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Introduction

Schizophrenia is a psychotic disorder (or a group of disorders) marked by severely impaired think
ing, emotions, and behaviors.Schizophrenic patients are typically unable to filter sensory stimuli and may
have enhanced perceptions of sounds, colors, and otherfeatures of their environment. Most schizophrenic
s, if untreated, gradually withdraw from interactions with other people, and lose theirability to take care of
personal needs and grooming.
The English term schizophrenia comes from two Greek words that mean "split mind." It was obser
ved around 1908, by a Swiss doctornamed Eugen Bleuler, to describe the splitting apart of mental functio
ns that he regarded as the central characteristic of schizophrenia.
Recently, some psychotherapists have begun to use a classification of schizophrenia based on two main t
ypes. People with Type I, orpositive schizophrenia, have a rapid (acute) onset of symptoms and tend to re
spond well to drugs. They also tend to suffer more from the"positive" symptoms, such as delusions and
hallucinations. People with Type II, or negative schizophrenia, are usually described aspoorly adjusted b
efore their schizophrenia slowly overtakes them. They have predominantly "negative" symptoms, such as
withdrawalfrom others and a slowing of mental and physical reactions (psychomotor retardation).

Paranoid
The key feature of this subtype of schizophrenia is the combination of false beliefs (delusions) and hearin
g voices (auditoryhallucinations), with more nearly normal emotions and cognitive functioning (cognitive fu
nctions include reasoning, judgment, andmemory). The delusions of paranoid schizophrenics usually invo
lve thoughts of being persecuted or harmed by others or exaggeratedopinions of their own importance, bu
t may also reflect feelings of jealousy or excessive religiosity. The delusions are typically organizedinto a
coherent framework. Paranoid schizophrenics function at a higher level than other subtypes, but are at ris
k for suicidal or violentbehavior under the influence of their delusions.

Symptoms of schizophrenia
Patients with a possible diagnosis of schizophrenia are evaluated on the basis of a set or constellation of sym
ptoms; there is no singlesymptom that is unique to schizophrenia. In 1959, the German psychiatrist Kurt
Schneider proposed a list of so-called first-ranksymptoms, which he regarded as diagnostic of the disorder.
These symptoms include:

delusions

somatic

hallucinations

hearing voices commenting on the patient's behavior

thought insertion or thought withdrawal


Somatic hallucinations refer to sensations or perceptions concerning body organs that have no known me
dical cause or reason, such asthe notion that one's brain is radioactive. Thought insertion and/or withdraw
al refer to delusions that an outside force (for example, theFBI, the CIA, Martians, etc.) has the power to p
ut thoughts into one's mind or remove them.
POSITIVE SYMPTOMS. The positive symptoms of schizophrenia are those that represent an excessive o
r distorted version of normalfunctions. Positive symptoms include Schneider's first-rank symptoms as well
as disorganized thought processes (reflected mainly inspeech) and disorganized or catatonic behavior. Di
sorganized thought processes are marked by such characteristics as looseness ofassociations, in which t
he patient rambles from topic to topic in a disconnected way; tangentially, which means that the patient gi
vesunrelated answers to questions; and "word salad," in which the patient's speech is so incoherent that it
makes no grammatical orlinguistic sense. Disorganized behavior means that the patient has difficulty with
any type of purposeful or goal-oriented behavior,including personal self-care or preparing meals. Other for
ms of disorganized behavior may include dressing in odd or inappropriate ways,sexual self-stimulation in
public, or agitated shouting or cursing.
NEGATIVE SYMPTOMS. Schizophrenia includes three so-called negative symptoms. They are called ne
gative because they representthe lack or absence of behaviors. The negative symptoms that are consider
ed diagnostic of schizophrenia are a lack of emotionalresponse (affective flattening), poverty of speech, a
nd absence of volition or will. In general, the negative symptoms are more difficult fordoctors to evaluate t
han the positive symptoms.