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The history of Schizophrenia is complex and does not
lend itself easily to a linear narrative. Accounts
of a Schizophrenia-like syndrome are thought to be
rare in historical records before the 19th century,
although reports of irrational, unintelligible, or
uncontrolled behavior were common. A detailed case
report in 1797 concerning James Tilly Matthews, and
accounts by PhillipePinel published in 1809, are
often regarded as the earliest cases of the illness
in the medical and psychiatric literature. |
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The Latinized term dementia praecox was first used
by German alienist Heinrich Schule in 1886 and then
in 1891 by Arnold Pick in a case report of a
psychotic disorder (hebephrenia). In 1893 Emil
Kraepelin borrowed the term from Schule and Pick and
in 1899 introduced a broad new distinction in the
classification of mental disorders between dementia
praecox and mood disorder (termed manic depression
and including both unipolar and bipolar depression).
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Kraepelin believed that dementia praecox was
probably caused by a long-term, smouldering systemic
or "whole body" disease process that affected many
organs and peripheral nerves in the body but which
affected the brain after puberty in a final decisive
cascade. His use of the term dementia distinguished
it from other forms of dementia such as Alzheimer's
disease which typically occur later in life. It is
sometimes argued that the use of the term
démenceprécoce in 1852 by the French physician
Bénédict Morel constitutes the medical discovery of
Schizophrenia. However this account ignores the fact
that there is little to connect Morel's descriptive
use of the term and the independent development of
the dementia praecox disease concept at the end of
the nineteenth-century.
Molecule of chlorpromazine (trade name Thorazine),
which revolutionized treatment of Schizophrenia in
the 1950s |
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The word Schizophrenia—which translates roughly as
"splitting of the mind" and comes from the Greek
roots schizein (σχίζειν, "to split") and phrēn,
phren- (φρήν, φρεν-, "mind")—was coined by
EugenBleuler in 1908 and was intended to describe
the separation of function between personality,
thinking, memory, and perception. American and
British interpretations of Beuler led to the claim
that he described its main symptoms as 4 A's:
flattened Affect, Autism, and impaired Association
of ideas and Ambivalence. Bleuler realized that the
illness was not a dementia, as some of his patients
improved rather than deteriorated, and thus proposed
the term Schizophrenia instead. Treatment was
revolutionized in the mid-1950s with the development
and introduction of chlorpromazine.
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The term Schizophrenia is commonly misunderstood
to mean that affected persons have a "split
personality". Although some people diagnosed with
Schizophrenia may hear voices and may experience the
voices as distinct personalities, Schizophrenia does
not involve a person changing among distinct
multiple personalities. The confusion arises in part
due to the literal interpretation of Bleuler's term
Schizophrenia (Bleuler originally associated
Schizophrenia with dissociation and included split
personality in his category of Schizophrenia).
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Both Bleuler and Kraepelin subdivided
Schizophrenia into categories, based on prominent
symptoms and prognoses. Over the years, those
working in this field have continued to attempt to
classify types of Schizophrenia. Five types were
delineated in the DSM-III: disorganized, catatonic,
paranoid, residual, and undifferentiated. The first
three categories were originally proposed by
Kraepelin. These classifications, while still
employed in DSM-IV, have not shown to be helpful in
predicting outcome of the disorder, and the types
are not reliably diagnosed. Many researchers are
using other systems to classify types of the
disorder, based on the preponderance of "positive"
vs "negative" symptoms (see symptoms of
Schizophrenia above), the progression of the
disorder in terms of type and severity of symptoms
over time, and the co-occurrence of other mental
disorders and syndromes. It is hoped that
differentiating types of Schizophrenia based on
clinical symptoms will help to determine different
etiologies or causes of the disorder. |
In the early 20th century, the psychiatrist Kurt
Schneider listed the forms of psychotic symptoms
that he thought distinguished Schizophrenia from
other psychotic disorders. These are called
first-rank symptoms or Schneider's first-rank
symptoms. They include delusions of being controlled
by an external force; the belief that thoughts are
being inserted into or withdrawn from one's
conscious mind; the belief that one's thoughts are
being broadcast to other people; and hearing
hallucinatory voices that comment on one's thoughts
or actions or that have a conversation with other
hallucinated voices. Although they have
significantly contributed to the current diagnostic
criteria, the specificity of first-rank symptoms has
been questioned. A review of the diagnostic studies
conducted between 1970 and 2005 found that they
allow neither a reconfirmation nor a rejection of
Schneider's claims, and suggested that first-rank
symptoms should be de-emphasized in future revisions
of diagnostic systems.
In the early 1970s, the diagnostic criteria for
Schizophrenia were the subject of a number of
controversies which eventually led to the
operational criteria used today. It became clear
after the 1971 US-UK Diagnostic Study that
Schizophrenia was diagnosed to a far greater extent
in America than in Europe. This was partly due to
looser diagnostic criteria in the US, which used the
DSM-II manual, contrasting with Europe and its
ICD-9. David
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Rosenhan's 1972 study, published in the journal
Science under the title "On being sane in insane
places", concluded that the diagnosis of
Schizophrenia in the US was often subjective and
unreliable. These were some of the factors leading
to the revision not only of the diagnosis of
Schizophrenia, but the revision of the whole DSM
manual, resulting in the publication of the DSM-III
in 1980. |
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Dissociative identity disorder (having a "split
personality") was also often misdiagnosed as
Schizophrenia based on the loose criteria in the
DSM-II. The first known misuse of the term to mean
"split personality" was in an article by the poet T.
S. Eliot in 1933. Other scholars have traced earlier
roots.
Mental illness has been recognized for thousands of
years. At one point, all people who were considered
"abnormal," whether due to mental illness, mental
retardation, or physical deformities, were largely
treated the same. Early theories supposed that
mental disorders were caused by evil possession of
the body, and the appropriate treatment was then
exorcising these demons, through various means,
ranging from innocuous treatments, such as exposing
the patient to certain types of music, to dangerous
and sometimes deadly means, such as releasing the
evil spirits by drilling holes in the patient's
skull.
One of the first to classify the mental disorders
into different categories was the German physician,
Emil Kraepelin. He used the term "dementia praecox"
for individuals who had symptoms that we now
associate with Schizophrenia. The classifications
for mental disorders continue to be revised. The
most recent diagnostic classification system that is
most commonly used in the United States is the
Diagnostic and Statistical Manual for Mental
Disorders - Fourth Edition (DSM-IV).
In 2002 the term for Schizophrenia in Japan was
changed from Seishin-Bunretsu-By ō精神分裂病
(mind-split-disease) to Tōgō-shitchō-shō統合失調症
(integration disorder) to reduce stigma. The new
name was inspired by the biopsychosocial model; it
increased the percentage of patients who were
informed of the diagnosis from 37% to 70% over three
years.
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In the United States, the cost of
Schizophrenia—including direct costs (outpatient,
inpatient, drugs, and long-term care) and non-health
care costs (law enforcement, reduced workplace
productivity, and unemployment)—was estimated to be
$62.7 billion in 2002.The book and film
A Beautiful
Mind chronicles the life of John Forbes Nash, a
Nobel Prize-winning mathematician who was diagnosed
with Schizophrenia. |
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