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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          thoughts are being withdrawn by some outside agency.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.

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.
           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
          Latent schizophrenic reaction
          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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