symptoms (illusions, hallucinations, delusions, and extravagant conduct) are the outcome of activity of nervous elements untouched by any pathological process; that they arise during activity on the lower end of evolution remaining.

  6. Positive Symptoms

  7. Negative Symptoms

  8. The Importance of Negative Symptoms • Impair ability to function in daily life • Holding a job • Attending school • Forming friendships • Having intimate family relationships

  9. Subdivision of Symptoms into Three Dimensions • Psychotic Delusions Hallucinations • Disorganized Disorganized speech Disorganized behavior Inappropriate affect • Negative Poverty of speech Avolition Affective Blunting Anhedonia

  10. Types of Hallucinations • Auditory • Visual • Tactile • Olfactory

  11. Types of Delusions • Persecutory • Grandiose • Religious • Jealous • Somatic

  12. Historical Concepts • Emil Kraepelin • Eugen Bleuler • Kurt Schneider • Others (e.g., Leonhard, Kleist, Langfeldt)

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