Episode 83: This is the second in our series of Gold Standard USMLE Audio Reviews covering the antipsychotic medications.  Let me know if your medical school uses a systems-based curriculum; if so we’ll organize the DVD-ROMs according to your block schedule if you’re interested.

History of Schizophrenia

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I. Brief History

* Kahlbaum ———Catatonia

* Hecker ————-Hebephrenia

* Sanders————-Paranoia (“absent mind”)

* Morel ————–Demence Precoce

* Kraepelin ———Dementia Praecox or Precox (Catatonia + Hebephrenia + Paranoia)

* Bleuler ————Schizophrenias (” splitting of the mind”)

* Langfeldt———-Schizophreniform Disorder

II. Essential features of Schizophrenia

Characteristic signs and Sx (+ and -) that have been present during a one-month period or shorter period if successfully treated …………(involves active psychosis w/ delusions & hallucinations)

……with some signs of the disorder persistent for at least 6 months

These signs and symptoms are associated with marked social or occupational dysfunction

The disorder is not obviously related to organic causes (drug-physical illness) or mood d/o (these options must be eliminated)

III. Symptoms at Onset

* Somatic Manifestations, changes in the ability to work- vague; ie headaches

* Anxiety

* Perplexity – “what did you say? I did not hear you.” (they are not mentally there)

* Abstract ideas (philosophy, occult, religion, etc.)

* Peculiar Behavior- not bathing; justify it by saying only dirty people bath and kept rationalizing it

* Trema (fright) – realize that something is wrong

* Apocalyptic- person falls to pieces

* Vegetable-like phase- pt had no pain with a horrid abdominal abscess

IV. Diagnostic Criteria (according to the DSM-IV)

* Characteristic symptoms- 2 or more of the following, each present for a significant portion of time during a one month period (or less, if successfully treated)

– Delusions

– Hallucinations

– Disorganized speech (frequent derailment or incoherance)

– Grossly disorganized or catatonic behavior

– Negative symptoms (affective flattening, alogia, or avolition)

Only one of the above is required if the delusions are bizarre of 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

* Social/occupational dysfunction- significant declining performance at work or in relationships since the onset of symptoms; or when the onset is in childhood, the child fails to achieve the expected levels of interpersonal, academic, or occupational achievement

* Duration- continuous signs of disturbance persist for at least 6 mos

– 6 mo pd must include at least 1 month (or less is successfully treated) that meet Criterion A (active phase Sx)

– May include pds of prodromal/residual Sx during whichsigns of disturbance are manifested by either

Only negative Sx or

2+ symptoms listed in Criterion A present in the attenuated form (odd beliefs, ususual perceprtions)

* Schizoaffective and Mood Disorder (w/psychotic features) have been Excluded

– Ruled out b/c either:

1. No major depressive, manic, or mixed episodes have occurred concurrently with acute phase symptoms

2.