The Gazette 1990

GAZETTE

SEPTEMBER 1990

S c h i z o p h r e n ia a n d t h e L aw Part I

and unimpaired perception with normal memory. He recognised three major sub types of the dis- order: hebephrenic, in which the most prominent symptom was thought disorder; catatonic, which was characterised by physical symptoms, such as stupor and muscular rigidity; and paranoid, in which the predominant symptom was systematised delusions, either of persecution, grandiosity or of a fantastical religious nature. Despite the title that he gave it, Kraepelin recognised that the con- dition did not always have a bad "Recognition of what we now call schizophrenia came at the end of the 19th century." prognosis and that true dementia, that is deterioration of intellectual functioning, did not occur. The patient's withdrawal into a private world of delusions and loss of initiative and drive gave the impression of dementia. The Swiss psychiatrist, Eugene Bleuler, introduced the term "the schizophrenias" commenting "the disconnection of splitting of the

Schizophrenia is the term applied to a group of disorders with a number of basic symptoms in common. One should probably speak of "the schizophrenias" or "the group of schizophrenias" rather than "schizophrenia" in the singular. However, that is rather cum- bersome and I will use the term schizophrenia in this paper. The disorder séems to occur in all ancient Indian, Greek and Roman cultures with a strikingly consistent writings which are strongly sug-

gestive of cases of schizophrenia. There is a good deal of evidence to

incidence of 0.8 to 1% of the pop- ulation. It occurs with equal fre- quency in both sexes but there is a slight tendency for it to first manifest itself in females at a slightly later age. It is predom- inantly a disease of young people, the onset in 70% or more occurring between the ages of 15 and 25 years. The contention that it occurs in all cultures has been borne out by a study conducted under the auspices of WHO and reported on in 1974. Psychiatrists from such diverse countries as the United Kingdom, the U.S.A., the U.S.S.R., India, China, Nigeria, Czechoslovakia and Colombia were trained in a standard- ised system of clinical examination known as the Present State Examination. This ensured that the trained psychiatrists achieved a very considerable degree of agreement as to what symptoms were present irrespective of the culture or lan- guage which they shared with the patient. Their findings could be incorporated in a computer pro- gramme. It was found that in each of the countries surveyed syndromes of acute and chronic schizophrenia were clearly described. The concept of Schizophrenia The concept of schizophrenia is a relatively recent one and it has been suggested that it may be a disorder of recent origin linked to the spread of modern civilization with a suggestion that it might be, say, of viral origin. However, in a recent paper from the National Institute of Mental Health in Washington, a group of psy- chiatrists quoted descriptions from

By S. Desmond McGrath* FRCPI., FRC.Psych., DPM,

suggest that Henry VI, King of England in the 15th century, suf- fered from schizophrenia. Recognition of what we nowcall schizophrenia came at the end of the 19th century. Until that timeall psychosis or madness had been regarded as a common disorder with varying manifestations. A German psychiatrist named Kraepelin distinguished two major groups of disorders, one character- ised by marked variations in mood from depression on the one hand to excitement or elation on the other, carrying a good prognosis, at least for the individual attacks (manic depressive psychosis), and another with anearlier onset and oftenwith a tendency to progressive deter- ioration. He gave the name dementia praecox to this group in his text book of psychiatry pub- lished in 1893. Kraepelin consider- ed the following symptoms characteristic of dementia praecox: hallucinations, a decrease in at- tention towards the outside world, lack of curiosity, disorder of thought, lack of insight and judgement, delusions, emotional blunting, negativism and streo- types. He stressed the importance of these symptoms being present in a setting of clear consciousness

S. Desmond McGrath.

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