What is schizophrenia – symptomatology
Joan M. Striebel
August 20, 2024
Cambridge University Press
What is schizophrenia – symptomatology
Abstract
Schizophrenia is a highly heterogenous disorder with substantial interindividual variation in how the illness is experienced and how it presents clinically. The disorder is composed of primary symptom clusters—positive symptoms, negative symptoms, disorganization, neurocognitive deficits, and social cognitive impairments. These, along with duration, severity, and excluding other possible etiologies, comprise the diagnostic criteria for the disorder outlined in the two commonly used diagnostic classification systems—the Diagnostic Statistical Manual of Mental Disorders, Fifth Edition, Text Revision and the International Classification of Diseases, 11th Revision. These primary symptoms as well as accessory symptoms (mood disturbances, anxiety, violence) and comorbidities (substance use, suicidality) bear upon each other to varying degrees and impact functional outcomes. The following review presents two patient cases illustrating the clinical heterogeneity of schizophrenia, the natural history of the illness and diagnosis, followed by the current understanding of the primary symptom clusters, accessory symptoms, and comorbidities. In addition to noting symptom prevalence, onset, and change over time, attention is paid to the impact of symptoms on functional outcome.
Even though I am always telling people about what I see through my stories, only when I was watching my friend pray did I make a connection. I realized that I’ve been referencing a painting featuring Phillippe Pinel unshackling a mental patient from chains in 1876, but weirdly this was the first time I asked, “isn’t this the same mythology”? We’d have to ask Freud why I repressed this parallel. Maybe because it is just too much to bear-the fact that mental health wards 250 years later are worse- so it has never really consciously occurred to me.
