The term schizophrenia was first used in 1911 by Eugen Bleuler, a Swiss psychiatrist, to categorize patients whose thought processes and emotional responses seemed disconnected. The term schizophrenia literally means split mind and many people still believe incorrectly that the condition causes a split personality (which is an uncommon problem involving dissociation). Schizophrenia is now used to describe a cluster of symptoms that typically includes delusions, hallucinations, disordered thinking, and emotional unresponsiveness. Several definitions of schizophrenia still exist and no single cause has been found to explain all aspects of this devastating syndrome. Most likely, the symptoms are triggered by a number of disease processes coupled with genetic factors and environmental stresses.
Because symptoms of schizophrenia arise from various physical processes and respond differently to treatments, some experts recommend classifying the disease based on the presence of positive (which includes psychosis and mental disorganization) and negative (including apathy and social withdrawal) symptoms. It is important to note that positive and negative symptoms may overlap and interact with each other, so categorization may be misleading. Positive symptoms, according to one study improve in concert with negative symptoms, indicating some biologic link. This report, then, used three categories: presence of negative symptoms, psychosis, and thought-disordered thinking. A schizophrenic patient may have more than one symptom, but rarely does a patient with schizophrenia have all of them. Symptoms often go into remission. As the mechanisms in the brain that lead to schizophrenia are being discovered, researchers are attempting to define more accurate ways of describing the disease as it relates to the biologic processes that cause them.
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Negative symptoms reflect the diminishment of the self, lack of emotions, colorless speaking tones, and a general loss of interest in life. Patients with negative symptoms may also display emotionally inappropriate reactions (eg, laughing hysterically over a sad event), a condition known as inappropriate affect. Negative symptoms, such as lack of responsiveness and poor sociability, often appear in childhood as the first symptoms of schizophrenia and go unnoticed in many people who later develop full-blown schizophrenia. In others, however, negative symptoms do not appear until after the positive symptoms develop. Negative symptoms may co-exist with positive symptoms and typically persist after positive symptoms have been treated, and they tend to be more common than positive symptoms in older patients.
Psychotic events, particularly delusions and hallucinations, are the most widely recognized signs of schizophrenia. Hallucinations can take the form of either seeing or hearing things that don't exist. Auditory hallucinations, which are false senses of sound, such as hearing voices that go unheard by others, are the most common symptoms. One study even reported that schizophrenic patients who had been profoundly deaf since birth were able to describe convincing experiences of hearing voices. Delusions, on the other hand, are fixed, false beliefs; they can be bizarre (eg, invisible aliens have entered the room through an electric socket) or nonbizarre (eg, unwarranted jealousy, or the paranoid belief in being persecuted or watched). When psychotic symptoms occur, they usually begin in men between the ages of 17 and 30 and in women between the ages of 20 and 40. After the initial event, psychotic symptoms usually occur episodically and are interspersed with periods of remission.
Cognitive Impairment (Disordered Thinking)
The symptoms of cognitive impairment and disordered thinking include a lack of attention, memory impairment, impaired information processing, and an aberrant association between words and sentences. Sometimes discontinuity between ideas is so extreme that speech becomes incoherent, a condition referred to as "word salad." Patients with a thought disorder are more likely to connect words because of similarity of sound, rather than by meaning; these are known as "clang associations." The ability to abstract may also be impaired. Oddly enough, studies have shown that vocabulary and spatial abilities, such as map reading, are not damaged. In keeping with other aspects of disordered thinking, memory impairment in schizophrenia is likely to involve the inability to connect an event with its source into a complete and whole memory. For instance, a patient may recall and even feel a familiarity with a specific event but be unable to remember where, when, or how it took place. Some cognitive impairment often occurs long before full-blown psychotic symptoms develop.