Saturday, 1 October 2011

Notes on Schizophrenia

Notes on Schizophrenia

Created: 23.10.2010. Updated: 25.10.2010.
Schizophrenia by ICD-10

Alright. I've organised it more gently now. Some little things remain. Cheers!

ICD-10 on Schizophrenia, F20-F29.

F20 - Schizophrenia
* The schizophrenic disorders are characterized in general by fundamental and characteristic distortions of thinking and perception, and affects that are inappropriate or blunted. Clear consciousness and intellectual capacity are usually maintained although certain cognitive deficits may evolve in the course of time. The most important psychopathological phenomena include thought echo; thought insertion or withdrawal; thought broadcasting; delusional perception and delusions of control; influence or passivity; hallucinatory voices commenting or discussing the patient in the third person; thought disorders and negative symptoms.

The course of schizophrenic disorders can be either continuous, or episodic with progressive or stable deficit, or there can be one or more episodes with complete or incomplete remission. The diagnosis of schizophrenia should not be made in the presence of extensive depressive or manic symptoms unless it is clear that schizophrenic symptoms antedate the affective disturbance. Nor should schizophrenia be diagnosed in the presence of overt brain disease or during states of drug intoxication or withdrawal. Similar disorders developing in the presence of epilepsy or other brain disease should be classified under F06.2, and those induced by psychoactive substances under F10-F19 with common fourth character.

Excludes: schizophrenia:
• acute (undifferentiated) (F23.2)
• cyclic (F25.2)
schizophrenic reaction (F23.2)
schizotypal disorder (F21)

F20.0 Paranoid schizophrenia
Paranoid schizophrenia is dominated by relatively stable, often paranoid delusions, usually accompanied by hallucinations, particularly of the auditory variety, and perceptual disturbances. Disturbances of affect, volition and speech, and catatonic symptoms, are either absent or relatively inconspicuous.
Paraphrenic schizophrenia

Excludes: involutional paranoid state (F22.8) paranoia (F22.0)

F20.1 Hebephrenic schizophrenia
A form of schizophrenia in which affective changes are prominent, delusions and hallucinations fleeting and fragmentary, behaviour irresponsible and unpredictable, and mannerisms common. The mood is shallow and inappropriate, thought is disorganized, and speech is incoherent. There is a tendency to social isolation. Usually the prognosis is poor because of the rapid development of "negative" symptoms, particularly flattening of affect and loss of volition.
Hebephrenia should normally be diagnosed only in adolescents or young adults.
Disorganized schizophrenia

F20.2 Catatonic schizophrenia
Catatonic schizophrenia is dominated by prominent psychomotor disturbances that may alternate between extremes such as hyperkinesis and stupor, or automatic obedience and negativism. Constrained attitudes and postures may be maintained for long periods. Episodes of violent excitement may be a striking feature of the condition. The catatonic phenomena may be combined with a dream-like (oneiroid) state with vivid scenic hallucinations.
Catatonic stupor
• catalepsy
• catatonia
• flexibilitas cerea

F20.3 Undifferentiated schizophrenia Psychotic conditions meeting the general diagnostic criteria for schizophrenia but not conforming to any of the subtypes in F20.0-F20.2, or exhibiting the features of more than one of them without a clear predominance of a particular set of diagnostic characteristics. Atypical schizophrenia

Excludes: acute schizophrenia-like psychotic disorder (F23.2) chronic undifferentiated schizophrenia (F20.5) post-schizophrenic depression (F20.4)

F20.4 Post-schizophrenic depression A depressive episode, which may be prolonged, arising in the aftermath of a schizophrenic illness. Some schizophrenic symptoms, either "positive" or "negative", must still be present but they no longer dominate the clinical picture. These depressive states are associated with an increased risk of suicide. If the patient no longer has any schizophrenic symptoms, a depressive episode should be diagnosed (F32.-). If schizophrenic symptoms are still florid and prominent, the diagnosis should remain that of the appropriate schizophrenic subtype (F20.0-F20.3).

F20.5 Residual schizophrenia
A chronic stage in the development of a schizophrenic illness in which there has been a clear progression from an early stage to a later stage characterized by long- term, though not necessarily irreversible, "negative" symptoms, e.g. psychomotor slowing; underactivity; blunting of affect; passivity and lack of initiative; poverty of quantity or content of speech; poor nonverbal communication by facial expression, eye contact, voice modulation and posture; poor self-care and social performance.
Chronic undifferentiated schizophrenia
Restzustand (schizophrenic)
Schizophrenic residual state

F20.6 Simple schizophrenia
A disorder in which there is an insidious but progressive development of oddities of conduct, inability to meet the demands of society, and decline in total performance. The characteristic negative features of residual schizophrenia (e.g. blunting of affect and loss of volition) develop without being preceded by any overt psychotic symptoms.

(Note: where is F20.7? Is it the cardinal sin?)

F20.8 Other schizophrenia
Cenesthopathic schizophrenia
• disorder NOS
• psychosis NOS

Excludes: brief schizophreniform disorders (F23.2).

F20.9 Schizophrenia, unspecified

F21 Schizotypal disorder
A disorder characterized by eccentric behaviour and anomalies of thinking and affect which resemble those seen in schizophrenia, though no definite and characteristic schizophrenic anomalies occur at any stage. The symptoms may include a cold or inappropriate affect; anhedonia; odd or eccentric behaviour; a tendency to social withdrawal; paranoid or bizarre ideas not amounting to true delusions; obsessive ruminations; thought disorder and perceptual disturbances; occasional transient quasi-psychotic episodes with intense illusions, auditory or other hallucinations, and delusion-like ideas, usually occurring without external provocation. There is no definite onset and evolution and course are usually those of a personality disorder.
Latent schizophrenic reaction
• borderline
• latent
• prepsychotic
• prodromal
• pseudoneurotic
• pseudopsychopathic
Schizotypal personality disorder

Excludes: Asperger's syndrome (F84.5)
schizoid personality disorder (F60.1)

F22 Persistent delusional disorders
Includes a variety of disorders in which long-standing delusions constitute the only, or the most conspicuous, clinical characteristic and which cannot be classified as organic, schizophrenic or affective. Delusional disorders that have lasted for less than a few months should be classified, at least temporarily, under F23.-.

F22.0 Delusional disorder
A disorder characterized by the development either of a single delusion or of a set of related delusions that are usually persistent and sometimes lifelong. The content of the delusion or delusions is very variable. Clear and persistent auditory hallucinations (voices), schizophrenic symptoms such as delusions of control and marked blunting of affect, and definite evidence of brain disease are all incompatible with this diagnosis. However, the presence of occasional or transitory auditory hallucinations, particularly in elderly patients, does not rule out this diagnosis, provided that they are not typically schizophrenic and form only a small part of the overall clinical picture.
• psychosis
• state
Paraphrenia (late)
Sensitiver Beziehungswahn

Excludes: paranoid:
personality disorder (F60.0)
psychosis, psychogenic (F23.3)
reaction (F23.3)
schizophrenia (F20.0)

F22.8 Other persistent delusional disorders
Disorders in which the delusion or delusions are accompanied by persistent hallucinatory voices or by schizophrenic symptoms that do not justify a diagnosis of schizophrenia (F20.-).
Delusional dysmorphophobia
Involutional paranoid state
Paranoia querulans

F22.9 Persistent delusional disorder, unspecified

F23 Acute and transient psychotic disorders
A heterogeneous group of disorders characterized by the acute onset of psychotic symptoms such as delusions, hallucinations, and perceptual disturbances, and by the severe disruption of ordinary behaviour. Acute onset is defined as a crescendo development of a clearly abnormal clinical picture in about two weeks or less. For these disorders there is no evidence of organic causation. Perplexity and puzzlement are often present but disorientation for time, place and person is not persistent or severe enough to justify a diagnosis of organically caused delirium (F05.-). Complete recovery usually occurs within a few months, often within a few weeks or even days. If the disorder persists, a change in classification will be necessary. The disorder may or may not be associated with acute stress, defined as usually stressful events preceding the onset by one to two weeks.

F23.0 Acute polymorphic psychotic disorder without symptoms of schizophrenia
An acute psychotic disorder in which hallucinations, delusions or perceptual disturbances are obvious but markedly variable, changing from day to day or even from hour to hour. Emotional turmoil with intense transient feelings of happiness or ecstasy, or anxiety and irritability, is also frequently present. The polymorphism and instability are characteristic for the overall clinical picture and the psychotic features do not justify a diagnosis of schizophrenia (F20.-). These disorders often have an abrupt onset, developing rapidly within a few days, and they frequently show a rapid resolution of symptoms with no recurrence.
If the symptoms persist the diagnosis should be changed to persistent delusional disorder (F22.-).
Bouff�e d�lirante without symptoms of schizophrenia or unspecified
Cycloid psychosis without symptoms of schizophrenia or unspecified

F23.1 Acute polymorphic psychotic disorder with symptoms of schizophrenia
An acute psychotic disorder in which the polymorphic and unstable clinical picture is present, as described in F23.0; despite this instability, however, some symptoms typical of schizophrenia are also in evidence for the majority of the time. If the schizophrenic symptoms persist the diagnosis should be changed to schizophrenia (F20.-).
Bouff�e d�lirante with symptoms of schizophrenia
Cycloid psychosis with symptoms of schizophrenia

F23.2 Acute schizophrenia-like psychotic disorder
An acute psychotic disorder in which the psychotic symptoms are comparatively stable and justify a diagnosis of schizophrenia, but have lasted for less than about one month; the polymorphic unstable features, as described in F23.0, are absent. If the schizophrenic symptoms persist the diagnosis should be changed to schizophrenia (F20.-).
Acute (undifferentiated) schizophrenia
Brief schizophreniform:
Schizophrenic reaction

Excludes: organic delusional [schizophrenia-like] disorder (F06.2)
schizophreniform disorders NOS (F20.8)

F23.3 Other acute predominantly delusional psychotic disorders
Acute psychotic disorders in which comparatively stable delusions or hallucinations are the main clinical features, but do not justify a diagnosis of schizophrenia (F20.-). If the delusions persist the diagnosis should be changed to persistent delusional disorder (F22.-).
Paranoid reaction
Psychogenic paranoid psychosis

(Note: where are F23.4-F23.7? Is it the hand of sin, of psychopathic control schemes?)

F23.8 Other acute and transient psychotic disorders
Any other specified acute psychotic disorders for which there is no evidence of organic causation and which do not justify classification to F23.0-F23.3.

F23.9 Acute and transient psychotic disorder, unspecified
Brief reactive psychosis NOS
Reactive psychosis

F24 Induced delusional disorder
A delusional disorder shared by two or more people with close emotional links. Only one of the people suffers from a genuine psychotic disorder; the delusions are induced in the other(s) and usually disappear when the people are separated.
Folie a (�, to be replaced) deux
• paranoid disorder
• psychotic disorder

F25 Schizoaffective disorders
Episodic disorders in which both affective and schizophrenic symptoms are prominent but which do not justify a diagnosis of either schizophrenia or depressive or manic episodes. Other conditions in which affective symptoms are superimposed on a pre-existing schizophrenic illness, or co-exist or alternate with persistent delusional disorders of other kinds, are classified under F20-F29. Mood-incongruent psychotic symptoms in affective disorders do not justify a diagnosis of schizoaffective disorder.

F25.0 Schizoaffective disorder, manic type
A disorder in which both schizophrenic and manic symptoms are prominent so that the episode of illness does not justify a diagnosis of either schizophrenia or a manic episode. This category should be used for both a single episode and a recurrent disorder in which the majority of episodes are schizoaffective, manic type.
Schizoaffective psychosis, manic type

F25.1 Schizoaffective disorder, depressive type
A disorder in which both schizophrenic and depressive symptoms are prominent so that the episode of illness does not justify a diagnosis of either schizophrenia or a depressive episode. This category should be used for both a single episode and a recurrent disorder in which the majority of episodes are schizoaffective, depressive type.
Schizoaffective psychosis, depressive type

F25.2 Schizoaffective disorder, mixed type
Cyclic schizophrenia
Mixed schizophrenic and affective psychosis

F25.8 Other schizoaffective disorders

F25.9 Schizoaffective disorder, unspecified
Schizoaffective psychosis NOS

(Note: where are F26-F27? Is this the couple of sin, sinful sex activities?)

F28 Other nonorganic psychotic disorders
Delusional or hallucinatory disorders that do not justify a diagnosis of schizophrenia (F20.-), persistent delusional disorders (F22.-), acute and transient psychotic disorders (F23.-), psychotic types of manic episode (F30.2), or severe depressive episode (F32.3).
Chronic hallucinatory psychosis

F29 Unspecified nonorganic psychosis
Psychosis NOS

Excludes: mental disorder NOS (F99) organic or symptomatic psychosis NOS (F09)
DSM IV TR Definition of Schizophrenia:

Some good information conveyed by shinxy on the PN forum for which I'm thankful.

A. Characteristic symptoms: Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated):

(1) delusions

(2) hallucinations

(3) disorganized speech (e.g., frequent derailment or incoherence)

(4) grossly disorganized or catatonic behavior

(5) negative symptoms, i.e., affective flattening, alogia, or avolition

Note: Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person's behavior or thoughts, or two or more voices conversing with each other.

B. Social/occupational dysfunction: For a significant portion of the time since the onset of the disturbance, one or more major areas of functioning such as work, interpersonal relations, or self-care are markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, failure to achieve expected level of interpersonal, academic, or occupational achievement).

C. Duration: Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms (or less if successfully treated) that meet Criterion A (i.e., active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the disturbance may be manifested by only negative symptoms or two or more symptoms listed in Criterion A present in an attenuated form (e.g., odd beliefs, unusual perceptual experiences).

D. Schizoaffective and Mood Disorder exclusion: Schizoaffective Disorder and Mood Disorder With Psychotic Features have been ruled out because either (1) no Major Depressive, Manic, or Mixed Episodes have occurred concurrently with the active-phase symptoms; or (2) if mood episodes have occurred during active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods.

E. Substance/general medical condition exclusion: The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

F. Relationship to a Pervasive Developmental Disorder: If there is a history of Autistic Disorder or another Pervasive Developmental Disorder, the additional diagnosis of Schizophrenia is made only if prominent delusions or hallucinations are also present for at least a month (or less if successfully treated).
My addition to the Schizophrenia illness:

Bizarre cognition and behaviour
Believing in demons and angels as reality
Being commanded by voices in their heads
Primacy to blind violence
Impaired language, both speech and written and general cognitive breakdown
Display general bodily ignorance to own pain and bodily harm
Fixation of energies, sniffing the energies of other people and acting upon this as also a primacy for perception, whatever it is supposed to represent...

Concerning bodily awareness: it's true that this may be the case of depressive people too, but mostly in the suicidal situation, thus depressed people are able to restore good bodily awareness, emotionally and otherwise.

Back to Views and Findings...< [This has also...]


  1. Some understanding to Schizophrenia (on a tentative level): Mode of thinking, they demand respect and I guess you say "respect" too, but in this fashion, "I understand your inclinations (in departing from ethics/morality) and I will try to compensate". Mode of behaviour, "I understand your behaviour and I understand that your top premise for respect lies in physical power and in being beaten or to beat others"! So for you who are serious: You can give them a smack/punch on the nose, hard or soft, to make them understand (as they rarely move outside this understanding) and this can actually be enough. There are other apporaches too, like ECT (Electro-Convulsion Therapy) and Zyprexa, but I think the final argument lies on the physical power and being "on top of them", being able to control them by your own physical power. If not, GET OUT OF THERE!! They may not act constructively toward you! Good?

  2. I've shared a thought that these measures can be useful to have in the arsenal too:
    -> straitjacket
    -> padded cell
    -> bed constraint
    -> laid back couch chair constraint

    There has been a controversy over the use of restraining measures in Psychiatry (at least here in Norway) and I have the impression that this is based on false premises! While ALL patients should be respected (as an end in themselves), one shouldn't forget the seriousness of the illness itself and what it represents! Rather, as people are misdiagnosed and people are given the wrong treatment, then this kind of controversy erupts. So I hereby claim that much of this controversy has taken place as a matter of misdiagnostics (and psychiatrists' game with the public, unseriously). So they better shapen up and the public should be able to get a more "informed image" of what schizophrenia really is and how these constraints may help these people to do less harm to both themselves and to others! One can add some cognition of this and that, but this is up to the psychiatrists (and psychologists). Good?

  3. The super-consideration for all schizophrenia, IMO:

    People are so geared toward violence against other people that hate becomes their driving motive as way of life.

    If one is to remove schizophrenia from the World completely, one (UN? Nations?) needs to work for reliable security and true justice for everyone. Final!

    Note: The symptoms are therefore as we see them: incoherency (by detachment to people), disregard for dignity, sh*t as value in life, some aspects of rationality can be present, etc.
    Else: see above.