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295 Schizophrenic disorders
A group of psychoses in which there is a fundamental disturbance of
personality, a characteristic distortion of thinking, often a sense of being
controlled by alien forces, delusions which may be bizarre, disturbed
perception, abnormal affect out of keeping with the real situation, and
autism. Nevertheless, clear consciousness and intellectual capacity are
usually maintained. The disturbance of personality involves its most basic
functions which give the normal person his feeling of individuality,
uniqueness and self-direction. The most intimate thoughts, feelings and acts
are often felt to be known to or shared by others and explanatory delusions
may develop, to the effect that natural or supernatural forces are at work to
influence the schizophrenic person's thoughts and actions in ways that are
often bizarre. He may see himself as the pivot of all that happens.
Hallucinations, especially of hearing, are common and may comment on the
patient or address him. Perception is frequently disturbed in other ways;
there may be perplexity, irrelevant features may become all-important and,
accompanied by passivity feelings, may lead the patient to believe that
everyday objects and situations possess a special, usually sinister, meaning
intended for him. In the characteristic schizophrenic disturbance of
thinking, peripheral and irrelevant features of a total concept, which are
inhibited in normal directed mental activity, are brought to the forefront and
utilized in place of the elements relevant and appropriate to the situation.
Thus thinking becomes vague, elliptical and obscure, and its expression in
speech sometimes incomprehensible. Breaks and interpolations in the flow of
consecutive thought are frequent, and the patient may be convinced that his
thoughts are being withdrawn by some outside agency. Mood may be shallow,
capricious or incongruous. Ambivalence and disturbance of volition may appear
as inertia, negativism or stupor. Catatonia may be present. The diagnosis
"schizophrenia" should not be made unless there is, or has been evident during
the same illness, characteristic disturbance of thought, perception, mood,
conduct, or personality--preferably in at least two of these areas. The
diagnosis should not be restricted to conditions running a protracted,
deteriorating, or chronic course. In addition to making the diagnosis on the
criteria just given, effort should be made to specify one of the following
subdivisions of schizophrenia, according to the predominant symptoms.
Includes: schizophrenia of the types described in 295.0-295.9 occurring
in children
Excludes: childhood type schizophrenia (299.9)
infantile autism (299.0)
295.0 Simple type
A psychosis in which there is insidious development of oddities of conduct,
inability to meet the demands of society, and decline in total performance.
Delusions and hallucinations are not in evidence and the condition is less
obviously psychotic than are the hebephrenic, catatonic and paranoid types of
schizophrenia. With increasing social impoverishment vagrancy may ensue and
the patient becomes self-absorbed, idle and aimless. Because the
schizophrenic symptoms are not clear-cut, diagnosis of this form should be
made sparingly, if at all.
Schizophrenia simplex
Excludes: latent schizophrenia (295.5)
295.1 Hebephrenic type
A form of schizophrenia in which affective changes are prominent, delusions
and hallucinations fleeting and fragmentary, behavior irresponsible and
unpredictable and mannerisms common. The mood is shallow and inappropriate,
accompanied by giggling or self-satisfied, self-absorbed smiling, or by a
lofty manner, grimaces, mannerisms, pranks, hypochondriacal complaints and
reiterated phrases. Thought is disorganized. There is a tendency to remain
solitary, and behavior seems empty of purpose and feeling. This form of
schizophrenia usually starts between the ages of 15 and 25 years.
Hebephrenia
295.2 Catatonic type
Includes as an essential feature prominent psychomotor disturbances often
alternating between extremes such as hyperkinesis and stupor, or automatic
obedience and negativism. Constrained attitudes may be maintained for long
periods: if the patient's limbs are put in some unnatural position they may
be held there for some time after the external force has been removed. Severe
excitement may be a striking feature of the condition. Depressive or
hypomanic concomitants may be present.
Catatonic: Schizophrenic:
agitation catalepsy
excitation catatonia
stupor flexibilitas cerea
295.3 Paranoid type
The form of schizophrenia in which relatively stable delusions, which may be
accompanied by hallucinations, dominate the clinical picture. The delusions
are frequently of persecution but may take other forms [for example of
jealousy, exalted birth, Messianic mission, or bodily change]. Hallucinations
and erratic behavior may occur; in some cases conduct is seriously disturbed
from the outset, thought disorder may be gross, and affective flattening with
fragmentary delusions and hallucinations may develop.
Paraphrenic schizophrenia
Excludes: paraphrenia, involutional paranoid state (297.2)
paranoia (297.1)
295.4 Acute schizophrenic episode
Schizophrenic disorders, other than those listed above, in which there is a
dream-like state with slight clouding of consciousness and perplexity.
External things, people and events may become charged with personal
significance for the patient. There may be ideas of reference and emotional
turmoil. In many such cases remission occurs within a few weeks or months,
even without treatment.
Oneirophrenia
Schizophreniform:
attack
psychosis, confusional type
Excludes: acute forms of schizophrenia of:
catatonic type (295.2)
hebephrenic type (295.1)
paranoid type (295.3)
simple type (295.0)
295.5 Latent schizophrenia
It has not been possible to produce a generally acceptable description for
this condition. It is not recommended for general use, but a description is
provided for those who believe it to be useful: a condition of eccentric or
inconsequent behavior and anomalies of affect which give the impression of
schizophrenia though no definite and characteristic schizophrenic anomalies,
present or past, have been manifest. The inclusion terms indicate that this
is the best place to classify some other poorly defined varieties of
schizophrenia.
Latent schizophrenic reaction
Schizophrenia:
borderline
prepsychotic
prodromal
pseudoneurotic
pseudopsychopathic
Excludes: schizoid personality (301.2)
295.6 Residual schizophrenia
A chronic form of schizophrenia in which the symptoms that persist from the
acute phase have mostly lost their sharpness. Emotional response is blunted
and thought disorder, even when gross, does not prevent the accomplishment of
routine work.
Chronic undifferentiated Restzustand (schizophrenic)
schizophrenia Schizophrenic residual state
295.7 Schizo-affective type
A psychosis in which pronounced manic or depressive features are intermingled
with schizophrenic features and which tends towards remission without
permanent defect, but which is prone to recur. The diagnosis should be made
only when both the affective and schizophrenic symptoms are pronounced.
Cyclic schizophrenia Schizo-affective psychosis
Mixed schizophrenic and Schizophreniform psychosis, affective type
affective psychosis
295.8 Other
Schizophrenia of specified types not classifiable under 259.0-295.7.
Acute (undifferentiated) Atypical schizophrenia
schizophrenia Cenesthopathic schizophrenia
Excludes: infantile autism (299.0)
295.9 Unspecified
To be used only as a last resort.
Schizophrenia NOS Schizophreniform psychosis NOS
Schizophrenic reaction NOS
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