Schizophrenia is a psychotic
disorder characterized by disturbances in thinking (cognition), emotional
responsiveness, and behavior, with an age of onset typically between the late
teens and mid-30s. Schizophrenia was first formally described in the late 19th
century by Emil Kraepelin, who named it dementia praecox; in 1908, Eugen
Bleuler renamed the disorder schizophrenia (Greek, “splitting of the mind”) to
characterize the disintegration of mental functions associated with what he
regarded as its fundamental symptoms of abnormal thinking and affect. According
to DSM–IV–TR, the characteristic disturbances must last for at least 6 months
and include at least 1 month of active-phase symptoms comprising two or more of
the following: delusions, hallucinations, disorganized speech, grossly
disorganized or catatonic behavior, or negative symptoms (e.g., lack of
emotional responsiveness, extreme apathy). These signs and symptoms are
associated with marked social or occupational dysfunction. Some have argued
(beginning with Bleuler) that disorganized thinking (see formal thought
disorder; schizophrenic thinking) is the single most important feature of
schizophrenia, but DSM–IV–TR and its predecessors have not emphasized this
feature, at least in their formal criteria. DSM–5 retains essentially the same
criteria but emphasizes that delusions, hallucinations, or disorganized speech
must be among the symptoms required for diagnosis. It also eliminates the five
distinct subtypes of schizophrenia previously described in DSM–IV–TR: catatonic
schizophrenia, disorganized schizophrenia, paranoid schizophrenia, residual
schizophrenia, and undifferentiated schizophrenia.
Schizophrenia Patient
Outcomes Research Team (PORT):
a group of researchers
established by the Agency for Health Care Policy and Research and the National
Institute of Mental Health. The team conducted a 5-year study to assess the
treatment and management of schizophrenia (including pharmacotherapies,
psychological and family interventions, vocational rehabilitation, and
assertive community treatment) and subsequently developed 15 recommendations
for improving patient outcomes. The researchers reviewed the literature on
schizophrenia treatment outcomes and also surveyed a random sample of 719
individuals diagnosed with schizophrenia in two U.S. states to determine how
the scientific evidence compared with actual clinical practice in outpatient
and inpatient settings in both urban and rural areas. It was found that the overall
rates at which patients’ treatment conformed to the study recommendations were
generally below 50%, indicating the need for greater efforts to ensure that
treatment research results are translated into practice, and that the key to
improving patient outcomes is adoption of a comprehensive and individualized
strategy that includes not only proper doses of appropriate medications but
also patient and family education and support.