Schizophrenic disorders seem to occur in almost all societies. The incidence and prevalence rates for this illness are difficult to pin down accurately. Schizophrenia is affecting about 7 per thousand of adult population, mostly the age group of 15-35 years.The global lifetime prevalence estimate dranged approximately0.3 to 0.7 percent.
The prevalence of schizophrenia in India is about 1%; this may be due to diagnostic drawbacks rather than decreased number of cases. The incidence would be expected to be considerably lower and is estimated in DSM-IV manual as 1per 10,000 persons per year.
Schizophrenia can occur during childhood or old age, about three fourths of all cases occur between the ages of 15 and 45 years. The incidence rate appears to be about the same for males and females, but males tend to have earlier onset and severe forms of disorder.(Marcus et al.,1993). Due to the complexity of the illness, high rate of incidence, and the tendency to recur, schizophrenia is considered as the most serious of all mental illness, as well as among the most perplexing.
Major Symptoms of Psychotic Disorders
Hallucinations and delusions are the major symptoms of psychotic disorders.Different people manifest the symptoms differently. Person with psychotic disorder has other symptoms also they are
disorganized or incoherent speech
strange or dangerous behaviour
slowed or unusual motor activities
poor personal hygiene
loss of interest in activities
problems at school or work and with relationships
cold, detached manner with the inability to express emotion
mood swings or other mood symptoms, such as depression or mania
Clinical Picture of Schizophrenia
Schizophrenia is characterized by profound disturbance in cognition and emotion,which affects language, thought, perception, affect, and sense of the self of an individual.
Schizophrenic disorders develop slowly and insidiously. In such cases person may become seclusive, gradually seem to lose interest in their surroundings, spend more time for day dreaming, low emotional responsibility and behave socially inappropriate ways. This pattern of symptoms is referred as process of schizophrenia. This pattern develops slowly may not be as a result of discrete stressors and have a tendency to last for a long time with poor prognosis.
Sometimes onset of symptoms is sudden and dramatic and is marked by intense emotional turmoil.This pattern always have an identifiable precipitating factor, is referred as reactive schizophrenia.
Typically the symptoms are divided into two positive and negative.The term negative refers to an absence or deficit of behaviours which normally present in a person, such as emotional expression, communication and reactivity to the environment. Positive symptoms are those in which something has been added to the normal behaviour of a person, such as delusions, hallucinations or motor agitation.Generally most of the patients demonstrate both positive and negative symptoms during the course of their illness.
Positive symptoms of schizophrenia are given below;
Delusion is a false unshakeable belief or an idea which is out of keeping with patients educational, cultural, and social back ground; it is held with extraordinary conviction and subjective certainty.
Hallucination is a perception without an object or the appearance of an individual thing in the world without any corresponding material event. (Cutting, 1997)
It is characterized by a marked decrease in reaction to the immediate surrounding environment, sometimes taking the form of motionless and apparent unawareness, rigid or bizarre postures, or aimless excess motor activity.
This term is used to describe incoherent or incomprehensible language, either speech orwritten language, as a reflection of un organised thinking process.Eg: flight of ideas in this condition patient switch from one idea to other idea which are unrelated.
Disorganised behaviour can be manifested indifferent ways such as difficulty to perform activities of dailyliving, sociald is inhibition, poor socials kills,and unpredictable behaviours (behaviours against social norms).
Negative symptoms of schizophrenia are:
Affective flattening or apathy
Affective flattening is the reduction in the range and intensity of emotional expression, including facial expression, voice tone, eye contact, and bodylanguage.
Alogia means poverty of speech. In this condition there is a decrease in the amount of speech. People showing the signs by responding slowly to the questions or sometimes not responding to the questions asked to them.
A volition means withdrawal or loss of motivation.In this condition patient shows difficulty, or inability to initiate and persist in goal-directed behaviour. Peoplewho have a volition have difficulty in making decisions,maybe inattentive to personal hygiene and difficulty to do daily activities.
It means inability to experience pleasure.This may manifest as lack of interest in social and recreational activities or failure to develop and maintain close relationships.
According to Kurt Schneider (1959) introduced first rank symptoms of schizophrenia
with a concern to differentiate schizophrenia fro mother forms of psychosis.
1. Audible thoughts or thought echo – audible thought means patient’s experience of hearing his or her own thoughts said out loud.
2. Voices arguing or discussing- it indicates that two or more hallucinatory voices quarrelling or discussing with each other.Patient usually features in the third person in the content of these hallucinatory voices.
3. Voices commenting on patient’s actions- hallucinatory voices giving running commentary on patient’s activities or behaviour.
Thought disorder: Passivity of thought
4. Thought withdrawal- it is delusion that thoughts have been taken out from patient’s mind by an external force.
5. Thought insertion- it is a delusion that thoughts are being inserted into one’s mind by someone else or an external force.
6. Thought broadcasting – it is a delusional experience that one’s thoughts are being broadcast from one’s mind to the external world through various modes where other people can hear them