Schizophrenia is a common psychiatric disorder which has remained an enigma for the scientists despite several years of extensive research. Over the years, it has been endowed several names such as “The Sacred Symbol of Psychiatry” (Szazs, 1976) and “The graveyard of Psychiatry” (Naqvi, 2008). This disorder was first defined and established as a distinct disease entity more than a century ago by Professor Emil Kraepelin who coined the term Dementia Praecox for it (Kruger, 2000). This name was based on the two most common characteristics of the disease which were elucidated at that time viz.
dementia, the loss of mental capacity and praecox, which referred to the early phase of one’s life (Kruger, 2000). Kraepelin integrated the symptoms of catatonia which were defined by described by Kahlbaum (1874), hebephrenia, elucidated by Hecker in 1871, and paranoid dementia in to his description of dementia praecox (Naqvi, 2008). Moreover, according to Kraepelin, the outcome for this disorder was poor with the damage to the brain being only partially reversible and the progressive worsening of function observed in almost three-fourth of the patients (DeLisi, 2008; Naqvi, 2008).
Later, during the same era, Eugen Bleuler coined the term “Schizophrenia” which literally means “splitting of the mind”, based on the apparent dissociation between mental functions, which are comprised of cognitive functioning and the affect, and the subsequent outward response or behavior which is observed commonly in Schizophrenic patients (Kruger, 2000). Bleuler proposed that the characteristic symptoms present in all cases of Schizophrenia were comprised of the 4 A’s viz. 4As: associations, affect, autism, and ambivalence (Andreasen & Flaum, 1991).
Nowadays, these 4 A’s are regarded as the negative symptoms of Schizophrenia (Tandon, Nasrallah, & Keshavan, 2009). Bleuler’s description was unique from Kraepelin’s in that he proposed that Schizophrenia can be diagnosed even in the absence of hallucinations or delusions (Naqvi, 2008). Moreover, although Bleuler differed from Kraepelin in his views regarding the pathogenesis and symptoms of Schizophrenia, he conformed to Kraepelin’s view on the outcome of Schizophrenic patients which was considered to be poor.
However, in Bleuler’s view, Schizophrenia, although chronic in nature, ran a relapsing and remitting course and had the potential for improvement in patient condition, although complete recovery or restituio ad integrum was not possible (Kruger, 2000). Further progress in defining the spectrum of symptoms which defined Schizophrenia was brought about by Kurt Schneider (1959) who defined the pathognomonic features of Schizophrenia as the 11 “first-rank symptoms” (Tandon, Nasrallah, & Keshavan, 2009).
These symptoms consist of many of the symptoms of Schizophrenia which are now termed as positive symptoms, however, it has now been observed that these symptoms are not exclusively present in Schizophrenia and considerable overlap with other psychotic disorder exists (Tandon, Nasrallah, & Keshavan, 2009). The most recent definitions of Schizophrenia as proposed by the WHO (ICD-10) and the American Psychiatric Association (DSM-IV TR) have adapted key points from all of the concepts of Schizophrenia previously adapted.
These include the concept of the chronic course of the disease, as proposed by Kraepelin, the negative symptoms defined by Bleuler and the positive symptoms which were a part of Schneider’s first rank symptoms (Tandon, Nasrallah, & Keshavan, 2009). Schizophrenia is a multifaceted, intriguing illness, which can present clinically in a multitude of ways. I chose to discuss this topic because of three main reasons. Firstly, Schizophrenia is one of the most common psychiatric disorders which are encountered in clinical practice; therefore, a thorough knowledge on all its aspects is imperative.
Moreover, the diversity of symptoms and presentations of this illness make it both challenging and interesting. Since the symptoms of this disorder display considerable overlap with other psychotic disorders, differentiation of Schizophrenia from other illnesses and its timely diagnosis is highly important. Secondly, throughout the history, this disorder has been associated with several misconceptions, myths and beliefs.
Ever since it was first defined, the widely held belief about Schizophrenia is that it is intractable and incurable and leads to progressive worsening of mental functioning with minimal hopes of recovery. Although, this is partly true, it has now been shown that the symptoms and course of Schizophrenia can be kept in control with appropriate management. There is also considerable stigma attached to Schizophrenia. It is therefore important to learn about this disorder and take steps to dispel all such misconceptions and educate both the patients and the family regarding the nature and course of the disease.
Thirdly, from a social and public health perspective, schizophrenia is a major health burden in that it occurs mainly in adolescence and persists for life thus affecting the major productive period of a person’s life. This leads to significant decrease in a person’s productivity, loss of daily activities and higher rates of unemployment (Wu et al. , 2005). This is important from social, economic and healthcare perspectives and underscores the importance of the effective management of this disorder.