Olguera, Pauline Anne G.
Dr. Serafina Maxino
Place great diagnostic significance on what it terms characteristic delusions and
hallucinations. The symptom lists in DSM-III for a diagnosis of a schizophrenic
disorder include six items. Three are delusional in nature, two are hallucinatory, and the
last item is thought disorder accompanied by affective disorder, delusions or
hallucinations, disorganized behavior, or catatonic symptoms. DSM-III reflects the idea
that the category of schizophrenia includes a group of disorders, and specifies the
following as essential characteristics: disorganization from the previous level of daily
functioning in at least two areas, such as work, social relations, and self-care; the
presence of at least one symptom from a least of six during the active phase of the illness;
at least a 6-month duration of illness, during which the symptom or symptoms necessary
for making the diagnosis are present
ICD-9 list the four basic types, but comments on simple schizophrenia that is
schizophrenic symptoms are not clear-cut and that should, therefore, be diagnose
sparingly, if at all. Other schizophrenic subtypes in ICD-9 include acute schizophrenic
episode, latent schizophrenia, schizoaffective type, other, and – to be used only as a five
resort – unspecified. DSM-III lists only five types under schizophrenic disorders:
Disorganized (Hebephrenic), catatonic, paranoid, undifferentiated, and residual
Is sometimes considered the most devastating of the mental illnesses because its onset
is early in a patient’s life and its symptoms can be destructive to the patient’s family and
friends. Although schizophrenia is discussed as a single disease, the category can include
a variety of disorders that present with somewhat similar behavioral symptoms.
Schizophrenia is probably comprises a group of disorders with heterogeneous causes
and definitely includes patients whose clinical presentations, treatment responses, and
courses of illness are varied.
Essential Features of Various Diagnostic Criteria for Schizophrenia
1. First-rank symptoms
a. Audible thoughts
b. Voices arguing or discussing or both
c. Voices commenting
d. Somatic passivity experiences
e. Thought withdrawal and other experiences of influenced thought
f. Thought broadcasting
g. Delusional perceptions
h. All other experiences involving volition, made affects, and made impulses
2. Second-rank symptoms
a. Other disorders of perception
b. Sudden delusional ideas
d. Depressive and euphoric mood changes
e. Feelings of emotional impoverishment
f. “…and several others as well”
1. Symptom criteria
Significant clues to a diagnosis of schizophrenia are (if no sign of organic mental
disorder, infection, or intoxication can be demonstrated):
a. Changes in personality, which manifest as a special type of emotional blunting
following by lack of initiative, and altered, frequently peculiar behavior. (In
hebephrenia, especially, these change are quite characteristic and are a principal
clue to the diagnosis.)
b. In catatonic types, the history and the typical signs in periods of restlessness and
stupor (with negativism, oily faces, catalepsy, special vegetative symptoms, etc.)
c. In paranoid psychoses, essential symptoms of split personality (or
depersonalization symptoms) and a loss or reality feeling (derealization
symptoms) or primary delusions
d. Chronic hallucinations
2. Course criterion
A final decision about diagnosis cannot be made before a follow-up of at least five
years has shown a chronic course of disease.
NEW HAVEN SCHIZOPHRENIA INDEX
1. a. Delusions: not specified or other-than-depressive: 2 points
b. Auditory hallucinations
c. Visual hallucinations
d. other hallucinations
2. a. bizarre thoughts
b. Autism or grossly unrealistic private thoughts
c. looseness of associations, illogical thinking, overinclusion
3. Inappropriate affect: 1 point
4. Confusion: 1 point
5. Paranoid ideation (self-referential thinking, suspiciousness): 1 point
6. Catatonic behavior
c. Waxy flexibility
g. Stereotyped motor activity
Scoring: To be considered part of the schizophrenic group, the patient must score on
item 1 or item 2a, 2b, or 2c, and must receive a total score of at least 4 points.
Minimum number of symptoms required can be four to eight, depending on investigator’s
1. Restricted affect
2. Poor insight
3. Thoughts aloud
4. Poor rapport
5. Wide spread delusions
6. Incoherent speech
7. Unreliable information
8. Bizarre delusions
9. Nihilistic delusions
10. Absence of early awakening (one to three hours)
11. Absence of depressed facies
12. Absence of elation
RESEARCH DIAGNOSTIC CRITERIA
Criteria 1 through 3 required for diagnosis.
1. At least of the following for definite illness, and one for probable (not couting those
occurring during period of drug or alcohol abuse or withdrawal):
a. Thought broadcasting, insertion, or withdrawal
b. Delusions of being controlled or influenced, other bizarre delusions, or multiple
c. Delusions other than persecution or jealousy lasting at least one week
e. Auditory hallucinations in which either a voice keeps up running commentary on
subject’s behaviors or thoughts as they occur or two or more voices converse with each
f. Nonaffective verbal hallucinations spoken to subject
g. Hallucinations of any type throughout day for several days or intermittently for at least
h. Definite instances of marked formal thought disorders accompanied by blunted or
inappropriate affect, delusions or hallucinations of any type, grossly disorganized
2. One of the following:
a. Current period of illness lasted at least two weeks from onset of noticeable change in
subject’s usual condition
b. Subject has has a previous period of illness lasting at least two weeks, during which he
or she met criteria, and residual signs of illness have remained (e.g. extreme social
withdrawal, blunted or inappropriate affect, formal thought disorder, or unusual thoughts
or perceptual experiences)
3. At no time during active period of illness being considered did subject meet criteria for
probable or definite manic or depressive syndrome to the degree that it was a prominent
part of illness.
ST. LOUIS CRITERIA
1. Both necessary:
a. Chronic illness at least six months of symptoms before index evaluation, without return
to premorbid level of psychosocial adjustment.
b. Absence of period of depressive or manic symptoms sufficient to qualify for moog
(affective) disorder or probable mood (affective) disorder.
2. At least one of the following:
a. Delusions or hallucinations without significant perplexity or disorientation
b. Verbal production that makes communication difficult owing to lack of logical or
understandable organization (in presence of muteness, diagnostic decision must be
3. At least three for definite, two for probable, illness:
a. Never married
b. Poor premorbid social adjustment or work history
c. Family history of schizophrenia
d. Absence of alcoholism or drug abuse within one year of onset
e. Onset before age 40
TAYLOR AND ABRAMS’ CRITERIA
All criteria must be met for diagnosis.
1. Duration of episode greater than six months
2. Clear consciousness
3. Presence of delusions, hallucinations, or formal thought disorder (variegation, non
sequiturs, word approximations, neologisms, blocking, and derailment)
4. Absence of broad affect
5. Absence signs and symptoms insufficient to kae diagnosis of affective disease
6. No alcoholism or drug abuse within one year of index episode
7. Absence of focal signs and symptoms of coarse brain disease or major medical illness
known to produce significant behavioral changes
Signs and Symptoms
The presence of some key symptoms, for schizophrenic weighs heavily in favor
of a diagnosis of schizophrenia.
1. Loosening of Associations- the specific thought disorder of the schizophrenic- is
perhaps the most valuable diagnostic criteria. But a good knowledge of psychopathology
is required to be sure of its presence, and to avoid confusing it with other forms of
disturbed thinking, such as manic flight of ideas, disintegration of thought process due to
clouding of consciousness, and impaired reasoning due to fatigue or distraction.
2. Bizarre Behavior – The patient’s behavior may furnish a significant clue for the
diagnosis. Bizarre postures and grimacing are the certainly characteristic of schizophrenic
conditions, but what constitutes a bizarre posture is not always easy to establish
unequivocally. Religious rituals and special positions for meditation or rock-and-roll
dancing with which the observer is not familiar may be called bizarre.
3. Hallucinations – sensory experiences or perception without corresponding external
stimuli are common without symptoms of schizophrenia. Most common are auditory
hallucinations, or the hearing of voices. Most characteristically, two or more voices talk
about the patient, discussing him in the third person.
4. Dream content – studies of the dream content of schizophrenia patients have shown
that dreams of schizophrenia are less coherent and less complex also less bizarre than are
the dreams of normal persons. Unpleasant emotions are the common in the dreams of
schizophrenics than in the dreams of normals.
5. Disturbances of thinking- the schizophrenic disturbance of thinking and
conceptualization is one of the most characteristics features of the disease.
6. Delusion- by definition, delusion is false ideas that cannot be corrected by reasoning,
and that are idiosyncratic for the patient that is not part of his cultural environment. they
are the most common symptoms of schizophrenia.
7. Incoherence- for the schizophrenic, language is primarily a means of self expression,
rather than a means of communication. His verbal and graphic productions are often
either empty or obscure.
8. Neologisms- occasionally, the schizophrenic creates a completely new expression, a
neologism, when he needs to express a concept for which no ordinary word exits.
9. Mutism- this function inhibition of speech and vocalization may last for hours or days,
but, before the area of modern treatment methods, it often used to last for years in chronic
schizophrenics of the catatonic type. Many schizophrenics tend to be monosyllabic and to
answer question as briefly as possible.
10. echolalia- occasionally, the schizophrenic patient exhibit echolalia, repeating in his
answers to the interviewer’s question’s many of the same words the questioner has used.
11. Verbigeration- this rare symptom is found almost exclusively in chronic and very
regressed schizophrenia. It consists of senseless repetition of the same words or phrases,
and it may, at the times, go on for days.
12. Stilted language- some schizophrenics make extraordinary efforts to maintain their
social relations in order to maintain their relatively stable adjustment. But they may
betray their rigidity and artificiality in their interpersonal relations by a peculiarly stilted
and grotesquely quaint language.
13. Stuporous states- these states used to be common in the catatonic subtype of
schizophrenia. Today, a modern physical treatment method permits therapists to interrupt
14. Echopraxia- this motor symptom is analogous to echolalia in the verbal sphere –
imitation of movements and gestures of a person the schizophrenic is observing.
15. Automatic Obedience- Another symptoms sometimes observed in catatonic patients
is automatic obedience, a patient may, without hesitation and in robot like fashion, carry
out most simple commands given to him.
16. Negativism- the term negativism refers to a patient’s failure to cooperate, without any
apparent reason for that failure. The patient does not appear to be fatigued, depressed,
suspicious, or angry. He is obviously capable of physical movement.
17. Stereotyped Behavior- this behavior is occasionally seen in chronic schizophrenics,
and not only in the back wards of old time mental hospitals. It may present itself as
repetitive patterns of moving or walking or perhaps pacing the same circle day in and day
18. Deteriorated appearance and manners- schizophrenic patients tend to deteriorate in
their appearance. Their efforts at grooming and self care may become minimal and they
may have to be reminded to wash, bathe, shave, change their underwear, and so on.
19. Reduced Emotional responses- the quantitative change invariably consists of
reduction in the intensity of emotional response. Many schizophrenics seems to be
different or, at times, totally apathetic.
20. Anhedonia- anhedonia is a particularly distressing symptom of many schizophrenics.
The anhedonia person is incapable of experiencing or even imagining any unpleasant
21. Inappropriate Responses- a typical emotional reaction of schizophrenic is an
incongruous or inappropriate response to life situations.