Derived from the Greek words, skhizein (to split) and phren (mind), Schizophrenia is a mental disorder that affects one’s thought process. The term ‘schizophrenia’ was coined by Eugen Bleuler in 1908. It was first described by Benedict Morel in 1853 as a mental illness affecting teenagers and young adults. The term Dementia Praecox was used in 1891 by Arnold Pick that means ‘early dementia’. Later in 1893 Emil Kraepelin also described Dementia Praecox as a disease of the brain, a form of dementia that affected young adults.
It was Kurt Schneider, a German psychiatrist who around 1950, first listed the symptoms of Schizophrenia, distinguishing them from other psychotic disorders. Called Schneider’s first-rank symptoms, these include delusions and hearing hallucinatory voices. There are positive and negative symptoms. Positive symptoms are mainly delusions and auditory hallucinations, which are present in only schizophrenics. Negative symptoms are those that are not present in schizophrenic persons but are found in healthy persons, such as the inability of normal speech and expression of pleasure, lack of motivation, and having no desire to form relationships.
Schizophrenia affects men and women equally. It rarely occurs in children, but awareness of childhood-onset Schizophrenia is increasing. The risk is highest for an identical twin of a person with schizophrenia. A young adult having an abnormal behaviour is confirmed to be a case of Schizophrenia based on the victim’s self-reported experiences and abnormalities in behaviour reported by family members and friends. Psychiatric assessment basically includes a psychiatric history of the disorder in the family and development of typical symptoms ascertaining the possible factors that might have triggered the disease. No laboratory tests are conducted for substantiating the diagnosis as the observed behaviour itself is quite typical of this mental disorder.
The most widely used standardized criteria for diagnosing schizophrenia is based on the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, version DSM-IV-TR, and the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems, the ICD-10. The latter criteria are typically used in European countries, while the DSM criteria are used in the United States and the rest of the world. The three diagnostic criteria generally accepted for diagnosing schizophrenia are the following: First, the presence of at least two characteristic symptoms (delusions, hallucinations, disorganized speech, disorganized behaviour, catatonic behaviours). Second, the presence of social/occupational dysfunction that makes the victim unable to carry out normal work where interaction with family members, friends and colleagues is important. Lastly is the presence of above symptoms for at least six months.
The symptoms of Schizophrenia are quite typical, although psychotic symptoms are also present in other mental disorders, like bipolar disorder, personality disorder and drug-induced psychosis, while non-bizzare delusions are present in social anxiety disorder. Similarly, the symptoms of obsessive compulsive disorder are different from the delusions of Schizophrenia.
Analysis of brain functioning with Positron Emission Tomography (PET) a nuclear medicine imaging technique that produces a 3D image of body’s functional processes has shown that a lowered frontal lobe activation of the brain during a working memory task, poses the risk of increased activity of a neurotransmitter called ‘dopamine’ in the synaptic junctions where neurons meet. Besides the frontal lobes, functional differences in the brain activity of schizophrenics also occur in the hippocampus and temporal lobes. Similarly, Magnetic Resonance Imaging (MRI) and other brain imaging technologies have toady revealed the clear-cut differences in the brain activity of schizophrenics.
The brains of people with Schizophrenia also look different from those of healthy people. Thanks to these imaging technologies, differences in the size and structure of certain areas of the brain in schizophrenics are clearly known today. MRI studies have shown that the volume of the whole brain and the hippocampus region are markedly reduced in schizophrenics, while the fluid-filled cavities at the center of the brain, called ventricles, are larger in schizophrenics as compared to healthy individuals.