This condition includes all those illnesses, in all age groups which are characterised from the onset of the illness, by primary or fundamental disturbances in the personality, thinking process, behaviour, emotional tone, interest in different affairs and relationship with other people.
A. Intrinsic factors –
1. Genetic factor – A single dominant or recessive gene or polygenic factors may be the cause.
2. Physical and constitutional built – Krelschmer’s theory states that subjects with narrow athletic and dysplastic physique have predominance in vulnerability over other physical types.
3. Hormonal cause – Endocrinal disturbance may have some role to play in some cases.
4. Metabolic cause – Disorder of nitrogen metabolism may contribute to the causation of schizophrenia.
B. Extrinsic factors –
1. Early parent-child relationship
2. Social class
3. Psycho-social stress
4. Physical illness
5. Head injury
7. Child birth.
General Features – In schizophrenia, there is withdrawal from reality ; detachment from the environment ; change in the affect or mood ; thought disorder ; disturbance of motor functions, perception (hallucination) and behaviour; delusion and paranoid disposition.
1. Simple schizophrenia – The onset is insidious with gradual deterioration of the condition. There is lack of interest, deficient ideation, poor performance in all activities. There may be delusion of reference. Ultimately they are totally spoiled.
2. Hebephrenia – The onset is insidious in the early life. There is emotional disturbances, delusion, thought disorder, auditory hallucination. The subject is mischievious, eccentric, grimacing or inert and apathetic. There is mannerism and silly behaviour.
3. Catatonic schizophrenia – The onset is acute. There is disturbance in motor functions with abnormal behaviour. The onset, is in adolescent age or early adulthood, or occasionally in the 4th decade of life or later.
There is extreme alteration of behaviour from stupor (catatonic stupor) to excitement (catatonic excitement).
There is mannerism, lutomatic response like automatic obedience, spontaneous overactivity, negativism, echolalia, echopraxia, maintenance of imposed constrained posture, emotional and thought disorders, delusions and hallucinations.
4. Paranoid schizophrenia – The onset is late. There is delusion of grandeur, persecution or hypochondriacal delusion, but delusion of persecution is the most common one.
Delusions may be variable, poorly held or systematised and highly complex and relatively fixed. Personality of the subject is usually preserved.
In paranoia, there is fixed delusion and there is no thought disorder and no hallucination. The personality of the subject is well preserved.
In paraphrenia, there is semisystematized delusion. There is also hallucination and thought disorder. There is disturbance of the personality.
5. Schizo-affective disorder – Here depression or mania occurs concurrently with schizophrenia.
6. Pseudo-neurotic schizophrenia – Here there is pan-anxiety and pan-neurosis. There is hysterical manifestations, anorexia, vomiting, palpitation, hypochondriacal delusion and delusion of reference, compulsive phenomena, obsession, phobias, depersonalisation and sexual perversion.
7. Periodic catatonia – Here, there are phases of stupor and excitement with metabolic changes resulting to nitrogen retention and excretion.
8. Late paraphrenia – Occurrence is comparatively more in widows and spinsters who live alone. Usually there is delusion of persecution and olfactory, auditory and visual hallucination.
9. Capgrass syndrome – In paranoid schizophrenia, there may be in some selective cases, feeling of positive doubles or negative doubles concerning the sufferer himself.