All psychiatrists should be aware, as Uchoastates, of the importance of factors such as constitution, temper, character, typological peculiarities, background experiences and family and/or social environment in the onset and development of psychosis. The links of this multiple causality in psychosis have drawn the permanent attention of researchers in psychopathology and have resulted in endless discussion among the different programs in Psychology.
If any conclusion about this bitter quarrel between the several tendencies on mental disease can be drawn, it is simply that there is a fundamental incompatibility between the two major approaches to deal with insanity: the clinical view and the cultural view. The clinical approach of mental disease will always differ from the cultural and philosophical approaches.
In clinical psychiatry there is an almost unanimously consent regarding the association of some configuration of predisposed personality and the onset of psychosis. These personalities are called pre-morbidity personalities, whose concept is dealt under the chapter of "Personality Problems", both by the ICD (International Classification of Disease) as well as by the DSM (Diagnostic and Statistical Manual of Mental Disorders). It refers to the constitution of problematic personalities that, by themselves,cause a major change in the life of the person, not allowing him or her to reach a total development and, under certain circumstances, provoking a higher susceptibility to the onset of some psychic conditions.The pre-morbid constitution (personality) is considered in psychopathology as a variation of being human and translates a possibility more prone to the development of certain psychic vulnerability. Here the term "possibility" must be considered in its full acception, that is, it is not a mandatory character but nevertheless it must be taken very seriously.
Psychotic symptomatology is characterized mainly by changes at thought and affectivity spheres and therefore, affects all behaviors and all existential performance of the person will suffer. While in neurosis, thought, feelings and affectivity are quantitatively altered, in the case of psychosis these psychic attributes are displayed as qualitatively ill, as a pathologic happening chronologically located in the life history of the patient, and that, from this moment on, acts morbidly upon his whole psychic performance.
Psychotic process imposes upon the patient a pathologic way of representing reality, of elaborating concepts and relating itself to the object word. What counts here is not so much the quantitative variations of perception of reality, as it might take place in depression, for instance, but rather something new and qualitatively different from all variation normally allowed in normal people, something essentially pathologic, morbid and suffering.
According to Kaplan, approximately 1% ofthe population suffers from this disease, which, generally, is shown before the age of 25 and reaches all socio-cultural levels. The diagnosis of the disease is still exclusively based upon a psychiatric history and an examination of the mental state, although news ways of investigation by means of functional imaging are advancing rapidly and will provide a more precise diagnosis. It is extremely rare that schizophrenia manifest itself before the age of 10 or after theage of 50 and it seems to prevail equally between men and women.
Esquirol (1772-1840) considered madness as the sum of two elements: a predisposition cause, bolted to personality, and an exciting cause, supplied by the environment. Nowadays, after many years of reflection and research, modern psychiatry reaffirms the same with updated words. The main model for the integration of ethiologic factors in schizophrenia is the stress-diatesis model, which supposes the person possesses certain specific vulnerabilities, which is under the influence of stressing environmental factors (exciting cause).
Under certain circumstances the binomial diatesis-stress would lead to the development of schizophrenia. Until anetiological factor for this disease is identified, this model seems to satisfy the accepted theories regarding this theme.
Nowadays, by means of the ICD-10, Schizotypical Disorder has been included among schizophrenia. In fact, we do consider it as yet another kind of disease, but maybe rather a specific stage of the same disease. Taking into consideration the general and first-degree symptoms of schizophrenia, we could understand Schyzotypical Disorder as being a pre-morbid phase of psychosis. It would constitute a stage more serious than the Schizoid Personality Disorder and less morbid than full Schizophrenia. This view is so adequate that ICD-10 itself considers this disorder as synnomin with Prodromic, Borderline or Pre-Psychotic Schizophrenia. .
Some symptoms, although not specific of schizophrenia, are of considerable diagnostic value. They include:
1- listening to your own thoughts (like voices)
2- audio hallucinations that comment upon the patient own behavior
3- somatic hallucinations
4- feeling of external thought control
5- irradiation of thoughts
6- sensation of his own actions controlled and influenced by some external object or force.
Trying to group to symptomatology of schizophrenia to sum um the main scholars in the field, we should underline three attributes of psychic activity that are morbidly involved: behavior, affectivity and thought. Deliria appear as changes in the content of schizophrenic thought and hallucinations as belonging to sensoperception. Both are at the same time cause and/or consequence of the alterations in the areas affected by the disease (behavior, affectivity and thought).
FIRST DEGREE SYMPTOMSAccording to Schneider
Feeling of controlled actions
All the other hallucinations, either sensorial ones such audio, visual, touch, smell or cenestesic and kynestesic ones, although considered as accessory symptoms by Bleuler, appear in schizophrenia with a highly significant frequency. Normally audio hallucinations are the first to appear and the last to disappear.
|Geraldo J. Ballone|
Site Coordinator PsiqWeb - Clinical Psychiatry- didática para pesquisas e consultas